Exercise Capacity in Children and Adolescents with Corrected Congenital Heart Disease

Abstract

Congenital heart disease promotes hemodynamic changes that can contribute to reduce exercise capacity. The aim of the study was to evaluate the exercise capacity of children and adolescents with cyanotic congenital heart disease and to assess respiratory muscle strength, plasma levels of B-type natriuretic peptide and ventricular ejection fraction, as well the associations between these variables. Cross-sectional study that evaluated 48 patients between 6 and 18 years-old that underwent a six-minute walk test (6MWT), respiratory muscle strength, dosage of B-type natriuretic peptide and echocardiography. The mean age was 13.3 ± 4.1 years, and the most prevalent heart disease was tetralogy of Fallot (54.2 %). The average distance walked was 452.7 ± 73.2 m, significantly below the predicted (69 %) (p < 0.001). The maximum inspiratory pressure was above the predicted result (111.4 %), average 58.2 ± 22.3 (p = 0.56), and the maximum expiratory pressure was 63.2 ± 23.3 cm H2O, significantly below the predicted (63 %) (p < 0.001). The level of B-type natriuretic peptide was elevated in all patients, with a median of 2087.17 (502.54-4,768.05). The ventricular ejection fraction showed a median of 65.9 (41-100). There was no correlation between the 6MWT, ventricular ejection fraction (r = -0.05; p = 0.72), inspiratory muscle strength (r = 0.03; p = 0.81), expiratory muscle strength (r = 0.09; p = 0.05) and B-type natriuretic peptide (r = -0.04; p = 0.77). Children and adolescents with cyanotic congenital heart disease present a lower exercise capacity and expiratory muscle strength. No associations were found between exercise capacity, respiratory muscle strength, B-type natriuretic peptide and left ventricular ejection fraction.

Cardiopulmonary Rehabilitation Improves Respiratory Muscle Function and Functional Capacity in Children with Congenital Heart Disease. A Prospective Cohort Study

“…Additionally, our study reveals the persistence of functional capacity improvement, a new but expected outcome considering previous analysis of aerobic capacity evolution in time [35]. We found no correlation between 6MWT and respiratory muscle function, as stated in a previous investigation by Feltez et al [40]. Concerning perceived fatigue (measured as muscle fatigue and dyspnea in our study), we found no previous evidence of the impact of exercise training on this outcome.…”

Tolerância Ao Exercício, Função Pulmonar, Força Muscular Respiratória E Qualidade De Vida Em Crianças E Adolescentes Com Cardiopatia Reumática

“…Regarding the response of respiratory muscle strength, participants showed inspiratory strength within the expected and expiratory strength below the expected. Feltez et al, 26 in addition to finding a deficit in 6MWT, reported children and adolescents with congenital heart disease with expiratory muscle strength lower than expected, which gives support to our findings. Although not measured, MEP values do not appear to have a great impact on the respiratory system function in a moment of clinical stability, but in a postoperative period, it is likely to cause impairments such as cough inefficiency and consequent airway protection failure.…”

“…The other study that used the 6MWT in children and adolescents with corrected congenital heart diseases, likewise this paper, reported a significant deficit in distance covered compared to predicted values. 26 …”

A novel HAND2 loss-of-function mutation responsible for tetralogy of Fallot

“…In terms of specific anatomic or hemodynamic lesions, various CHDs are clinically classified into at least 21 distinct categories, including ventricular septal defect, atrial septal defect, endocardial cushion defect, tetralogy of Fallot (TOF), Ebstein's anomaly, double outlet of right ventricle, transposition of the great arteries, patent ductus arteriosus, persistent truncus arteriosus, coarctation of the aorta, aortic stenosis, pulmonary atresia, tricuspid atresia, interrupted aortic arch, total anomalous pulmonary venous connection and hypoplastic left heart syndrome, of which TOF is the most common type of cyanotic CHD, accounting for approximately 10% of all CHD cases (4). Severe CHD may give rise to a diminished quality of life, decreased exercise performance, retarded fetal brain develop ment, depression, infective endocarditis, thromboembolism, pulmonary arterial hypertension, Eisenmenger's syndrome, heart failure, arrhythmias and even death (4)(5)(6)(7)(8)(9)(10)(11). Hence, CHD is responsible for substantial morbidity and mortality, which lays a heavy economic burden on patients and health care systems (4).…”