Article

Exercise studies in patients with congenital heart disease (CHD)
suggest that exercise capacity declines progressively.
This study aims to assess
the natural history of exercise capacity in patients with CHD from serial
cardiopulmonary exercise tests (CPETs) and to identify factors that are
associated with the rate of decrease. METHODS: From July 2001-August
2012 we included all patients with CHD who had two CPETs separated by at least
six months. Patients with any kind of intervention (surgery, catheter
intervention, or change in medication) between the two tests were excluded.
RESULTS: In 522 patients (24.8 +/- 10.2 years, 215 female) peak oxygen uptake
(VO2) was reduced to 80.0 +/- 20.7% predicted and declined significantly during a
mean follow-up of 2.5 +/- 1.8 years to 78.1 +/- 20.4% predicted (p < 0.0001). The
annual declining rate of peak VO2 was only -1.01 +/- 6.83% points per year.
Higher peak oxygen pulse (% predicted) (r = -0.230; p < 0.0001), higher peak VO2
(% predicted) (r = -0.213; p < 0.0001) at baseline testing and the presence of a
pacemaker (r = -0.095; p = 0.031) were only weakly associated with a more rapid
decline in peak VO2 (% predicted) over time. The decline was independent from
diagnosis, heart defect severity, systemic ventricular morphology and age.
CONCLUSIONS: There was a progressive, but slow, decline in the natural history of
exercise capacity in all kind of patients with CHD. Except for having a
pacemaker, we could not find any factors associated with this decline.
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Langue : ANGLAIS