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Differences in cerebral and muscle oxygenation patterns during exercise in children with univentricular heart after
Kristof Vandekerckhove1, Ilse Coomans1, Annelies Moerman2
1Department of Pediatric Cardiology, Ghent University Hospital, Ghent, Belgium.
Insights
Children with univentricular heart (UVH) after Fontan operation show altered cerebral and muscular oxygenation during exercise. This impacts their reduced exercise tolerance, highlighting a different balance between oxygen supply and demand.
Area of Science:
- Pediatric Cardiology
- Cardiovascular Physiology
- Exercise Science
Background:
- Children with univentricular heart (UVH) often exhibit lower exercise tolerance post-Fontan operation.
- Altered peripheral muscular and cerebral tissue oxygenation may underlie this reduced exercise capacity.
Purpose of the Study:
- To investigate the association between exercise tolerance and tissue oxygenation in children with UVH after Fontan procedure.
- To compare cerebral and muscular oxygenation patterns during exercise between UVH patients and healthy controls.
Main Methods:
- Near Infrared Spectroscopy (NIRS) was used to measure oxygenated hemoglobin (O2Hb), deoxygenated hemoglobin (HHb), and tissue oxygenation index (TOI) in cerebral and muscular tissues.
- 18 children with UVH and 20 healthy subjects underwent an incremental ramp exercise test.
- Correlations between arterial saturation during exercise and tissue oxygenation parameters were analyzed.
Main Results:
- UVH patients demonstrated significantly lower peak oxygen consumption (VO2peak/kg), heart rate, and peak load compared to controls.
- Cerebral tissue in UVH patients showed a faster and steeper increase in HHb with no increase in O2Hb, and a steady decrease in TOI during exercise.
- Muscular tissue in UVH patients exhibited an early cessation of HHb changes and discontinuation of O2Hb at a higher level, with a lower starting TOI compared to controls.
Conclusions:
- Children post-Fontan procedure exhibit distinct cerebral and muscular oxygenation mechanisms during exercise.
- These altered oxygenation patterns, reflecting an imbalance in oxygen supply and demand, likely contribute to reduced exercise tolerance in UVH patients.
Background:
We assess whether the lower exercise tolerance in children with univentricular heart (UVH) after Fontan operation is associated with altered peripheral muscular and cerebral tissue oxygenation.
Methods:
18 children with UVH and 20 healthy subjects performed an incremental ramp exercise test. Changes in the cerebral and muscular pattern of oxygenated (O2Hb) and deoxygenated hemoglobin (HHb) and local tissue oxygenation (TOI) were analyzed by means of Near Infrared Spectroscopy (NIRS). Correlations between arterial saturation during exercise and tissue oxygenation were evaluated.
Results:
In UVH, maximal oxygen consumption (VO2peak/kg, 28.9 ± 7.9 vs. 46.3 ± 11.9 ml/min/kg, P < 0.001), heart rate (HRpeak, 168 ± 13 vs. 193 ± 12 bpm, P < 0.001) and load (Ppeak, 73 ± 19 vs. 133 ± 68 W, P < 0.001) were lower, VE/VCO2 slope was higher (34.5 ± 5.9 vs. 27.1 ± 3.9, P < 0.001). A faster and steeper course up to the same level of HHb and absent increase in O2Hb was seen at cerebral level in UVH; tissue oxygenation index (TOI) demonstrated a steady decrease from the start of exercise. At the muscular level, HHb curve has a similar pattern compared to controls, with an early cessation. O2Hb has a similar pattern, but with early discontinuation at a higher O2Hb-level. Muscular TOI has the same course throughout exercise, starting from a lower level. Lower arterial saturation and higher age correlated with lower VO2peak; higher amplitude of muscular TOI and lower amplitude cerebral TOI correlated with higher VO2peak.
Conclusion:
Children after Fontan procedure have different oxygenation mechanisms at muscular and cerebral level. This reflects a different balance between O2 supply to O2 demand which might contribute to the reduced exercise tolerance in this patient population.
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