Hostname: page-component-586b7cd67f-dsjbd Total loading time: 0 Render date: 2024-11-24T09:16:05.276Z Has data issue: false hasContentIssue false
  • English
  • Français

Appropriate heart rate during exercise in Fontan patients

Published online by Cambridge University Press:  17 April 2020

Eva R. Hedlund Open the ORCID record for Eva R. Hedlund [Opens in a new window] ,
Liselott Söderström  and
Bo Lundell
Eva R. Hedlund*
Affiliation:
Department of Women’s and Children’s Health, Karolinska Institutet, Stockholm, Sweden
Liselott Söderström
Affiliation:
Department of Women’s and Children’s Health, Karolinska Institutet, Stockholm, Sweden
Bo Lundell
Affiliation:
Department of Women’s and Children’s Health, Karolinska Institutet, Stockholm, Sweden
*
Author for correspondence: E. R. Hedlund, MD, PhD, Karolinska University Hospital, Astrid Lindgren Children’s Hospital Solna, Barnhjärtcentrum, Eugeniavägen 23, C8:34, S-171 76Stockholm, Sweden. Tel: +46-707421285; Fax: +46-8-51777778; E-mail: [email protected]
Get access Rights & Permissions [Opens in a new window]

Abstract

Objective:

To evaluate heart rate against workload and oxygen consumption during exercise in Fontan patients.

Method:

Fontan patients (n = 27) and healthy controls (n = 25) underwent cardiopulmonary exercise testing with linear increase of load. Heart rate and oxygen uptake were measured during tests. Heart rate recovery was recorded for 10 minutes.

Results:

Heart rate at midpoint (140 ± 14 versus 153 ± 11, p < 0.001) and at maximal effort (171 ± 14 versus 191 ± 10 beats per minute, p < 0.001) of test was lower for patients than controls. Heart rate recovery was similar between groups. Heart rate in relation to workload was higher for patients than controls both at midpoint and maximal effort. Heart rate in relation to oxygen uptake was similar between groups throughout test. Oxygen pulse, an indirect surrogate measure of stroke volume, was reduced at maximal effort in patients compared to controls (6.6 ± 1.1 versus 7.5 ± 1.4 ml·beat−1·m−2, p < 0.05) and increased significantly less from midpoint to maximal effort for patients than controls (p < 0.05).

Conclusions:

Heart rate is increased in relation to workload in Fontan patients compared with controls. At higher loads, Fontan patients seem to have reduced heart rate and smaller increase in oxygen pulse, which may be explained by inability to further increase stroke volume and cardiac output. Reduced ability to increase or maintain stroke volume at higher heart rates may be an important limiting factor for maximal cardiac output, oxygen uptake, and physical performance.

Keywords

Heart rateexerciseoxygen consumptionoxygen pulseFontan patients
Type
Original Article
Information
Cardiology in the Young , Volume 30 , Issue 5 , May 2020 , pp. 674 - 680
Copyright
© The Author(s), 2020. Published by Cambridge University Press

