Abstract:
BACKGROUND:Patients with univentricular hearts have decreased exercise tolerance and may demonstrate exertional dyspnoea. It is not known if chronic hypoxaemia exacerbates exercise intolerance and contributes to symptomatic limitation. The extent to which surgical correction of a right-to-left shunt by a Fontan-type procedure can increase exercise tolerance by reducing arterial deoxygenation is not well documented. The cardiopulmonary exercise responses and the symptomatic status in two groups of univentricular patients, those who are cyanotic and those who are acyanotic with Fontan-type circulation, were compared. METHODS AND FINDINGS:Cardiopulmonary exercise testing was performed in 10 univentricular patients with rest or stress-induced cyanosis (age 30.5 +/- 2.3 [SE] years; 5 men) who had palliative or no surgery and eight patients (age 29.4 +/- 1.5 years; 4 men) with Fontan-type circulation. Peak oxygen consumption was comparable in both groups of univentricular patients (21.7 +/- 2.5 vs 21.0 +/- 1.9 ml.kg-1.min-1, P = 0.85) but was less than an age-matched group of 10 healthy subjects (34.7 +/- 1.9 ml.kg-1.min-1, P < 0.001 for both). Arterial oxygen saturation was 90.6% at rest in the cyanotic patients compared with 95.1% in the Fontan patients (P < 0.001) and at peak exercise, 66.2% compared with 90.5% (P < 0.001). Using a modified Borg scale (0-10), the symptoms of dyspnoea and fatigue were also assessed during exercise in the patient groups. The Borg scores for dyspnoea in the cyanotic and the corrected univentricular patients were, respectively, as follows: Stage 1: 0.5 vs 1.7; P= 0.04; Stage 2: 1.8 vs 2.3, P = 0.5; Stage 3: 3.0 vs 3.5, P = 0.7; Peak Exercise: 4.9 vs 4.8, P = 0.9. In addition, the Borg scores for fatigue were: Stage 1: 0.4 vs 1.6, P = 0.08; Stage 2: 2.0 vs 2.2, P = 0.9; Stage 3: 3.0 vs 4.3, P = 0.5; Peak Exercise: 4.9 vs 5.4, P = 0.5. The major limiting symptom at peak exercise was dyspnoea in four cyanotic patients compared with one in the Fontan group (Chi-square 0.982, P > 0.10). The arterial oxygen desaturation at peak exercise in the cyanotic patients limited by dyspnoea was not different from those limited by fatigue (67.5 +/- 10.1% vs 66.7 +/- 13.7%, P = 0.92). Exercise tolerance was also not related to the arterial oxygen saturation at peak exercise (r = 0.47, P = 0.17) in these patients. CONCLUSIONS:Despite correction with Fontan-type surgery, the exercise tolerance and symptoms of these univentricular patients remained similar to those who were cyanosed. Cyanotic patients have adjusted to chronic hypoxaemia and it does not appear to determine the exercise tolerance or the genesis of dyspnoea in these patients. Further randomized prospective studies are required to investigate the long-term benefits of Fontan-type procedures in these patients on exercise tolerance, symptoms and prognosis.
journal_name
Eur Heart Jjournal_title
European heart journalauthors
Iserin L,Chua TP,Chambers J,Coats AJ,Somerville Jdoi
10.1093/oxfordjournals.eurheartj.a015449subject
Has Abstractpub_date
1997-08-01 00:00:00pages
1350-6issue
8eissn
0195-668Xissn
1522-9645journal_volume
18pub_type
杂志文章abstract::The effects of flosequinan and enalapril on exercise capacity (bicycle exercise duration), quality-of-life symptomatology (visual analogue scales) and New York Heart Association (NYHA) grading, were compared in 61 patients with chronic heart failure (NYHA, grade III). Bicycle exercise duration improved similarly with ...
journal_title:European heart journal
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1093/oxfordjournals.eurheartj.a060320
更新日期:1992-08-01 00:00:00
abstract:AIMS:To evaluate the association between occupational and leisure-time physical activity (PA), ownership of goods promoting sedentary behaviour, and the risk of myocardial infarction (MI) in different socio-economic populations of the world. Studies in developed countries have found low PA as a risk factor for cardiova...
