Chest
Clinical InvestigationsCARDIOLOGYAssessment of Symptoms and Exercise Capacity in Cyanotic Patients With Congenital Heart Disease
Section snippets
Patients
Twenty-five consecutive cyanotic patients with uncorrected congenital heart disease (12 women and 13 men) aged 18 to 59 years (mean age, 31 years; mean weight, 59 ± 12 kg; mean height, 171 ± 10 cm) underwent CPX. The study group consisted of patients treated in the outpatient clinic for congenital heart disease at the University Hospital Charité.
Two patients (patient 12/13 and patient 23/24) underwent evaluation twice with an interval of at least 6 months. Both patients were surgically
Symptomatology and Exercise Gas Exchange
Eighteen patients were assigned to NYHA class II, 8 patients to NYHA class III, and 1 patient to NYHA class IV. Ability classification was II in 6 patients, III in 17 patients, and IV in 4 patients. Seven patients were unable to work professionally; the remaining 20 patients were able to do so with limitations (avoiding physical labor).
The changes in ventilatory parameters and differences in exercise capacity as compared to normal values are given in Table 2. The maximal aerobic capacity was
Symptomatology and Exercise Gas Exchange
Patients with cyanotic congenital heart disease are generally thought to be limited by hypoxemia. Dyspnea, limited exercise capacity, lifestyle, and employment status are relevant factors for comprehensively evaluating the health of these patients. Consequently the ability index represents a supplemental tool in judging symptomatology.12 In this study, all patients stated an impaired quality of life. However, despite the severity of the cardiac malformations and the extent of cyanosis, 60% of
Conclusion
In cyanotic patients with congenital heart disease, CPX with gas exchange analysis provides additional and independent information, permitting more accurate and objective evaluation of their symptomatic state. In our patients, cyanosis and e alone did not accurately reflect the symptomatic state. Peak o2 did partially correlate with it, but was not able to describe the entire spectrum of symptoms as judged by the ability index and NYHA class.
Overall, the summation of disease-related factors is
ACKNOWLEDGMENT
We thank Karlman Wasserman, MD, PhD, Harbor-UCLA Medical Center, Torrance, CA, for his remarks and discussion of the manuscript.
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Effect of oxygen therapy on exercise performance in patients with cyanotic congenital heart disease: Randomized-controlled trial
2022, International Journal of CardiologyCitation Excerpt :The mechanisms of an increased V′E/V′CO2 in CHD-patients is still incompletely understood and the increase of the V′E/V′CO2 slope is even more pronounced in cyanotic CHD-patients with or without PH compared to those with mere CHD [25,26]. In the study of Dimopoulos et al. adult CHD patients had a lower V′E/V′CO2 slope (36.3 ± 15.3) compared to the current study (44.2(39.4; 48.0) [25], however, the subgroup of cyanotic patients in their study revealed a much higher slope 56.9 ± 23.2 compared to non-cyanotic CHD 32.8 ± 9.9 [25], similarly also to the study of Gläser et al. [27], In the current study the slope was significantly different in the IET with oxygen compared to air, however there was also trend for a steeper slope with air compared to oxygen. Despite the significantly increased SpO2 with oxygen vs. air, MTO and CTO at end-exercise were similar in the IET and CWRET but with a longer exercise duration, which may indicate that the cerebral and muscular deoxygenation contributed to maintain exercise longer under oxygen vs. air.
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The work was performed at the Department of Medicine, Charité Medical School Humboldt University of Berlin, Berlin, Germany.