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Couck T, Buys R, Santens B, De Meester P, Goetschalckx K, Moons P, Troost E, Van De Bruaene A, Budts W. Short-term results of serial cardiopulmonary exercise testing in adults with repaired coarctation of the aorta. Acta Cardiol 2023; 78:798-804. [PMID: 34979884 DOI: 10.1080/00015385.2021.2015143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2021] [Revised: 09/22/2021] [Accepted: 12/02/2021] [Indexed: 11/01/2022]
Abstract
BACKGROUND Data on the evolution of exercise capacity in adults with repaired coarctation of the aorta (CoA) are scarce. We aimed to investigate the evolution and change of measures of exercise capacity obtained by cardiopulmonary exercise testing (CPET) in adults with repaired CoA. METHODS Patients 16 years of age and older with CoA, who performed at least two maximal CPETs in our institution, were included in the study. The first and last available tests were used for comparative statistical analysis of common exercise variables. RESULTS Sixty patients (43 men) performed serial maximal CPET. Mean age at first assessment was 30 ± 10 years (range 17-68). Mean time between first and last assessment was 3.5 years (range 1-7). Mean peak VO2 was 85.6 ± 20.4% of the predicted value at the initial test, and 87.0 ± 20.5% at the final test (p = 0.294). There were no significant differences in the mean values of oxygen pulse, VO2 at anaerobic threshold, systolic and diastolic blood pressures and peak heart rate between the two assessments. There was a slightly higher VE/VCO2 slope at the final test (p = 0.047). Higher age and Borg scale were found to be related with a decline in percent-predicted peak VO2 from initial to final assessment. CONCLUSION In adults with repaired CoA, we found no significant change in peak VO2 during a mean follow-up of 3.5 years, yet a small increase in VE/VCO2 slope was observed. Higher age was predictive for a decline in percent-predicted peak VO2, starting in the third decade of life.
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Affiliation(s)
- Thomas Couck
- Department of Cardiovascular diseases, University Hospitals Leuven, Leuven, Belgium
| | - Roselien Buys
- Research Centre for Cardiovascular and Respiratory Rehabilitation, Department of Rehabilitation Sciences, Catholic University Leuven, Leuven, Belgium
| | - Béatrice Santens
- Department of Cardiovascular diseases, University Hospitals Leuven, Leuven, Belgium
| | - Pieter De Meester
- Department of Cardiovascular diseases, University Hospitals Leuven, Leuven, Belgium
| | - Kaatje Goetschalckx
- Department of Cardiovascular diseases, University Hospitals Leuven, Leuven, Belgium
| | - Philip Moons
- Academic Centre for Nursing and Midwifery, Department of Public Health and Primary Care, Catholic University Leuven, Leuven, Belgium
| | - Els Troost
- Department of Cardiovascular diseases, University Hospitals Leuven, Leuven, Belgium
| | | | - Werner Budts
- Department of Cardiovascular diseases, University Hospitals Leuven, Leuven, Belgium
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Shah SS, Mohanty S, Karande T, Maheshwari S, Kulkarni S, Saxena A. Guidelines for physical activity in children with heart disease. Ann Pediatr Cardiol 2022; 15:467-488. [PMID: 37152503 PMCID: PMC10158469 DOI: 10.4103/apc.apc_73_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2022] [Revised: 10/05/2022] [Accepted: 11/20/2022] [Indexed: 03/03/2023] Open
Abstract
Justification In recent years, there has been increasing recognition of children with heart disease in our country. These children belong to different age groups and have untreated, partially treated, or completely treated heart disease. The role of physical activity for optimal physical, emotional, and psychosocial well-being for children is well understood. There is a challenge for the parents and the medical professionals to take a decision regarding the type of physical activity safe for the child as heart disease may affect the hemodynamic demands. Most of the existing international guidelines focus on competitive sports in operated heart disease children. This may be of limited use when we have a mixed population of children with heart disease, different types of sports in our country and where a larger subset is looking for recommendations to leisure time activities. Process The Pediatric Cardiac Society of India decided to formulate recommendations for physical activity in children with heart diseases. A committee of experts, who were well-versed with the subject of physical activity in children with heart disease, volunteered to take up the task of writing the guidelines. The recommendations emerged following deliberations of the committee members, on the virtual platform as well as mails. The final version of manuscript was approved by all committee members and all members are co-authors of this manuscript. The different types of physical activities were defined including leisure sports and competitive sports. The exercise was classified based on the mechanical action of muscles involved into dynamic and static components. Each type of exercise was then classified based on the intensity into low, medium, and high. Recommendations for the type of physical activity for individual heart lesions were decided based on the rationale available. Objectives The recommendations here are made with an intention to provide general guidelines for physical activity in children with operated and unoperated heart diseases, not excluding a need for individualizing a plan, serial assessment, and comprehensive checkup in special situations. Recommendations We hope the recommendations mentioned below would provide basic clarity in planning physical activity in children with heart disease. This is with the hope to encourage physically active life, at the same time ensuring a safety net.
