Stratum, E.B.H.J. van (Elisabeth) (2015) Predictors of exercise capacity in a cohort of Fontan patients. thesis, Medicine.
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Abstract
Introduction Each year, approximately 3-8 per 1000 babies are born with a congenital heart defect (CHD). One category of congenital heart defects, characterized by a univentricular physiology, has unoperated poor odds to survival. Therefore, in 1971, Fontan and Baudet described a surgical procedure that greatly improves their life expectancy: the Fontan procedure. On short-term, this palliative procedure offers numerous advantages and enhances quality of life. On the long run, however, patients suffer from co-morbidities and eventually from death as the created circulation fails, leading to decreased exercise capacity. Cardiopulmonary Exercise Testing (CPET) offers a great insight in patients’ performance levels and functions as a tool to assess physical and functional status. Our purpose therefore is to identify predictors of exercise capacity, measured with Cardiopulmonary Exercise Testing, in a large cohort of Fontan patients. Methods In this single-centre retrospective cohort study, 190 patients were included. Their exercise capacity was assessed with CPET and quantified using maximal oxygen uptake (VO2max). We have stratified our cohort into tertiles according to VO2max and maximum achieved workload (WLmax). Patients with and without CPETs were compared. Patients with stable exercise capacity over time were compared with patients whose exercise capacity deteriorated. For all Fontan patients, linear regression analysis was performed to determine (independent) predictors of exercise capacity. Results Within the cohort, a total cavopulmonary connection with an autologous right auricular tunnel was the most prevalent Fontan type (n=41, 21,5%) Also, 55 (28,8%) atriopulmonary connections were included as well as other forms of total cavopulmonary connection. Average age at Fontan completion was 5,6±3,9 years. At time of CPET, average age was 25,8±10,7 years. Average height and weight were 1.67m and 62,5kg respectively. Mean VO2max was 24,7±7,9 ml/kg/min, equivalent to 65±17% of the predicted exercise capacity. Univariable analysis revealed that sex (p=0,007), height (p<0,001), weight (p=0,002), fat percentage (p=0,014), O2 saturation at rest (p=0,011) and heart rate reserve (p<0,001) were strongly associated with VO2max. In multivariable analysis, the final model included height (p<0,001), heart rate reserve (p<0,001) and Fontan type (p=0,037). Moreover, a group of relatively stable Fontan patients has been identified and they do not differ from the unstable group. Conclusions Exercise capacity is reduced in Fontan patients compared to reference values. The type of Fontan, heart rate reserve and height appear to be the strongest predictors of exercise capacity in this population.
| Item Type: | Thesis (Thesis) |
|---|---|
| Supervisor name: | Melle, Dr. J.P. van |
| Faculty: | Medical Sciences |
| Date Deposited: | 25 Jun 2020 10:45 |
| Last Modified: | 25 Jun 2020 10:45 |
| URI: | https://umcg.studenttheses.ub.rug.nl/id/eprint/637 |
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