Exercise intolerance in adult congenital heart disease - Comparative severity, correlates, and prognostic implication
Exercise intolerance in adult congenital heart disease - Comparative severity, correlates, and prognostic implication
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DOI：
10.1161/circulationaha.104.529800
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发表时间：
2005-08-09
期刊：
影响因子：
37.8
通讯作者：
Gatzoulis, MA
中科院分区：
文献类型：
--
作者：
Diller, GP;Dimopoulos, K;Gatzoulis, MA
背景--尽管一些成人先天性心脏病（ACHD）患者报告运动能力受限，但我们假设，在临床咨询期间，运动能力降低可能比表面上明显的更普遍，并且可能是评估风险的一种手段。（年龄，33 +/-13岁）、40名非先天性心力衰竭患者（年龄，58 +/-15岁）和11名年轻（年龄，29 +/-5岁）和12名老年（年龄，59 +/-9岁）健康受试者。与年龄相似的健康受试者相比，ACHD患者的峰值耗氧量（峰值VO 2）降低（21.7 +/- 8.5 vs 45.1 +/- 8.6; P +/- 0.001）。ACHD与相应NYHA分级的心力衰竭患者之间的峰值VO 2无显著差异（P = NS）。在ACHD亚组中，从主动脉缩窄（28.7 ± 10.4）到艾森曼格（11.5 ± 3.6）患者，峰值VO 2逐渐下降（P < 0.001）。峰值Vo（2）的多变量相关因素包括峰值心率（r = 0.33）、用力呼气量（r = 0.33）、肺动脉高压（r =-0.26）、性别（r =-0.23）和体重指数（r =-0.19）。中位随访10个月后，62例患者（18.5%）住院或死亡。在多变量考克斯分析中，峰值Vo（2）预测住院或死亡（危险比，0.937; P = 0.01），并且与住院的频率和持续时间相关（每个P = 0.01）。缺乏对运动的心率反应、肺动脉高压和肺功能受损是运动能力的重要相关因素，这与潜在的心脏解剖结构一样。运动能力差的ACHD患者有住院或死亡的风险。
Background - Although some patients with adult congenital heart disease ( ACHD) report limitations in exercise capacity, we hypothesized that depressed exercise capacity may be more widespread than superficially evident during clinical consultation and could be a means of assessing risk.Methods and Results - Cardiopulmonary exercise testing was performed in 335 consecutive ACHD patients ( age, 33 +/- 13 years), 40 non - congenital heart failure patients ( age, 58 +/- 15 years), and 11 young ( age, 29 +/- 5 years) and 12 older ( age, 59 +/- 9 years) healthy subjects. Peak oxygen consumption ( peak VO2) was reduced in ACHD patients compared with healthy subjects of similar age ( 21.7 +/- 8.5 versus 45.1 +/- 8.6; P +/- 0.001). No significant difference in peak VO2 was found between ACHD and heart failure patients of corresponding NYHA class ( P = NS for each NYHA class). Within ACHD subgroups, peak VO2 gradually declined from aortic coarctation ( 28.7 +/- 10.4) to Eisenmenger ( 11.5 +/- 3.6) patients ( P < 0.001). Multivariable correlates of peak Vo(2) were peak heart rate ( r = 0.33), forced expiratory volume ( r = 0.33), pulmonary hypertension ( r = - 0.26), gender ( r = - 0.23), and body mass index ( r = - 0.19). After a median follow-up of 10 months, 62 patients ( 18.5%) were hospitalized or had died. On multivariable Cox analysis, peak Vo(2) predicted hospitalization or death ( hazard ratio, 0.937; P = 0.01) and was related to the frequency and duration of hospitalization ( P = 0.01 for each).Conclusions - Exercise capacity is depressed in ACHD patients ( even in allegedly asymptomatic patients) on a par with chronic heart failure subjects. Lack of heart rate response to exercise, pulmonary arterial hypertension, and impaired pulmonary function are important correlates of exercise capacity, as is underlying cardiac anatomy. Poor exercise capacity identifies ACHD patients at risk for hospitalization or death.