Analysis of the recovery phase after maximal exercise in children with repaired tetralogy of Fallot and the relationship with ventricular function

Abstract

Background Few studies demonstrate delayed recovery after exercise in children and adults with heart disease. We assess the recovery patterns of gas exchange parameters and heart rate (HR) in children with repaired Tetralogy of Fallot (rToF) compared to healthy peers and investigate the correlation with ventricular function and QRS duration. Methods 45 children after rToF and 45 controls performed a maximal incremental cardiopulmonary exercise test. In the subsequent recovery period, patterns of VO2, VCO2 and HR were analysed. Half-life time (T1/2) of the exponential decay and drop per minute (Recmin) were compared between groups. In the rToF group, correlations were examined between the recovery parameters and QRS-duration and ventricular function, described by fractional shortening (FS) and tricuspid annular plane systolic excursion (TAPSE) measured at baseline prior to exercise. Results Recovery of VO2 and VCO2 was delayed in rToF patients, half-life time values were higher compared to controls (T1/2VO2 52.51 ±11.29 s vs. 44.31 ± 10.47 s; p = 0.001 and T1/2VCO2 68.28 ± 13.84 s vs. 59.41 ± 12.06 s; p = 0.002) and percentage drop from maximal value was slower at each minute of recovery (p<0.05). Correlations were found with FS (T1/2VO2: r = -0.517; p<0.001; Rec1minVO2: r = -0.636, p<0.001; Rec1minVCO2: r = -0.373, p = 0.012) and TAPSE (T1/2VO2: r = -0.505; p<0.001; Rec1minVO2: r = -0.566, p<0.001; T1/2VCO2: r = -0.466; p = 0.001; Rec1minVCO2: r = -0.507, p<0.001), not with QRS-duration. No difference was found in HR recovery between patients and controls. Conclusions Children after rToF show a delayed gas exchange recovery after exercise. This delay correlates to ventricular function, demonstrating its importance in recovery after physical activity.

Exercise Capacity in Children and Adolescents With Congenital Heart Disease: A Systematic Review and Meta-Analysis

“…Fifteen studies were conducted in Europe ( 18 – 32 ), three in the United States ( 33 – 35 ), one in Brazil ( 36 ), one in Japan ( 37 ), and one was conducted in Egypt ( 38 ). Regarding the design, 20 were cross-sectional ( 18 – 23 , 25 – 38 ), and only one was an RCT ( 24 ).…”

“…To assess exercise capacity, 18 studies used the direct CPET method: seven of them performed the CPET on a treadmill ( 18 – 20 , 27 , 36 – 38 ) and 13 in a cycle ergometer ( 21 – 26 , 29 – 35 ). One study used the 6MWT ( 24 ).…”

“…Ten studies reported the Wmax in watts ( 21 – 24 , 27 , 30 – 32 , 34 , 35 ). These studies compared 1168 participants with CHD vs. 938 healthy controls.…”

“…Participants with CHD averaged −41.5 Wmax (95% CI: −57.9, −25.1 watts) compared with controls ( p < 0.00001) ( Figure 4 ). If we analyze only studies with patients surgically repaired ( 22 , 24 , 27 , 30 , 31 , 34 , 35 ) the participants with CHD averaged −49.9 watts (95% CI: −77.2, −22.6) of Wmax compared with controls ( p < 0.0003, I 2 = 95%) ( Supplementary File 2 , Figure 2 ). In addition, we sub-analyzed by age range and observed that the Wmax of the group under 12 years old was similar with the control group [−79.7 watts (95% CI: −229.2, 69.8), p = 0.3, I 2 = 98%], and the group ≥ 12 years old had a reduction of −45.5 watts (95% CI: −54.4, −36.7) compared to the control group ( p < 0.00001, I 2 = 0%) ( Figure 5 ).…”

Tingkat aktivitas fisik dan kualitas tidur masyarakat di Jawa Timur selama masa pandemi covid-19

“…Hal tersebut disebabkan olahraga menstimulasi pembentukan zat kimia pada otak, misalnya serotonin dan endorphin yang dapat membuat tubuh merasa lebih bahagia (Wolf et al, 2021). Selain itu strategi pemulihan yang bagus dapat memberikan dukungan kepada seseorang untuk lebih maksimal dalam menjalani aktivitas olahraga (Coomans et al, 2020). Hal tersebut dibuktikan dengan adanya data sebanyak 49,4% masyarakat aktif melakukan olahraga tiga kali dalam seminggu.…”