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Decreased Muscle Strength in Children With Repaired Tetralogy of Fallot: Relation With Exercise Capacity
Graziëlla Eshuis1, Hiske van Duinen2, Otto T H M Lelieveld3
1Department of Pediatric Cardiology University of Groningen, University Medical Center Groningen, Beatrix Children's Hospital, Center for Congenital Heart Disease Groningen The Netherlands.
Insights
Children with repaired tetralogy of Fallot exhibit decreased muscle strength, impacting their exercise capacity. This study highlights a strong correlation between muscle strength and peak oxygen uptake in these pediatric patients.
Area of Science:
- Pediatric Cardiology
- Exercise Physiology
- Rehabilitation Medicine
Background:
- Tetralogy of Fallot is a congenital heart defect requiring surgical repair.
- Post-surgical outcomes in pediatric patients often include considerations for physical development and exercise capacity.
- Assessing muscle strength is crucial for understanding functional limitations in children with repaired Tetralogy of Fallot.
Purpose of the Study:
- To compare muscle strength in pediatric patients with repaired Tetralogy of Fallot against healthy controls.
- To investigate the correlation between muscle strength and exercise capacity, specifically peak oxygen uptake.
- To identify factors influencing exercise performance in this patient population.
Main Methods:
- A prospective, cross-sectional study involving 67 pediatric patients (aged 8-19) with repaired Tetralogy of Fallot.
- Comparison of muscle strength (handgrip, maximal voluntary isometric contraction, dynamic strength) with two healthy pediatric cohorts.
- Analysis of correlations between muscle strength parameters and peak oxygen uptake (exercise capacity in mL/min) using univariate and multivariate models.
Main Results:
- Patients with repaired Tetralogy of Fallot demonstrated significantly reduced grip strength (z-score -1.5±1.2) and total muscle strength (z-score -0.9±1.3) compared to healthy peers.
- Dynamic muscle strength was also reduced, although running, speed, and agility remained within normal ranges.
- Strong correlations were found between muscle strength (grip and total) and peak oxygen uptake (r=0.83 and r=0.88, respectively).
- Multivariate analyses confirmed that total muscle strength and forced vital capacity independently correlated with peak oxygen uptake.
Conclusions:
- Pediatric patients with repaired Tetralogy of Fallot exhibit diminished muscle strength.
- Reduced muscle strength is a significant factor correlating with lower exercise performance and peak oxygen uptake in this population.
- These findings underscore the importance of addressing muscle strength deficits in the rehabilitation and management of children with repaired Tetralogy of Fallot.
Abstract:
Background The aim of this study is to describe muscle strength in pediatric patients with repaired tetralogy of Fallot compared with healthy peers and to analyze the correlation between muscle strength and peak oxygen uptake, exercise capacity (mL/min). Methods and Results A prospective, cross-sectional study was carried out in the University Medical Center Groningen between March 2016 and December 2019, which included 8 -to-19-year-old patients with repaired tetralogy of Fallot. Exclusion criteria comprised the following: Down syndrome, unstable pulmonary disease and severe scoliosis affecting pulmonary function, neuromuscular disease, and mental or physical limitations that prohibit the execution of the functional tests. Muscle strength was compared with 2 healthy pediatric cohorts from the Northern Netherlands. Handgrip strength, maximal voluntary isometric contraction, and dynamic muscle strength in correlation with peak oxygen uptake, exercise capacity (mL/min) were the main outcomes of the study. The 67 patients with repaired tetralogy of Fallot (42% female; aged 12.9 [interquartile range, 10.0-16.3] years old) were compared with healthy children. The patients showed reduced grip strength (z-score [mean±SD] -1.5±1.2, P<0.001), and total muscle strength (z-score -0.9±1.3, P<0.001). Dynamic strength (Bruininks-Oseretsky test) was significantly reduced (z-score -0.3±0.8, P=0.001), but running, speed, and agility were normal (z-score 0.1±0.7, P=0.4). Univariate correlation analyses showed strong correlations between absolute peak oxygen uptake, exercise capacity (mL/min), and muscle strength (grip strength r=0.83, total muscle strength r=0.88; P<0.001). In multivariate analyses, including correction for age and sex, total muscle strength (B 0.3; P=0.009), and forced vital capacity (B 0.5; P=0.02) correlated with peak oxygen uptake, exercise capacity (mL/min), independent of conventional cardiovascular parameters. Conclusions Children with repaired tetralogy of Fallot show reduced muscle strength, which strongly correlated with their exercise performance.
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