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Fontan, FBaudet, E. Surgical repair of tricuspid atresia. Thorax 1971; 26: 240–248.CrossRefGoogle ScholarPubMed
Kanakis, MA, Petropoulos, AC, Mitropoulos, FA. Fontan operation. Hellenic J Cardiol 2009; 50: 133–141.Google ScholarPubMed
d’Udekem, Y, Iyengar, AJ, Galati, JCet al.Redefining expectations of long-term survival after the Fontan procedure: twenty-five years of follow-up from the entire population of Australia and New Zealand. Circulation 2014; 130: S32–S38.CrossRefGoogle ScholarPubMed
Kverneland, LS, Kramer, P, Ovroutski, S. Five decades of the Fontan operation: a systematic review of international reports on outcomes after univentricular palliation. Congenit Heart Dis 2018; 13: 181–193.CrossRefGoogle ScholarPubMed
Hock, J, Reiner, B, Neidenbach, RCet al.Functional outcome in contemporary children with total cavopulmonary connection - Health-related physical fitness, exercise capacity and health-related quality of life. Int J Cardiol 2018; 255: 50–54.CrossRefGoogle ScholarPubMed
Jenkins, PC, Chinnock, RE, Jenkins, KJet al.Decreased exercise performance with age in children with hypoplastic left heart syndrome. J Pediatr 2008; 152: 507–512.10.1016/j.jpeds.2007.09.050CrossRefGoogle ScholarPubMed
Muller, J, Christov, F, Schreiber, C, Hess, J, Hager, A. Exercise capacity, quality of life, and daily activity in the long-term follow-up of patients with univentricular heart and total cavopulmonary connection. Eur Heart J 2009; 30: 2915–2920.CrossRefGoogle ScholarPubMed
Dulfer, K, Bossers, SS, Utens, EMet al.Does functional health status predict health-related quality of life in children after Fontan operation? Cardiol Young 2016; 26: 459–468.10.1017/S1047951115000426CrossRefGoogle ScholarPubMed
Holbein, CE, Fogleman, ND, Hommel, Ket al.A multinational observational investigation of illness perceptions and quality of life among patients with a Fontan circulation. Congenit Heart Dis 2018; 13: 392–400.CrossRefGoogle ScholarPubMed
Knowles, RL, Day, T, Wade, Aet al.Patient-reported quality of life outcomes for children with serious congenital heart defects. Arch Dis Child 2014; 99: 413–419.CrossRefGoogle ScholarPubMed
Uzark, K, Zak, V, Shrader, Pet al.Assessment of quality of life in young patients with single ventricle after the Fontan operation. J Pediatr 2016; 170: 166–172 e161.CrossRefGoogle ScholarPubMed
Atz, AM, Zak, V, Mahony, Let al.Longitudinal outcomes of patients with single ventricle after the Fontan procedure. J Am Coll Cardiol 2017; 69: 2735–2744.CrossRefGoogle ScholarPubMed
Astrand, PO, Rodahl, K. Textbook of Work Physiology. McGraw Hill, New York 1970.Google Scholar
Higginbotham, MB, Morris, KG, Williams, RSet al.Regulation of stroke volume during submaximal and maximal upright exercise in normal man. Circ Res 1986; 58: 281–291.CrossRefGoogle ScholarPubMed
Hebert, A, Jensen, AS, Mikkelsen, URet al.Hemodynamic causes of exercise intolerance in Fontan patients. Int J Cardiol 2014; 175: 478–483.CrossRefGoogle ScholarPubMed
Legendre, A, Guillot, A, Ladouceur, M, Bonnet, D. Usefulness of stroke volume monitoring during upright ramp incremental cycle exercise in young patients with Fontan circulation. Int J Cardiol 2017; 227: 625–630.10.1016/j.ijcard.2016.10.087CrossRefGoogle ScholarPubMed
Smas-Suska, M, Dluzniewska, N, Werynski, Pet al.What determines the quality of life of adult patients after Fontan procedure? Cardiol J 2018; 25: 72–80.CrossRefGoogle ScholarPubMed
von Scheidt, F, Meier, S, Kramer, Jet al.Heart rate response during treadmill exercise test in children and adolescents with congenital heart disease. Front Pediatr 2019; 7: 65.10.3389/fped.2019.00065CrossRefGoogle ScholarPubMed
Claessen, G, La Gerche, A, Van De Bruaene, Aet al.Heart rate reserve in Fontan patients: chronotropic incompetence or hemodynamic limitation? J Am Heart Assoc 2019; 8: e012008.CrossRefGoogle ScholarPubMed
Gewillig, M, Brown, SC. The Fontan circulation after 45 years: update in physiology. Heart 2016; 102: 1081–1086.10.1136/heartjnl-2015-307467CrossRefGoogle ScholarPubMed
Gewillig, M, Brown, SC, Eyskens, Bet al.The Fontan circulation: who controls cardiac output? Interact Cardiovasc Thorac Surg 2010; 10: 428–433.CrossRefGoogle ScholarPubMed
Gewillig, M, Brown, SC, Heying, Ret al.Volume load paradox while preparing for the Fontan: not too much for the ventricle, not too little for the lungs. Interact Cardiovasc Thorac Surg 2010; 10: 262–265.CrossRefGoogle Scholar
La Gerche, A, Gewillig, M. What limits cardiac performance during exercise in normal subjects and in healthy Fontan patients? Int J Pediatr 2010; 2010.CrossRefGoogle ScholarPubMed
Hedlund, ER, Lundell, B, Villard, L, Sjoberg, G. Reduced physical exercise and health-related quality of life after Fontan palliation. Acta Paediatr 2016; 105: 1322–1328.CrossRefGoogle ScholarPubMed
Hedlund, ER, Lundell, B, Soderstrom, L, Sjoberg, G. Can endurance training improve physical capacity and quality of life in young Fontan patients? Cardiol Young 2018; 28: 438–446.CrossRefGoogle ScholarPubMed
Hedlund, ER, Ljungberg, H, Soderstrom, L, Lundell, B, Sjoberg, G. Impaired lung function in children and adolescents with Fontan circulation may improve after endurance training. Cardiol Young 2018; 28: 1115–1122.CrossRefGoogle ScholarPubMed
Ortega, FB, Konstabel, K, Pasquali, Eet al.Objectively measured physical activity and sedentary time during childhood, adolescence and young adulthood: a cohort study. PLoS One 2013; 8: e60871.CrossRefGoogle Scholar
Raustorp, A, Pagels, P, Froberg, A, Boldemann, C. Physical activity decreased by a quarter in the 11- to 12-year-old Swedish boys between 2000 and 2013 but was stable in girls: a smartphone effect? Acta Paediatr 2015; 104: 808–814.CrossRefGoogle ScholarPubMed
Paridon, SM, Mitchell, PD, Colan, SDet al.A cross-sectional study of exercise performance during the first 2 decades of life after the Fontan operation. J Am Coll Cardiol 2008; 52: 99–107.CrossRefGoogle ScholarPubMed
Wilkoff, BL, Miller, RE. Exercise testing for chronotropic assessment. Cardiol Clin 1992; 10: 705–717.CrossRefGoogle ScholarPubMed
Unnithan, V, Rowland, TW. Use of Oxygen pulse in predicting Doppler-derived maximal stroke volume in adolescents. Pediatr Exerc Sci 2015; 27: 412–418.CrossRefGoogle ScholarPubMed
Brubaker, PH, Kitzman, DW. Chronotropic incompetence: causes, consequences, and management. Circulation 2011; 123: 1010–1020.CrossRefGoogle ScholarPubMed
Banks, L, McCrindle, BW, Russell, JL, Longmuir, PE. Enhanced physiology for submaximal exercise in children after the fontan procedure. Med Sci Sports Exerc 2013; 45: 615–621.CrossRefGoogle ScholarPubMed
Dahlqvist, JA, Karlsson, M, Wiklund, Uet al.Heart rate variability in children with Fontan circulation: lateral tunnel and extracardiac conduit. Pediatr Cardiol 2012; 33: 307–315.CrossRefGoogle ScholarPubMed
Gewillig, MH, Lundstrom, UR, Bull, C, Wyse, RK, Deanfield, JE. Exercise responses in patients with congenital heart disease after Fontan repair: patterns and determinants of performance. J Am Coll Cardiol 1990; 15: 1424–1432.10.1016/S0735-1097(10)80034-8CrossRefGoogle Scholar