Atrial septal defect and exercise capacity: value of cardio-pulmonary exercise test in assessment and follow-up
Pascal Amedro1,2,3, Sophie Guillaumont1,4,3, Charlene Bredy1,3
1Paediatric and Adult Congenital Cardiology Department, M3C Regional Reference CHD Centre, University Hospital, Montpellier, France.
Insights
Cardio-pulmonary exercise testing (CPET) is crucial for assessing exercise capacity in atrial septal defect (ASD) patients. Regular CPET helps manage comorbidities and guides cardiac rehabilitation, improving quality of life.
Area of Science:
- Cardiology
- Exercise Physiology
Background:
- Functional capacity assessments are vital for understanding chronic disease impact on quality of life.
- Congenital heart diseases (CHDs), including atrial septal defects (ASDs), often require monitoring of exercise capacity.
- Maximum oxygen uptake (VO2max) and ventilatory efficiency (VE/VCO2 slope) from CPET are key prognostic indicators.
Purpose of the Study:
- To highlight the importance of cardio-pulmonary exercise testing (CPET) in the assessment and follow-up of patients with atrial septal defects (ASDs).
- To discuss how CPET provides critical insights into exercise capacity, prognosis, and quality of life in ASD patients.
- To emphasize the role of CPET in managing comorbidities and guiding interventions like cardiac rehabilitation.
Main Methods:
- Cardio-pulmonary exercise testing (CPET) to evaluate maximal oxygen uptake (VO2max) and ventilatory efficiency (VE/VCO2 slope).
- Analysis of factors influencing exercise capacity in unrepaired ASDs (shunt, RV function, pulmonary pressure, arrhythmias).
- Assessment of factors affecting exercise capacity in repaired ASDs (timing of closure, procedure type).
Main Results:
- Exercise capacity in ASD patients can be impaired and is influenced by shunt severity, RV status, and pulmonary pressures.
- For repaired ASDs, exercise capacity depends on closure timing and intervention type.
- CPET is instrumental in promoting sports participation and monitoring for comorbidities like heart failure and pulmonary hypertension.
Conclusions:
- CPET is essential for evaluating and managing exercise capacity in both children and adults with ASDs.
- Regular CPET follow-up is necessary to detect and manage comorbidities and muscular deconditioning.
- CPET findings can inform decisions regarding cardiac rehabilitation to enhance patient outcomes and quality of life.
Abstract:
Nearly four decades ago, the World Health Organization stated that functional capacity explorations best reflected the impact of a chronic disease on quality of life. Today, cardio-pulmonary exercise test (CPET) is recommended in the follow-up of patients with congenital heart diseases (CHDs). Indeed, the maximum oxygen uptake (VO2max) and the ventilatory efficiency (VE/VCO2 slope) correlate with both the prognosis and the quality of life in this population. Atrial septal defects (ASDs) represent the second most frequent CHD and are usually considered as simple CHDs. However, the exercise capacity of ASD patients may be impaired. Therefore, the CPET provides important information in assessment and follow-up of patients with ASDs, for both children and adults. Exercise capacity of patients with unrepaired ASDs depends on the importance of the shunt, the right ventricular (RV) function and volume overload, the level of pulmonary arterial pressure, and the occurrence of arrhythmias. For repaired ASDs, exercise capacity also depends on the delay before closure and the type of procedure (catheter or surgery). In most cases, the exercise capacity is nearly normal and CPET contributes to promote sports participation. In addition, a regular CPET follow-up is necessary to evaluate the occurrence, severity and physiological mechanisms of comorbidities, i.e., heart failure, pulmonary hypertension and arrhythmia. Furthermore, CPET follow-up in patients with ASDs may detect early onset of muscular deconditioning, for which cardiac rehabilitation may be considered.
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