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doi:10.1093/eurheartj/ehr432
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doi:10.1093/oxfordjournals.eurheartj.a060618
更新日期:1994-07-01 00:00:00
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journal_title:European heart journal
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更新日期:1995-03-01 00:00:00
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journal_title:European heart journal
pub_type: 杂志文章
doi:10.1093/oxfordjournals.eurheartj.a061589
更新日期:1984-11-01 00:00:00
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journal_title:European heart journal
pub_type: 杂志文章
doi:
更新日期:1998-10-01 00:00:00
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journal_title:European heart journal
pub_type: 杂志文章
doi:10.1093/oxfordjournals.eurheartj.a059530
更新日期:1989-06-01 00:00:00
abstract::The role of ventricular rate-adaptive pacing (VVIR) in the elderly was investigated in 12 patients with a mean age of 85 +/- 2 years (range 75-95 years) with implanted activity-initiated VVIR pacemakers. Although four patients had significant extracardiac diseases, all were capable of independent walking and self care...
journal_title:European heart journal
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1093/oxfordjournals.eurheartj.a060291
更新日期:1992-07-01 00:00:00
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journal_title:European heart journal
pub_type: 杂志文章,评审
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更新日期:1983-05-01 00:00:00
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journal_title:European heart journal
pub_type: 杂志文章
doi:10.1053/euhj.1999.1982
更新日期:2000-10-01 00:00:00
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journal_title:European heart journal
pub_type: 杂志文章
doi:10.1093/oxfordjournals.eurheartj.a060150
更新日期:1992-02-01 00:00:00
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doi:10.1093/eurheartj/ehs239
更新日期:2013-02-01 00:00:00
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journal_title:European heart journal
pub_type: 临床试验,杂志文章,多中心研究,随机对照试验
doi:10.1053/euhj.1999.1483
更新日期:1999-10-01 00:00:00
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journal_title:European heart journal
pub_type: 杂志文章
doi:10.1093/eurheartj/ehu081
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pub_type: 杂志文章,多中心研究
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更新日期:2006-10-01 00:00:00
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pub_type: 杂志文章,随机对照试验
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doi:10.1093/oxfordjournals.eurheartj.a060426
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journal_title:European heart journal
pub_type: 杂志文章
doi:10.1093/eurheartj/10.suppl_f.97
更新日期:1989-11-01 00:00:00
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journal_title:European heart journal
pub_type: 杂志文章,多中心研究,随机对照试验
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更新日期:2005-10-01 00:00:00
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journal_title:European heart journal
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doi:10.1053/euhj.1997.0799
更新日期:1998-06-01 00:00:00
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journal_title:European heart journal
pub_type: 杂志文章
doi:10.1053/euhj.1997.0803
更新日期:1998-04-01 00:00:00
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journal_title:European heart journal
pub_type: 杂志文章
doi:10.1093/eurheartj/16.1.43
更新日期:1995-01-01 00:00:00
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更新日期:2011-10-01 00:00:00
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journal_title:European heart journal
pub_type: 杂志文章
doi:10.1093/oxfordjournals.eurheartj.a015046
更新日期:1996-08-01 00:00:00
abstract::Although the number of individuals reaching 80 who are considered to be healthy is increasing, the very elderly are likely to have long-term conditions, to report symptoms and/or be taking at least one regular medication. The impact of antihypertensive treatment has to be taken into account in this context. The treatm...
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pub_type: 杂志文章,评审
doi:10.1093/eurheartj/eht464
更新日期:2014-07-01 00:00:00
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journal_title:European heart journal
pub_type: 杂志文章
doi:10.1053/euhj.2001.2894
更新日期:2002-05-01 00:00:00