Abnormal Ventilatory Response to Exercise in Adults With Congenital Heart Disease Relates to Cyanosis and Predicts Survival
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- Konstantinos Dimopoulos
- From the Adult Congenital Heart Programme (K.D., G.-P.D., C.S.B., S.V.B.-N., W.L., A.U., S.B., M.A.G.), Department of Cardiology, Royal Brompton Hospital, London, United Kingdom; Department of Clinical Cardiology (K.D., D.O.O., G.-P.D., T.V.S., R.W., M.F.P., P.A.P.-W.), National Heart and Lung Institute, Imperial College School of Medicine, London, United Kingdom; and International Centre for Circulatory Health (T.V.S., D.P.F.), St. Mary’s Hospital & Imperial College, London, United Kingdom.
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- Darlington O. Okonko
- From the Adult Congenital Heart Programme (K.D., G.-P.D., C.S.B., S.V.B.-N., W.L., A.U., S.B., M.A.G.), Department of Cardiology, Royal Brompton Hospital, London, United Kingdom; Department of Clinical Cardiology (K.D., D.O.O., G.-P.D., T.V.S., R.W., M.F.P., P.A.P.-W.), National Heart and Lung Institute, Imperial College School of Medicine, London, United Kingdom; and International Centre for Circulatory Health (T.V.S., D.P.F.), St. Mary’s Hospital & Imperial College, London, United Kingdom.
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- Gerhard-Paul Diller
- From the Adult Congenital Heart Programme (K.D., G.-P.D., C.S.B., S.V.B.-N., W.L., A.U., S.B., M.A.G.), Department of Cardiology, Royal Brompton Hospital, London, United Kingdom; Department of Clinical Cardiology (K.D., D.O.O., G.-P.D., T.V.S., R.W., M.F.P., P.A.P.-W.), National Heart and Lung Institute, Imperial College School of Medicine, London, United Kingdom; and International Centre for Circulatory Health (T.V.S., D.P.F.), St. Mary’s Hospital & Imperial College, London, United Kingdom.
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- Craig S. Broberg
- From the Adult Congenital Heart Programme (K.D., G.-P.D., C.S.B., S.V.B.-N., W.L., A.U., S.B., M.A.G.), Department of Cardiology, Royal Brompton Hospital, London, United Kingdom; Department of Clinical Cardiology (K.D., D.O.O., G.-P.D., T.V.S., R.W., M.F.P., P.A.P.-W.), National Heart and Lung Institute, Imperial College School of Medicine, London, United Kingdom; and International Centre for Circulatory Health (T.V.S., D.P.F.), St. Mary’s Hospital & Imperial College, London, United Kingdom.
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- Tushar V. Salukhe
- From the Adult Congenital Heart Programme (K.D., G.-P.D., C.S.B., S.V.B.-N., W.L., A.U., S.B., M.A.G.), Department of Cardiology, Royal Brompton Hospital, London, United Kingdom; Department of Clinical Cardiology (K.D., D.O.O., G.-P.D., T.V.S., R.W., M.F.P., P.A.P.-W.), National Heart and Lung Institute, Imperial College School of Medicine, London, United Kingdom; and International Centre for Circulatory Health (T.V.S., D.P.F.), St. Mary’s Hospital & Imperial College, London, United Kingdom.
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- Sonya V. Babu-Narayan
- From the Adult Congenital Heart Programme (K.D., G.-P.D., C.S.B., S.V.B.-N., W.L., A.U., S.B., M.A.G.), Department of Cardiology, Royal Brompton Hospital, London, United Kingdom; Department of Clinical Cardiology (K.D., D.O.O., G.-P.D., T.V.S., R.W., M.F.P., P.A.P.-W.), National Heart and Lung Institute, Imperial College School of Medicine, London, United Kingdom; and International Centre for Circulatory Health (T.V.S., D.P.F.), St. Mary’s Hospital & Imperial College, London, United Kingdom.
