Hemodynamic causes of exercise intolerance in Fontan patients

Anders Hebert; Annette S Jensen; Ulla Ramer Mikkelsen; Lars Idorn; Keld E Sørensen; Ulf Thilen; Katarina Hanseus; Lars Søndergaard

doi:10.1016/j.ijcard.2014.06.015

Hemodynamic causes of exercise intolerance in Fontan patients

Anders Hebert, Annette S Jensen, Ulla Ramer Mikkelsen, Lars Idorn, Keld E Sørensen, Ulf Thilen, Katarina Hanseus, Lars Søndergaard

8 Citations (Scopus)

Abstract

Background Exercise intolerance is frequent among Fontan patients and an important determinant for quality of life. This study investigated the hemodynamic causes of impaired exercise capacity in Fontan patients with particular focus on the influence of stroke volume index (SVI) and heart rate (HR). Methods and results In 38 Fontan patients, peak oxygen consumption (VO₂), SVI and HR were recorded during incremental load exercise test and compared with 19 age and gender matched controls. SVI (ml/m²) was lower in patients than controls during warm-up (28[26-31] vs. 35[30-39], p = 0.0093), at submaximal (40[37-43] vs. 55[51-59], p < 0.0001) and at maximal exercise (38[35-40] vs. 54[51-58], p < 0.0001). Similarly, HR (% of expected maximum) was lower in patients at warm-up (45[43-48]% vs. 64[57-64]%, p < 0.0001), submaximal (71[68-75]% vs 85[82-88]%, p < 0.0001) and maximal exercise (84[80-88]% vs. 97[95-99]%, p < 0.0001). Furthermore, SVI dropped 14% (from 44[41-48] to 38[35-40] ml/m²) in Fontan patients from the peak plateau to maximal exercise vs. 5% (from 57[53-61] to 54[51-58] ml/m ²) in controls, p < 0.0001. The low SVI and HR explained 67% and 20% of the difference in peak VO₂ between Fontan patients and controls respectively. Conclusion SVI decreased significantly in Fontan patients near the end of maximal effort exercise. The low SVI at maximal exercise was the most important hemodynamic factor limiting exercise capacity in Fontan patients, whereas chronotropic impairment had a smaller impact. The low SVI and HR at maximal exercise accounted for the difference in peak VO₂ between Fontan patients and controls in this study. Clinical trial registration http://www.cvk.sum.dk/CVK/Home/English.aspx (protocol nr: H-3-2010-045).

Original language	English
Journal	International Journal of Cardiology
Volume	175
Issue number	3
Pages (from-to)	478–483
Number of pages	6
ISSN	0167-5273
DOIs	https://doi.org/10.1016/j.ijcard.2014.06.015
Publication status	Published - 20 Aug 2014
Externally published	Yes

Keywords

Adolescent
Adult
Case-Control Studies
Child
Exercise Test
Exercise Tolerance
Female
Fontan Procedure
Heart Rate
Hemodynamics
Humans
Male
Oxygen Consumption
Stroke Volume
Young Adult

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10.1016/j.ijcard.2014.06.015

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@article{f760f26cf2d44c32ba9cfaf6486ce086,

title = "Hemodynamic causes of exercise intolerance in Fontan patients",

abstract = "Background Exercise intolerance is frequent among Fontan patients and an important determinant for quality of life. This study investigated the hemodynamic causes of impaired exercise capacity in Fontan patients with particular focus on the influence of stroke volume index (SVI) and heart rate (HR). Methods and results In 38 Fontan patients, peak oxygen consumption (VO2), SVI and HR were recorded during incremental load exercise test and compared with 19 age and gender matched controls. SVI (ml/m2) was lower in patients than controls during warm-up (28[26-31] vs. 35[30-39], p = 0.0093), at submaximal (40[37-43] vs. 55[51-59], p < 0.0001) and at maximal exercise (38[35-40] vs. 54[51-58], p < 0.0001). Similarly, HR (% of expected maximum) was lower in patients at warm-up (45[43-48]% vs. 64[57-64]%, p < 0.0001), submaximal (71[68-75]% vs 85[82-88]%, p < 0.0001) and maximal exercise (84[80-88]% vs. 97[95-99]%, p < 0.0001). Furthermore, SVI dropped 14% (from 44[41-48] to 38[35-40] ml/m2) in Fontan patients from the peak plateau to maximal exercise vs. 5% (from 57[53-61] to 54[51-58] ml/m 2) in controls, p < 0.0001. The low SVI and HR explained 67% and 20% of the difference in peak VO2 between Fontan patients and controls respectively. Conclusion SVI decreased significantly in Fontan patients near the end of maximal effort exercise. The low SVI at maximal exercise was the most important hemodynamic factor limiting exercise capacity in Fontan patients, whereas chronotropic impairment had a smaller impact. The low SVI and HR at maximal exercise accounted for the difference in peak VO2 between Fontan patients and controls in this study. Clinical trial registration http://www.cvk.sum.dk/CVK/Home/English.aspx (protocol nr: H-3-2010-045).",

keywords = "Adolescent, Adult, Case-Control Studies, Child, Exercise Test, Exercise Tolerance, Female, Fontan Procedure, Heart Rate, Hemodynamics, Humans, Male, Oxygen Consumption, Stroke Volume, Young Adult",

