Cardiorespiratory Response to Exercise After Venous Switch Operation for Transposition of the Great Arteries

Douard, H.; Labbé, Laurent; Barat, J. L.; Jp, Broustet; Baudet, E; Choussat, A

doi:10.1378/chest.111.1.23

Cited by 25 publications

(29 citation statements)

References 33 publications

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“…during exercise, a further increase in heart rate enables a further increase in cardiac output. However, our results, in concordance with other studies, show that d-TGA patients present with chronotropic incompetence 2,3,5,8 .…”

Section: Study Limitationssupporting

confidence: 93%

“…This reduced peak VO 2 has been related to impaired chronotropic response, impaired systemic ventricular function, impaired function of the intra-atrial conduit, the inability to increase stroke volume, impaired lung function and peripheral deconditioning 1,[4][5][6][7][8] . Moreover, poor exercise capacity identifies d-TGA patients at risk for hospitalization and death 10 .…”

Section: Introductionmentioning

confidence: 99%

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In adults with atrial switch operation for transposition of the great arteries low physical activity relates to reduced exercise capacity and decreased perceived physical functioning

et al. 2012

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Objective Patients with Mustard/Senning repair for transposition of the great arteries (d-TGA) have an impaired exercise capacity, but information about physical activity levels is scarce. The aim of the study was to come to a better understanding of the interrelationships between determinants of exercise capacity, physical activity and self-perceived health status. Methods and resultsWe studied 39 d-TGA patients who underwent echocardiography and exercise testing, and who completed questionnaires about physical activity and perceived health status. All results were compared with normal values. Stepwise multiple regression analysis was used to assess the determinants of peak VO 2 % and exercise duration. Peak VO 2 averaged 64 ± 14.1% of the predicted normal values, which is signifi cantly lower than expected (P < 0.0001). Physical activity measures as well as perceived general health were signifi cantly lower compared to a reference population (P < 0.05). Peak heart rate and peak oxygen pulse explained together 90% of the variability in exercise duration (model F = 162.72; P < 0.0001). Type of surgery, total energy expenditure and right ventricular contractility were independent predictors of peak VO 2 % explaining 43% of the variability (model F = 8.75; P = 0.0002).Conclusions Impaired peak exercise performance in d-TGA patients results mainly from the inability to increase stroke volume and heart rate at higher exercise intensities. Senning repair and a well-preserved right ventricular function are related to a better peak VO 2 %. Furthermore, an active lifestyle has a positive eff ect on exercise capacity and perceived physical functioning. Therefore it might be indicated to encourage d-TGA patients to adopt a more physically active lifestyle.

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Section: Study Limitationssupporting

confidence: 93%

Section: Introductionmentioning

confidence: 99%

In adults with atrial switch operation for transposition of the great arteries low physical activity relates to reduced exercise capacity and decreased perceived physical functioning

et al. 2012

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“…11 Chronotropic incompetence is also seen in children and adolescents who have undergone intracardiac repair for congenital heart disease, [12][13][14][15][16][17][18][19] those with congenital long QT syndrome, 20,21 recipients of cardiac transplantation, 26 and patients with anorexia nervosa. 27 Although the clinical significance of chronotropic incompetence in the paediatric populations is still unclear, chronotropic incompetence is present many years before heart disease develops.…”

Section: Discussionmentioning

confidence: 99%

“…22,23 To our knowledge, however, the clinical diagnosis of chronotropic incompetence in children and adolescents is almost exclusively based on a failure to reach standard heart rate at peak exercise or at each stage of treadmill testing as estimated according to age and sex. [13][14][15][16][17][18][19][20][21]24 Therefore, in the present study we tested the hypothesis that the CRI is not influenced by exercise intensity, and is also independent of Circulation Journal Vol.69, April 2005 age, sex, functional capacity, and resting heart rate in young patients. …”

mentioning

confidence: 99%

“…11 Chronotropic incompetence is also seen in children and adolescents who have undergone intracardiac repair for congenital heart disease, [12][13][14][15][16][17][18][19] or who have congenital long QT syndrome. 20,21 The chronotropic response in adults is assessed by the chronotropic index (CRI), which utilizes the linear relationship between heart rate reserve and metabolic reserve during incremental exercise testing, 22,23 and this has become the standard method.…”

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Is the Chronotropic Index Applicable to Children and Adolescents?

Baba

Iwagaki

Tauchi³

et al. 2005

Circ J

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hronotropic incompetence, or an attenuated heart rate response to exercise, is considered to be associated with the presence and severity of coronary heart disease, [1][2][3][4] and has proved a useful prognostic tool for patients with coronary heart disease, [5][6][7][8][9][10] and predictor of allcause mortality. 11 Chronotropic incompetence is also seen in children and adolescents who have undergone intracardiac repair for congenital heart disease, [12][13][14][15][16][17][18][19] or who have congenital long QT syndrome. 20,21 The chronotropic response in adults is assessed by the chronotropic index (CRI), which utilizes the linear relationship between heart rate reserve and metabolic reserve during incremental exercise testing, 22,23 and this has become the standard method. [3][4][5][6][7][8][9][10] The main advantages of using the CRI are, first, that it enables evaluation of the chronotropic response at any point in the exercise protocol and, second, that it is independent of age, sex, functional capacity and resting heart rate. 22,23 To our knowledge, however, the clinical diagnosis of chronotropic incompetence in children and adolescents is almost exclusively based on a failure to reach standard heart rate at peak exercise or at each stage of treadmill testing as estimated according to age and sex. [13][14][15][16][17][18][19][20][21]24 Therefore, in the present study we tested the hypothesis that the CRI is not influenced by exercise intensity, and is also independent of Circulation Journal Vol.69, April 2005 age, sex, functional capacity, and resting heart rate in young patients. Methods SubjectsA total of 132 normal Japanese children and adolescents (64 boys, 68 girls) were recruited to participate in the study. Clinical consultation and examination, including auscultation, chest X-ray, exercise ECG, and echocardiography, revealed that all the subjects were in good health. The subjects and their parent(s) gave informed consent for participation, in accordance with the requirements of the institutional review board. Subjects who did not reach maximal exercise, defined as a peak exercise gas exchange ratio less than 1.05 during exercise testing, were excluded (n=3), leaving a total of 129 subjects (63 boys and 66 girls) ( Table 1). None of the subjects failed to reach a peak heart rate below -2SD of age-and sex-predicted standard values. 24 All subjects were moderately or highly active. Is the Chronotropic Index Applicable to Children and Adolescents?Reizo Baba, MD; Suketsune Iwagaki, PhD; Nobuo Tauchi, MD*; Masahito Tsurusawa, MD** Background The aim of the present study was to investigate whether the chronotropic index (CRI) is independent of age, sex, stage of exercise testing, functional capacity and resting heart rate in children, as it is in adult populations. Methods and Results A total of 129 normal children and adolescents underwent maximal treadmill exercise testing according to the Bruce protocol. Submaximal chronotropic response was assessed by the CRI at the end of stages 1, 2, 3, and 4...

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2003

The Natural and Modifed History of Congenital Heart Disease

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Cardiorespiratory Response to Exercise After Venous Switch Operation for Transposition of the Great Arteries

Cited by 25 publications

References 33 publications

In adults with atrial switch operation for transposition of the great arteries low physical activity relates to reduced exercise capacity and decreased perceived physical functioning

In adults with atrial switch operation for transposition of the great arteries low physical activity relates to reduced exercise capacity and decreased perceived physical functioning

Is the Chronotropic Index Applicable to Children and Adolescents?

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