Aerobic capacity in adults with various congenital heart diseases

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Abstract

As an increasing number of patients with congenital heart disease reach adulthood, more information is needed regarding outcomes. The first signs of impaired heart function may appear during exercise testing. The aim of the present study was to establish mean values for maximal oxygen uptake in adults with various congenital heart diseases. Patients from 6 major diagnostic groups were identified, including patients with atrial septal defect (ASD, n = 93), transposition of the great arteries corrected with the Mustard procedure (n = 84), congenitally corrected transposition of the great arteries (CCTGA, n = 41), Tetralogy of Fallot (n = 168), Ebstein’s anomaly (n = 37), and Modified Fontan procedure (n = 52). Diminished maximal oxygen uptake was found in all diagnostic groups across age compared with healthy subjects. A significant decrease in maximal oxygen uptake with aging was found in those with ASD (p <0.0001), CCTGA (p = 0.01), and Tetralogy of Fallot (p <0.0001). There was no significant decline, however, in Ebstein’s anomaly (p = 0.270), Fontan procedure (p = 0.182), and in the Mustard patients (p = 0.188). All patients achieved significantly lower heart rates than predicted (mean for all groups, p <0.0001). Forced vital capacity values (3.51 L, mean SD ± 1.02) were lower than predicted values (4.10 L, mean SD ± 0.90, p <0.0001) for all patients groups except those with ASD. Mean values, however, were within the accepted 20% range of variance. This study showed diminished aerobic capacity in all diagnostic groups when compared with a healthy population. The maximal oxygen uptake values across age groups can be used as reference values in patients with similar diagnoses and as the basis for further research.

Section snippets

Patient population

A total of 5,733 patients are listed in the database at the University of Toronto Congenital Cardiac Center for Adults. Listed patients include inactive and actively followed patients. Late mortality (>18 years) occurred in 295 patients. Cardiopulmonary exercise tests were performed in 475 patients (230 male and 245 female patients) who attended the clinic as outpatients for follow-up and enrolled in the study. Six major diagnostic groups: ASD, CCTGA, Ebstein, Fontan, Mustard, and repaired ToF

Aerobic capacity

A significant decrease in maximal oxygen consumption with aging was found in patients with ASD (p <0.0001), CCTGA (p = 0.01), and ToF (p <0.0001). In Ebstein (p = 0.270), Fontan (p = 0.182) and Mustard (p = 0.188) patients, however, no significant decline was observed. Compared with healthy subjects, severely diminished maximal oxygen consumption values were found in all diagnostic groups across age (Figure 1) There was a large variation in the results of maximal oxygen consumption in all

Discussion

In the present study severely diminished aerobic capacity was revealed in all groups with congenital heart disease compared with a healthy population. A similar pattern was found regarding static lung function.

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This study was supported in part by The Norwegian Association for Children with Congenital Heart Disorder, The Norwegian Lung and Heart Association, the National Foundation of Public Health in Norway, Oslo, Norway; and The National Heart Research Fund, Leeds, United Kingdom.

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