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Affiliation(s)
- Sejal Suresh Shah
- Department of Pediatric Cardiology, Hands on Heart, RxDx Healthcare, Bengaluru, Karnataka, India
| | - Sweta Mohanty
- Department of Pediatric Cardiology, Indira Gandhi Institute of Child Health, Bengaluru, Karnataka, India
| | - Tanuja Karande
- Department of Pediatric Cardiology, Kokilaben Dhirubhai Ambani Hospital, Mumbai, Maharashtra, India
| | - Sunita Maheshwari
- Department of Pediatric Cardiology, Hands on Heart, RxDx Healthcare, Bengaluru, Karnataka, India
| | - Snehal Kulkarni
- Department of Pediatric Cardiology, Sri Sathya Sai Sanjeevani Hospital, Navi Mumbai, Maharashtra, India
| | - Anita Saxena
- Department of Cardiology, Pt. BD Sharma University of Health Sciences, Rohtak, Haryana, India
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Colombo JN, Sawda CN, White SC. Cardiac Concerns in the Pediatric Athlete. Clin Sports Med 2022; 41:529-548. [PMID: 35710276 DOI: 10.1016/j.csm.2022.02.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Cardiovascular disease remains the number one cause of death in Americans. It is no secret that exercise mitigates this risk. Exercise and regular physical activity are beneficial for physical health including aerobic conditioning, endurance, strength, mental health, and overall improved quality of life. Unfortunately, today many children and adolescents are sedentary, lacking the recommended daily amount of physical activity, leading to higher rates of obesity, cardiovascular disease, stroke, diabetes, anxiety, and depression. Given this rising concern, the World Health Organization launched a 12-year plan to improve physical activity in children and adolescents by reducing the inactivity rate by 15% in the world. How does this apply to children and adolescents with acquired or congenital heart disease?.
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Affiliation(s)
- Jamie N Colombo
- Department of Pediatrics, Division of Cardiology, Washington University School of Medicine/St. Louis Children's Hospital, 1 Childrens Place, St. Louis, MO 63110, USA
| | - Christine N Sawda
- Department of Pediatrics, Division of Cardiology, Children's National Medical Center, 111 Michigan Avenue Northwest, Washington, DC 20010, USA
| | - Shelby C White
- Department of Pediatrics, Division of Cardiology, University of Virginia, PO Box 800386, Charlottesville, VA 22908, USA.
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Zhang R, Chen C, Yeung EHK, Yiu KH. Benefits of Outpatient Cardiac Rehabilitation in an Adult Patient with Coarctation of the Aorta and Moyamoya Disease. J Rehabil Med Clin Commun 2021; 4:1000069. [PMID: 34703526 PMCID: PMC8526919 DOI: 10.2340/20030711-1000069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Accepted: 09/07/2021] [Indexed: 11/16/2022]
Abstract
Case report We report the effect of a 6-week outpatient (phase II) cardiac rehabilitation in a 38-year-old man with post-stented coarctation of the aorta, moyamoya disease and hypertension. The cardiac rehabilitation programme comprised physiotherapist-guided aerobic exercises, resistance training and relaxation exercises. Clinical and functional assessment was performed before and after the cardiac rehabilitation programme. Discussion There is a lack of recommendations to guide cardiac rehabilitation in patients with coarctation of the aorta. This case not only had coarctation of the aorta, but also had moyamoya disease and hypertension. A cardiac rehabilitation programme after surgery provided meaningful improvements in all outcomes, including exercise capacity, clinical outcomes, quality of life and depression symptoms. Systematic cardiac rehabilitation was found to be feasible in this patient with coarctation of the aorta, and may have the potential to benefit more patients. Conclusion Cardiac rehabilitation resulted in significant clinical and functional improvements in this case with coarctation of the aorta following surgery. Guidelines should be implemented to provide safe and effective cardiac rehabilitation in such patients. Furthermore, large-scale studies are needed to evaluate the clinical benefits of structured cardiac rehabilitation in patients following cardiac surgery. LAY ABSTRACT This case report describes the effect of a 6-week outpatient cardiac rehabilitation in a 38-year-old man with coarctation of the aorta, moyamoya disease and hypertension. The cardiac rehabilitation programme comprised physiotherapist-guided aerobic exercises, resistance training and relaxation exercises. Clinical and functional assessment was performed before and after the cardiac rehabilitation programme. There is a lack of recommendations to guide cardiac rehabilitation in patients with coarctation of the aorta. Cardiac rehabilitation provided significant clinical and functional improvements, including exercise capacity, clinical outcomes, quality of life and depression symptoms, in this patient with coarctation of the aorta following surgery. Systematic cardiac rehabilitation was found to be feasible in this patient with coarctation of the aorta, and may have the potential to benefit more patients. Guidelines should be implemented to provide safe and effective cardiac rehabilitation in such patients.
