Functional Capacity in Congenital Heart Disease: A Systematic Review and Meta-Analysis

Abstract

BackgroundChildren and adolescents with congenital heart disease often have alterations in their exercise capacity that can be evaluated by various functional testing.ObjectiveTo evaluate the functional capacity of children and adolescents with congenital heart disease (CHD) with systematic review and meta-analyses.MethodsThe review included observational studies, data from the first evaluation of randomized clinical trials or observational follow-up periods after clinical trials which evaluated functional capacity by cardiopulmonary exercise test, stress testing, six-minute walk test or step test, in children and adolescents with CHD, aged between six and 18 years, and comparisons with healthy controls in the same age group. The quantitative assessment was performed by meta-analysis, by comparing the maximal oxygen consumption (VO2max) of children and adolescents with CHD and respective control groups.ResultsTwenty-five of 2.683 studies identified in the search met the inclusion criteria. The VO2max measurement showed that patients with CHD have a decrease of 9.31 ml/Kg/min (95% CI. -12.48 to -6.13; I2, 94.3%, P for heterogeneity < 0.001) compared with the control group. The meta-analysis of the data of maximum heart rate (HR) reached during cardiopulmonary test and stress testing, retrieved from 18 studies, showed a HR value of -15.14 bpm (95% CI. -20.97 to -9.31; I2, 94.3%, P for heterogeneity < 0.001) compared with the control group.ConclusionChildren and adolescents with CHD have lower VO2max and HR compared to controls.

Physical activity assessments in children with congenital heart disease: A systematic review

“…One of the factors that determine the level of PA has to do with the social environment and the influence that the family has on children. 43 In the case of children with CHD, in addition to the limitation in physical capacity due to the heart defect, 13 the social restriction is even greater and probably maximised by the parents. 44 Several authors showed that the restriction for the development of PA has to do with aspects surrounding cardiac dysfunction, such as the restrictive attitude of the family limiting the ability of follow the recommendations of the cardiologist, 22,28 and the self-efficacy that the child perceives of his/her own ability to perform PA. 27 The severity of CHD is another aspect to consider within the determinants of PA.…”

“…Although it has been reported that physical capacity, understood as the maximum physical effort that a subject can perform, and PA are determinants of morbidity and mortality in adults with CHD 8,11,12 and, in children with CHD it is significantly lower in comparison with healthy controls, 13,14 it has been stated that MVPA is the variable that has a direct relationship with increases in self‐reported HRQOL 15,16 . Several studies have described the impact of CHD on PA in children, reporting the risk of suffering other cardiovascular and metabolic diseases during adolescence 4,7,17,18 and adulthood 8,12 …”

“…9 Thus, the level of expenditure ranges between 1.1 and 2.9 MET for sedentary PA and between 3.0 and 5.9 MET for moderate PA and is ≥6.0 MET for vigorous PA. To achieve health benefits, the World Health Organization (WHO) recommends 60 minutes/day of moderate-to-vigorous PA (MVPA; ≥3.0 MET). 10 Although it has been reported that physical capacity, understood as the maximum physical effort that a subject can perform, and PA are determinants of morbidity and mortality in adults with CHD 8,11,12 and, in children with CHD it is significantly lower in comparison with healthy controls, 13,14 it has been stated that MVPA is the variable that has a direct relationship with increases in self-reported HRQOL. 15,16 Several studies have described the impact of CHD on PA in children, reporting the risk of suffering other cardiovascular and metabolic diseases during adolescence 4,7,17,18 and adulthood.…”

Caregiving strategies in families of children with congenital heart disease: A qualitative study

“…Moreover, these children face restricted physical activity and lower exercise capacity. [ 20 ] Thus, families tried to supervise their children's activities to prevent fatigue and dyspnea, and teach them about it. In a similar study, parents tried to prevent activities which increased the heart rate.…”

Three-dimensional alignment of microvasculature and cardiomyocytes in the developing ventricle

“…For example, swollen coronary sinusoids have been detected in children with pulmonary atresia 4,5 and patients with d-transposition of the great arteries and tetralogy of Fallot have reduced myocardial perfusion via the microvasculature 6 . Patients with CHDs often have reduced exercise tolerance, which could point toward microvascular defects 7 . However, expansion in our understanding of microvascular heart development and its role in heart disease requires new tools and a quantitative approach.…”