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- Wei Li
- From the Adult Congenital Heart Programme (K.D., G.-P.D., C.S.B., S.V.B.-N., W.L., A.U., S.B., M.A.G.), Department of Cardiology, Royal Brompton Hospital, London, United Kingdom; Department of Clinical Cardiology (K.D., D.O.O., G.-P.D., T.V.S., R.W., M.F.P., P.A.P.-W.), National Heart and Lung Institute, Imperial College School of Medicine, London, United Kingdom; and International Centre for Circulatory Health (T.V.S., D.P.F.), St. Mary’s Hospital & Imperial College, London, United Kingdom.
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- Anselm Uebing
- From the Adult Congenital Heart Programme (K.D., G.-P.D., C.S.B., S.V.B.-N., W.L., A.U., S.B., M.A.G.), Department of Cardiology, Royal Brompton Hospital, London, United Kingdom; Department of Clinical Cardiology (K.D., D.O.O., G.-P.D., T.V.S., R.W., M.F.P., P.A.P.-W.), National Heart and Lung Institute, Imperial College School of Medicine, London, United Kingdom; and International Centre for Circulatory Health (T.V.S., D.P.F.), St. Mary’s Hospital & Imperial College, London, United Kingdom.
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- Stephanie Bayne
- From the Adult Congenital Heart Programme (K.D., G.-P.D., C.S.B., S.V.B.-N., W.L., A.U., S.B., M.A.G.), Department of Cardiology, Royal Brompton Hospital, London, United Kingdom; Department of Clinical Cardiology (K.D., D.O.O., G.-P.D., T.V.S., R.W., M.F.P., P.A.P.-W.), National Heart and Lung Institute, Imperial College School of Medicine, London, United Kingdom; and International Centre for Circulatory Health (T.V.S., D.P.F.), St. Mary’s Hospital & Imperial College, London, United Kingdom.
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- Roland Wensel
- From the Adult Congenital Heart Programme (K.D., G.-P.D., C.S.B., S.V.B.-N., W.L., A.U., S.B., M.A.G.), Department of Cardiology, Royal Brompton Hospital, London, United Kingdom; Department of Clinical Cardiology (K.D., D.O.O., G.-P.D., T.V.S., R.W., M.F.P., P.A.P.-W.), National Heart and Lung Institute, Imperial College School of Medicine, London, United Kingdom; and International Centre for Circulatory Health (T.V.S., D.P.F.), St. Mary’s Hospital & Imperial College, London, United Kingdom.
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- Massimo F. Piepoli
- From the Adult Congenital Heart Programme (K.D., G.-P.D., C.S.B., S.V.B.-N., W.L., A.U., S.B., M.A.G.), Department of Cardiology, Royal Brompton Hospital, London, United Kingdom; Department of Clinical Cardiology (K.D., D.O.O., G.-P.D., T.V.S., R.W., M.F.P., P.A.P.-W.), National Heart and Lung Institute, Imperial College School of Medicine, London, United Kingdom; and International Centre for Circulatory Health (T.V.S., D.P.F.), St. Mary’s Hospital & Imperial College, London, United Kingdom.
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- Philip A. Poole-Wilson
- From the Adult Congenital Heart Programme (K.D., G.-P.D., C.S.B., S.V.B.-N., W.L., A.U., S.B., M.A.G.), Department of Cardiology, Royal Brompton Hospital, London, United Kingdom; Department of Clinical Cardiology (K.D., D.O.O., G.-P.D., T.V.S., R.W., M.F.P., P.A.P.-W.), National Heart and Lung Institute, Imperial College School of Medicine, London, United Kingdom; and International Centre for Circulatory Health (T.V.S., D.P.F.), St. Mary’s Hospital & Imperial College, London, United Kingdom.