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Affiliation(s)
- Ruiwen Zhang
- Department of Cardiology.,Department of Physiotherapy, The University of Hong Kong-Shenzhen Hospital, Shenzhen, Guangdong, China
| | | | - Eric H K Yeung
- Department of Cardiology.,Department of Physiotherapy, The University of Hong Kong-Shenzhen Hospital, Shenzhen, Guangdong, China
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Schubert C, Brüning J, Goubergrits L, Hennemuth A, Berger F, Kühne T, Kelm M. Assessment of hemodynamic responses to exercise in aortic coarctation using MRI-ergometry in combination with computational fluid dynamics. Sci Rep 2020; 10:18894. [PMID: 33144605 DOI: 10.1038/s41598-020-75689-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Accepted: 10/16/2020] [Indexed: 01/16/2023] Open
Abstract
In patients with aortic coarctation it would be desirable to assess pressure gradients as well as information about blood flow profiles at rest and during exercise. We aimed to assess the hemodynamic responses to physical exercise by combining MRI-ergometry with computational fluid dynamics (CFD). MRI was performed on 20 patients with aortic coarctation (13 men, 7 women, mean age 21.5 ± 13.7 years) at rest and during ergometry. Peak systolic pressure gradients, wall shear stress (WSS), secondary flow degree (SFD) and normalized flow displacement (NFD) were calculated using CFD. Stroke volume was determined based on MRI. On average, the pressure gradient was 18.0 ± 16.6 mmHg at rest and increased to 28.5 ± 22.6 mmHg (p < 0.001) during exercise. A significant increase in cardiac index was observed (p < 0.001), which was mainly driven by an increase in heart rate (p < 0.001). WSS significantly increased during exercise (p = 0.006), whereas SFD and NFD remained unchanged. The combination of MRI-ergometry with CFD allows assessing pressure gradients as well as flow profiles during physical exercise. This concept has the potential to serve as an alternative to cardiac catheterization with pharmacological stress testing and provides hemodynamic information valuable for studying the pathophysiology of aortic coarctation.
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Moons P, Luyckx K, Thomet C, Budts W, Enomoto J, Sluman MA, Lu CW, Jackson JL, Khairy P, Cook SC, Chidambarathanu S, Alday L, Eriksen K, Dellborg M, Berghammer M, Johansson B, Mackie AS, Menahem S, Caruana M, Veldtman G, Soufi A, Fernandes SM, White K, Callus E, Kutty S, Ombelet F, Apers S, Kovacs AH; APPROACH-IS Consortium and the International Society for Adult Congenital Heart Disease (ISACHD). Physical Functioning, Mental Health, and Quality of Life in Different Congenital Heart Defects: Comparative Analysis in 3538 Patients From 15 Countries. Can J Cardiol 2021; 37:215-23. [PMID: 32739453 DOI: 10.1016/j.cjca.2020.03.044] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Revised: 03/28/2020] [Accepted: 03/29/2020] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND We compared physical functioning, mental health, and quality of life (QoL) of patients with different subtypes of congenital heart disease (CHD) in a large international sample and investigated the role of functional class in explaining the variance in outcomes across heart defects. METHODS In the cross-sectional Assessment of Patterns of Patient-Reported Outcome in Adults with Congenital Heart Disease-International Study (APPROACH-IS), we enrolled 4028 adult patients with CHD from 15 countries. Diagnostic groups with at least 50 patients were included in these analyses, yielding a sample of 3538 patients (median age: 32 years; 52% women). Physical functioning, mental health, and QoL were measured with the SF-12 health status survey, Hospital Anxiety and Depression Scale (HADS), linear analog scale (LAS) and Satisfaction with Life Scale, respectively. Functional class was assessed using the patient-reported New York Heart Association (NYHA) class. Multivariable general linear mixed models were applied to assess the relationship between the type of CHD and patient-reported outcomes, adjusted for patient characteristics, and with country as random effect. RESULTS Patients with coarctation of the aorta and those with isolated aortic valve disease reported the best physical functioning, mental health, and QoL. Patients with cyanotic heart disease or Eisenmenger syndrome had worst outcomes. The differences were statistically significant, above and beyond other patient characteristics. However, the explained variances were small (0.6% to 4.1%) and decreased further when functional status was added to the models (0.4% to 0.9%). CONCLUSIONS Some types of CHD predict worse patient-reported outcomes. However, it appears that it is the functional status associated with the heart defect rather than the heart defect itself that shapes the outcomes.
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