Functional Characterization of Children with Chronic Venous Thromboembolic Disease

项目摘要 静脉血栓形成影响约1/200的住院儿童。深呼吸后的重要症状 涉及下肢的静脉血栓形成（DVT）和肺栓塞（PE），包括 呼吸和运动不耐受导致生活质量下降。这些症状的机制 是未知的。尽管静脉血栓形成伴手术不耐受和劳力性呼吸困难的患者， 我们的初步数据对这一传统看法提出了挑战。照经上所 目前尚不清楚运动不耐受或劳力性呼吸困难是否是由于心血管、肺或肢体- 肌肉功能障碍，以及是否获得性风险因素，如失调或肥胖，有助于这些 问题如果我们发现运动失调导致运动不耐受或呼吸困难， 运动训练将是非常有益的;对于与肥胖相关的呼吸力学变化， 在可以忍受运动训练之前，可能需要积极的减肥措施。在这 应用，我们将利用最先进的措施，包括7特斯拉磁共振成像，在休息和 在运动过程中，研究这些常见症状的中枢和外周机制。目标1将 表征心脏局限性;目标2，肺和目标3，骨骼肌代谢畸变， 儿科患者诊断后3个月和12个月的DVT和PE。我们的长期 目的是提供新的和临床相关的结果，可能会改变预防方法， 治疗运动不耐受和呼吸困难，改善儿童VTE患者的生活质量。

PROJECT SUMMARY Venous thrombosis affects approximately 1 in 200 hospitalized children. Important symptoms after deep venous thrombosis (DVT) involving lower extremities and pulmonary embolism (PE) include shortness of breath and exercise intolerance resulting in a decreased quality of life. The mechanisms of these symptoms are unknown. Although patients with venous thrombosis with excise intolerance and exertional dyspnea are generally considered to be deconditioned, our preliminary data challenge this conventional wisdom. Thus, it is presently unclear if exercise intolerance or exertional dyspnea are due to cardiovascular, pulmonary, or limb- muscle dysfunction and whether acquired risk-factors such as deconditioning or obesity contribute to these problems. If we find evidence of deconditioning causing or complicating exercise intolerance or dyspnea, exercise training would be dramatically beneficial; for obesity-related changes in respiratory mechanics, aggressive weight loss measures may be necessary before exercise training can be tolerated. In this application, we will utilize state-of-the-art measures, including 7 Tesla magnetic resonance imaging, at rest and during exercise to investigate central and peripheral mechanisms of these common symptoms. Aim 1 will characterize cardiac limitations; Aim 2, pulmonary and Aim 3, skeletal muscle metabolic aberrations following DVT and PE at 3 and 12 months post-diagnosis in pediatric patients following diagnosis. Our long-term objective is to provide novel and clinically relevant results that could potentially alter approaches for preventing and treating exercise intolerance and dyspnea and improving the quality of life for pediatric patients with VTE.