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- Darrel P. Francis
- From the Adult Congenital Heart Programme (K.D., G.-P.D., C.S.B., S.V.B.-N., W.L., A.U., S.B., M.A.G.), Department of Cardiology, Royal Brompton Hospital, London, United Kingdom; Department of Clinical Cardiology (K.D., D.O.O., G.-P.D., T.V.S., R.W., M.F.P., P.A.P.-W.), National Heart and Lung Institute, Imperial College School of Medicine, London, United Kingdom; and International Centre for Circulatory Health (T.V.S., D.P.F.), St. Mary’s Hospital & Imperial College, London, United Kingdom.
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- Michael A. Gatzoulis
- From the Adult Congenital Heart Programme (K.D., G.-P.D., C.S.B., S.V.B.-N., W.L., A.U., S.B., M.A.G.), Department of Cardiology, Royal Brompton Hospital, London, United Kingdom; Department of Clinical Cardiology (K.D., D.O.O., G.-P.D., T.V.S., R.W., M.F.P., P.A.P.-W.), National Heart and Lung Institute, Imperial College School of Medicine, London, United Kingdom; and International Centre for Circulatory Health (T.V.S., D.P.F.), St. Mary’s Hospital & Imperial College, London, United Kingdom.
説明
<jats:p> <jats:bold> <jats:italic>Background—</jats:italic> </jats:bold> Limited data exist with which to stratify risk in adult congenital heart disease (ACHD). An increased ventilatory response to exercise, expressed as ventilation per unit of carbon dioxide production (V̇ <jats:sc>e</jats:sc> /V̇ <jats:sc>co</jats:sc> <jats:sub>2</jats:sub> slope), is an established predictor of impaired survival in acquired heart disease. We sought to establish the distribution, relation to cyanosis, and prognostic value of the V̇ <jats:sc>e</jats:sc> /V̇ <jats:sc>co</jats:sc> <jats:sub>2</jats:sub> slope across a wide spectrum of ACHD patients. </jats:p> <jats:p> <jats:bold> <jats:italic>Methods and Results—</jats:italic> </jats:bold> Five hundred sixty ACHD patients of varying diagnoses and 50 healthy controls underwent cardiopulmonary exercise testing at a single laboratory between 2001 and 2004. Patient age was 33.2±12.9 years (mean±SD). Peak oxygen consumption was 23.5±9.0 mL · kg <jats:sup>−1</jats:sup> · min <jats:sup>−1</jats:sup> . V̇ <jats:sc>e</jats:sc> /V̇ <jats:sc>co</jats:sc> <jats:sub>2</jats:sub> slope for all patients was 36.3±15.3. The slope was raised in all ACHD groups compared with controls and was 73% higher in cyanotic patients. Cyanosis, with or without pulmonary arterial hypertension, was the strongest predictor of abnormal V̇ <jats:sc>e</jats:sc> /V̇ <jats:sc>co</jats:sc> <jats:sub>2</jats:sub> slope. The V̇ <jats:sc>e</jats:sc> /V̇ <jats:sc>co</jats:sc> <jats:sub>2</jats:sub> slope was the most powerful univariate predictor of mortality in the noncyanotic group and the only independent predictor of mortality among exercise parameters on multivariate analysis. In cyanotic patients, no parameter was predictive of death. </jats:p> <jats:p> <jats:bold> <jats:italic>Conclusions—</jats:italic> </jats:bold> Ventilatory response to exercise is abnormal across the spectrum of ACHD. Cyanosis is a powerful stimulus for such exaggerated ventilatory patterns irrespective of the presence of pulmonary arterial hypertension. Increased V̇ <jats:sc>e</jats:sc> /V̇ <jats:sc>co</jats:sc> <jats:sub>2</jats:sub> slope is the strongest exercise predictor of death in noncyanotic ACHD patients. </jats:p>
収録刊行物
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- Circulation
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Circulation 113 (24), 2796-2802, 2006-06-20
Ovid Technologies (Wolters Kluwer Health)
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詳細情報 詳細情報について
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- CRID
- 1364233268206769536
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- NII論文ID
- 30022669275
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- ISSN
- 15244539
- 00097322
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- データソース種別
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