Author + information
- Samuel G. Wittekind,
- Wayne Mays,
- Yvette Gerdes,
- Sandra Knecht,
- John Hambrook,
- William Border and
- John Jefferies
Background: Patients with Fontan circulation have impaired exercise capacity. Cardiac rehabilitation (CR) has shown promise in improving peak exercise performance in this population, but its role in improving submaximal exercise performance has not been shown to date. We assessed the hypothesis that participation in CR will be associated with improved exercise performance in pediatric Fontans, and that this change will be mediated by increased efficiency in oxygen delivery and ventilation during submaximal effort.
Methods: In this prospective study, pediatric Fontans were recruited from cardiology clinic at Cincinnati Children's Hospital Medical Center. Participants completed two 60 minute sessions per week for 12 weeks. Safety was assessed by counting adverse events during CR sessions. Anthropometrics and cardiopulmonary exercise test (CPET) parameters were measured at baseline and at last CR visit then compared with a paired sample t-test for statistical significance (p<0.05).
Results: Ten pediatric Fontans completed the study. The mean age was 12 (minimum 8, maximum 16) years at enrollment and 40% were male. Five had tricuspid atresia and 5 had hypoplastic left heart syndrome. No serious adverse events occurred during CR sessions. Total working capacity increased by a mean of 1497 kpm (95% CI, 947 to 2047; p<0.001), peak indexed oxygen consumption increased by a mean of 3.7 mL/kg/min (95% CI, 1.5 to 5.9; p=0.004), and peak oxygen pulse increased by a mean of 0.9 mL/beat (95% CI, 0.4 to 1.4; p=0.004). The mean respiratory exchange ratio did not change significantly. The significant difference in oxygen pulse became evident in stage 2 of submaximal exercise. The slope for the volume of expired ventilation to the volume of carbon dioxide production (VE/VCO2 slope) improved by a mean of 4.5 (95% CI, −0.6 to −8.4; p<0.03).
Conclusions: In conclusion, we demonstrated significant improvements in both submaximal and peak exercise performance in pediatric Fontans undergoing prescribed exercise therapy with no serious adverse events. These changes are mediated, at least in part, by more efficient oxygen delivery (lower HR and higher oxygen pulse) and ventilation (VE/VCO2 slope).
Moderated Poster Contributions
Congenital Heart Disease and Pulmonary Hypertension Moderated Poster Theater, Poster Hall, Hall C
Saturday, March 18, 2017, 1:30 p.m.-1:40 p.m.
Session Title: Therapeutic Advances in Congenital Heart Disease
Abstract Category: 10. Congenital Heart Disease: Pediatric
Presentation Number: 1220M-11
- 2017 American College of Cardiology Foundation