Analysis of Cardiopulmonary Fitness and Risk Factors of Impaired Exercise Tolerance in Children After Total Cavopulmonary Connection
Objectives:To investigate the prevalence of impaired exercise tolerance,risk factors of impaired exercise tolerance after total cavopulmonary connection(TCPC).Methods:Clinical data of 81 children after TCPC and underwent incremental cardiopulmonary exercise test(CPET)at Shanghai Children's Medical Center from 2021 to 2023 were retrospectively analyzed and patients were divided into the worse exercise capacity Fontan(WCF)group(n=61)and the better exercise capacity Fontan(BCF)group(n=20)according to the percentage of predicted maximal oxygen uptake during exercise(pred VO2max)＜60%or≥60%.The cardiopulmonary function was compared between the two groups to explore risk factors affecting cardiopulmonary exercise function.Results:The average age of 81 children after TCPC was(12.28±3.28)years.All the children completed CPET examination safely without serious circulation abnormalities.Their pred VO2max was(55.43±14.80)%.Compared with the BCF group,VO2/kg max([30.26±3.16]ml/kg vs.[20.55±4.26]ml/kg),chronotropic index(CI,0.63±0.15 vs.0.46±0.18),oxygen uptake(ΔVO2/ΔWR)slope([11.89±2.43]ml/[min∙W]vs.[9.88±2.25]ml/[min∙W]),oxygen uptake efficiency slope per kilogram([36.49±6.16]ml/[log L∙kg]vs.[26.83±6.38]ml/[log L∙kg])were worse in the WCF group(all P＜0.01).End-expiratory carbon dioxide partial pressure(PetCO2),the minute ventilation/carbon dioxide output(VE/VCO2)slope,and the incidence of exercise oscillatory ventilation(EOV)were similar between the two groups(all P＞0.05).Multivariate logistic analysis showed that age,body mass index(BMI)and CI were independent risk factors for poor exercise tolerance,while VO2/kg max and oxygen uptake with increasing power at anaerobic threshold(ΔVO2/ΔWR@AT)were risk factors for exercise oscillatory ventilation.Conclusions:Exercise impairment,mostly presented as impaired aerobic exercise ability,is common in children after TCPC.The exercise function tends to decline during late adolescence,risk factors for poor exercise tolerance included age,BMI,and CI.The risk factors for exercise oscillatory ventilation included VO2/kg max and ΔVO2/ΔWR@AT.
total cavopulmonary connectionFontan procedurecardiopulmonary exercise testexercise tolerance
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