author = "Anders Hebert and Jensen, {Annette S} and Mikkelsen, {Ulla Ramer} and Lars Idorn and S{\o}rensen, {Keld E} and Ulf Thilen and Katarina Hanseus and Lars S{\o}ndergaard",

year = "2014",

month = aug,

day = "20",

doi = "10.1016/j.ijcard.2014.06.015",

language = "English",

volume = "175",

pages = "478–483",

journal = "International Journal of Cardiology",

issn = "0167-5273",

publisher = "Elsevier Ireland Ltd",

number = "3",

}

TY - JOUR

T1 - Hemodynamic causes of exercise intolerance in Fontan patients

AU - Hebert, Anders

AU - Jensen, Annette S

AU - Mikkelsen, Ulla Ramer

AU - Idorn, Lars

AU - Sørensen, Keld E

AU - Thilen, Ulf

AU - Hanseus, Katarina

AU - Søndergaard, Lars

PY - 2014/8/20

Y1 - 2014/8/20

N2 - Background Exercise intolerance is frequent among Fontan patients and an important determinant for quality of life. This study investigated the hemodynamic causes of impaired exercise capacity in Fontan patients with particular focus on the influence of stroke volume index (SVI) and heart rate (HR). Methods and results In 38 Fontan patients, peak oxygen consumption (VO2), SVI and HR were recorded during incremental load exercise test and compared with 19 age and gender matched controls. SVI (ml/m2) was lower in patients than controls during warm-up (28[26-31] vs. 35[30-39], p = 0.0093), at submaximal (40[37-43] vs. 55[51-59], p < 0.0001) and at maximal exercise (38[35-40] vs. 54[51-58], p < 0.0001). Similarly, HR (% of expected maximum) was lower in patients at warm-up (45[43-48]% vs. 64[57-64]%, p < 0.0001), submaximal (71[68-75]% vs 85[82-88]%, p < 0.0001) and maximal exercise (84[80-88]% vs. 97[95-99]%, p < 0.0001). Furthermore, SVI dropped 14% (from 44[41-48] to 38[35-40] ml/m2) in Fontan patients from the peak plateau to maximal exercise vs. 5% (from 57[53-61] to 54[51-58] ml/m 2) in controls, p < 0.0001. The low SVI and HR explained 67% and 20% of the difference in peak VO2 between Fontan patients and controls respectively. Conclusion SVI decreased significantly in Fontan patients near the end of maximal effort exercise. The low SVI at maximal exercise was the most important hemodynamic factor limiting exercise capacity in Fontan patients, whereas chronotropic impairment had a smaller impact. The low SVI and HR at maximal exercise accounted for the difference in peak VO2 between Fontan patients and controls in this study. Clinical trial registration http://www.cvk.sum.dk/CVK/Home/English.aspx (protocol nr: H-3-2010-045).

AB - Background Exercise intolerance is frequent among Fontan patients and an important determinant for quality of life. This study investigated the hemodynamic causes of impaired exercise capacity in Fontan patients with particular focus on the influence of stroke volume index (SVI) and heart rate (HR). Methods and results In 38 Fontan patients, peak oxygen consumption (VO2), SVI and HR were recorded during incremental load exercise test and compared with 19 age and gender matched controls. SVI (ml/m2) was lower in patients than controls during warm-up (28[26-31] vs. 35[30-39], p = 0.0093), at submaximal (40[37-43] vs. 55[51-59], p < 0.0001) and at maximal exercise (38[35-40] vs. 54[51-58], p < 0.0001). Similarly, HR (% of expected maximum) was lower in patients at warm-up (45[43-48]% vs. 64[57-64]%, p < 0.0001), submaximal (71[68-75]% vs 85[82-88]%, p < 0.0001) and maximal exercise (84[80-88]% vs. 97[95-99]%, p < 0.0001). Furthermore, SVI dropped 14% (from 44[41-48] to 38[35-40] ml/m2) in Fontan patients from the peak plateau to maximal exercise vs. 5% (from 57[53-61] to 54[51-58] ml/m 2) in controls, p < 0.0001. The low SVI and HR explained 67% and 20% of the difference in peak VO2 between Fontan patients and controls respectively. Conclusion SVI decreased significantly in Fontan patients near the end of maximal effort exercise. The low SVI at maximal exercise was the most important hemodynamic factor limiting exercise capacity in Fontan patients, whereas chronotropic impairment had a smaller impact. The low SVI and HR at maximal exercise accounted for the difference in peak VO2 between Fontan patients and controls in this study. Clinical trial registration http://www.cvk.sum.dk/CVK/Home/English.aspx (protocol nr: H-3-2010-045).

KW - Adolescent

KW - Adult

KW - Case-Control Studies

KW - Child

KW - Exercise Test

KW - Exercise Tolerance

KW - Female

KW - Fontan Procedure

KW - Heart Rate

KW - Hemodynamics

KW - Humans

KW - Male

KW - Oxygen Consumption

KW - Stroke Volume

KW - Young Adult

U2 - 10.1016/j.ijcard.2014.06.015

DO - 10.1016/j.ijcard.2014.06.015

M3 - Journal article

C2 - 25023794

SN - 0167-5273

VL - 175

SP - 478

EP - 483

JO - International Journal of Cardiology

JF - International Journal of Cardiology

IS - 3

ER -

Hemodynamic causes of exercise intolerance in Fontan patients

Abstract

Keywords

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