Comparison of the right and left ventricle as a systemic ventricle during exercise in patients with congenital heart disease

Long-term results of total cavopulmonary connection with low ejection fraction

“…Indeed, in previous reports 14 a low ventricular ejection fraction was not related to poor exercise capacity in adult patients. In other reports, 17,18 in contrast, exercise testing demonstrated signifi cant limitation in terms of cardiac function, with a reduced ejection fraction at rest and during exercise being accompanied by reduced anaerobic threshold and reduced oxygen consumption. Undoubtedly, this issue is not clear-cut.…”

Is the Chronotropic Index Applicable to Children and Adolescents?

“…11 Chronotropic incompetence is also seen in children and adolescents who have undergone intracardiac repair for congenital heart disease, [12][13][14][15][16][17][18][19] those with congenital long QT syndrome, 20,21 recipients of cardiac transplantation, 26 and patients with anorexia nervosa. 27 Although the clinical significance of chronotropic incompetence in the paediatric populations is still unclear, chronotropic incompetence is present many years before heart disease develops.…”

“…6,28 Diagnosis of chronotropic incompetence in children and adolescents is almost exclusively based on a failure to reach standard heart rate at peak exercise. [13][14][15][16][17][18][19][20][21]29 However, when paediatricians interpret the data of paediatric exercise testing with low values of peak heart rate, it is often difficult to distinguish poor motivation from a true chronotropic response because poor effort will result in early test termination. Therefore, rather than the measurements obtained from maximal exercise, clinically valuable information on exercise testing in children and adolescents often lies in the submaximal phases.…”

“…22,23 To our knowledge, however, the clinical diagnosis of chronotropic incompetence in children and adolescents is almost exclusively based on a failure to reach standard heart rate at peak exercise or at each stage of treadmill testing as estimated according to age and sex. [13][14][15][16][17][18][19][20][21]24 Therefore, in the present study we tested the hypothesis that the CRI is not influenced by exercise intensity, and is also independent of Circulation Journal Vol.69, April 2005 age, sex, functional capacity, and resting heart rate in young patients. …”

“…11 Chronotropic incompetence is also seen in children and adolescents who have undergone intracardiac repair for congenital heart disease, [12][13][14][15][16][17][18][19] or who have congenital long QT syndrome. 20,21 The chronotropic response in adults is assessed by the chronotropic index (CRI), which utilizes the linear relationship between heart rate reserve and metabolic reserve during incremental exercise testing, 22,23 and this has become the standard method.…”