Habitual Exercise Correlates With Exercise Performance in Patients With Conotruncal Abnormalities
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ORIGINAL ARTICLE
Habitual Exercise Correlates With Exercise Performance in Patients With Conotruncal Abnormalities Michael L. O’Byrne • Laura Mercer-Rosa Eitan Ingall • Michael G. McBride • Stephen Paridon • Elizabeth Goldmuntz
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Received: 19 July 2012 / Accepted: 4 October 2012 / Published online: 27 October 2012 Ó Springer Science+Business Media New York 2012
Abstract Cardiopulmonary exercise testing (CPET), particularly maximal oxygen consumption (VO2max), has been used to assess the outcome for patients with palliated congenital heart disease (CHD). Small studies correlating VO2max with noninvasive imaging measures of ventricular function have led to the hypothesis that VO2max reflects cardiac performance. In other settings, physical training is associated with increased VO2max. The authors hypothesized that habitual exercise correlates with VO2max to a greater degree than ventricular function in a relatively healthy cohort of patients with palliated CHD. The habitual exercise behavior of 208 subjects with conotruncal abnormalities (tetralogy of Fallot, truncus arteriosus, and interrupted aortic arch) at the time of previously performed, study-based CPET and cardiac magnetic resonance imaging (CMR) were retrospectively assessed via questionnaire. The association of VO2max with habitual exercise duration and CMR measures of ventricular function was tested. Of 208 subjects, 89 (43 %) completed questionnaires, and 78 % of the 89 patients had a concurrent CMR. The mean VO2max was 76 ± 21 % of that predicted. The CMR-assessed left ventricular ejection fraction was 67.6 ± 7.4 %. The hours of habitual exercise per week correlated with VO2max (p \ 0.001; r2 = 0.14). No association was found between right and left ventricular ejection fraction, cardiac index, or right ventricular end-diastolic volume and VO2max. In this study, VO2max correlated with habitual exercise to a greater degree than CMR measurements of ventricular function. These findings highlight the importance
M. L. O’Byrne (&) L. Mercer-Rosa E. Ingall M. G. McBride S. Paridon E. Goldmuntz Division of Pediatric Cardiology, Children’s Hospital of Philadelphia, 34th Street and Civic Center Boulevard, Philadelphia, PA 19147, USA e-mail: [email protected]
of considering the contribution of noncardiac factors when exercise data in both clinical and research settings are interpreted. The contribution of these factors to clinical outcomes deserves further study. Keywords Cardiac MRI Cardiopulmonary exercise testing Exercise Interrupted aortic arch Tetralogy of Fallot Truncus arteriosus
Introduction Cardiopulmonary exercise testing (CPET) quantifies a subject’s response to exertion. With graded escalation of work, ergonometric, spirometric, and metabolic data are collected to measure a subject’s exercise performance. Maximal oxygen consumption (VO2max), the measure of the peak oxygen delivery achieved during a test, has been used both as an end point in research studies and as a clinical measure of wellness. In both contexts, it is used
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