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Indication for Pediatric Heart Transplant Affects Longitudinal Chronotropy on Cardiopulmonary Exercise Testing
Sebastian Otto-Meyer1, Alan P Wang2, Garett J Griffith3
1Division of Pediatric Cardiology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA. sottomeyer@luriechildrens.org.
Insights
Pediatric heart transplant (HT) patients with cardiomyopathy (CM) show improved exercise capacity over time compared to those with congenital heart disease (CHD). These differences in cardiopulmonary exercise testing (CPET) become more apparent years after HT.
Area of Science:
- Pediatric Cardiology
- Cardiopulmonary Exercise Testing
- Heart Transplantation
Background:
- Pediatric heart transplant (HT) recipients with congenital heart disease (CHD) and cardiomyopathy (CM) may exhibit different outcomes.
- Previous studies suggest varying cardiopulmonary exercise testing (CPET) performance between these groups, but longitudinal changes are unclear.
Purpose of the Study:
- To investigate longitudinal differences in CPET parameters between pediatric HT patients with CHD versus CM.
- To determine if the etiology of heart failure influences long-term exercise performance post-transplant.
Main Methods:
- Retrospective cohort study of 250 CPETs from 93 pediatric HT patients (40 with CHD, 53 with CM).
- CPET data analyzed across three timeframes: <2 years, 2 to <6 years, and ≥6 years post-HT.
- Comparison of key CPET parameters including maximal heart rate (HR) and heart rate recovery (HRR).
Main Results:
- No significant differences in CPET parameters were observed between CHD and CM groups within 2 years post-HT.
- Between 2 to <6 years post-HT, the CM group demonstrated higher maximal HR and percentage of age-predicted maximal heart rate (APMHR).
- At ≥6 years post-HT, the CM group maintained higher maximal HR and APMHR, and showed improved one-minute HR recovery.
Conclusions:
- The underlying reason for heart transplantation (CHD vs. CM) impacts long-term CPET performance in pediatric recipients.
- Pediatric patients with HT due to CM exhibit superior chronotropic function and exercise capacity compared to those with HT due to CHD.
- These disparities in exercise performance widen progressively over time after heart transplantation.
Abstract:
Studies have suggested that pediatric patients with heart transplants (HT) due to congenital heart disease (CHD) perform differently on cardiopulmonary exercise testing compared to pediatric patients with HT due to cardiomyopathy (CM). However, it is not known if this relationship changes over time. The aim of this study was to examine the differences in cardiopulmonary exercise test (CPET) parameters over time between patients with HT due to CHD versus CM. A large single-institution CPET database was used for this study. We conducted a retrospective cohort study of 250 total CPETs from 93 unique patients, examining how patients with HT due to CHD (109 CPETs, 40 unique patients) differed in CPET performance from patients with HT due to CM (141 CPETs, 53 unique patients) from < 2 years post-HT, 2 to < 6 years post-HT, and ≥ 6 years post-HT. There were no differences between patients with HT due to CHD compared to CM in CPETs performed < 2 years post-HT. In CPETs performed 2 to < 6 years post-HT, the CM group had higher maximal HR and percentage of age-predicted maximal heart rate (APMHR) achieved. At ≥ 6 years post-HT, the CM group continued to have higher maximal HR and percentage of APMHR achieved, but also improved HR recovery at one minute. Initial indication for transplant may affect performance on CPETs post-transplant. Patients with HT due to CM have improved chronotropic measures compared to patients with HT due to CHD and these differences are more pronounced with increased time post-HT.
