Outcome of muscle and bone development in congenital heart disease

Abstract

Muscles and bones of patients with congenital heart disease (CHD) are subject to various potentially deleterious influences during growth. The aim of the present study was to analyse the outcome of bone and muscle parameters in adolescents and young adults with a spectrum of CHD. Bone and muscle parameters of the forearm were examined at two standard sites, 4% and 65%, in 29 adolescents and young adults with CHD, aged 14-24 years, by quantitative computed tomography. For the entire study population, bone and muscle parameters did not deviate significantly from the reference values except for age- and gender-corrected body height (ASDS-height: -0.6+/-1.2, p=0.01). Both age- and gender- and height- and gender-corrected (HSDS) abnormal bone mass (BMC) was found at the distal radius in patients with Fontan repair (ASDS-BMC4%: -1.5+/-0.9, p=0.008; HSDS-BMC4%: -1.2+/-1.0, p=0.05) and in those in NYHA class III (ASDS-BMC4%: -1.3+/-0.4, p=0.001; HSDS-BMC4%: -1.4+/-0.5, p=0.004). There was minimal overlap between Fontan patients (n=6) and NYHA class III (5 Fontan patients were in NYHA class I or II). In conclusion, most patients with CHD show a normal muscle and bone development in proportion to their reduced body height. Further follow-up is required to determine whether patients in a worse clinical status (NYHA III) and those with single ventricle physiology are at increased risk of osteoporosis and fractures.

Mechanographic characteristics of adolescents and young adults with congenital heart disease

“…The anthropometric characteristics of the study population are provided in Table 1. These patients and the analyses of the corresponding pQCT measurements have been formerly described in detail in an earlier report [10]. None of the individuals had any known musculoskeletal impairment, a fresh fracture, a recent operation and/or hypotrophy or paresis of the non-dominant forearm.…”

“…Data are presented in tables as mean ± standard deviation (SD), with the exception of hypoxemia and NYHA classification for which the range is given in parenthesis a SDS a , Age-dependent SD score; SDS h , height-and gender-dependent SD score; BMI, body mass index; NYHA, New York Heart Association b Data published earlier by Witzel et al 2006 [10] Measurement of the maximal isometric grip force (MIGF) MIGF of the non-dominant hand was measured using a Jamar dynamometer (Preston, Jackson, Mich.), as previously described [5].…”

“…A study on musculoskeletal interaction by Witzel el al. [10] revealed that there is no disturbance in the adaptation of the bone to biomechanical and -in particular -muscular forces in adolescents and young adults with CHD. These researchers found that parameters reflecting bone mass (BMC4%, bone mineral count) and muscle development (MA, cross-sectional muscle area) were not significantly decreased in comparison to reference individuals.…”

Exercise prescription for patients with a Fontan circulation: current evidence and future directions

“…19 Moreover, compared with healthy peers, a reduced body mass is frequently observed in patients with congenital heart disease. 20 A lower muscle mass also contributes to a lower oxygen utilisation during exercise and a lower VO 2peak . 21 Patients with a Fontan circulation who are in good condition are advised to participate in regular lowintensity aerobic exercise to increase their physical fitness.…”

The ‘Functional Muscle-Cartilage Unit’: A Reasonable Approach to Describe a Putative Relationship between Muscle Force and Longitudinal Growth at the Forearm in Children and Adolescents?

“…The key idea of this concept was that the development of bone mass and geometry obeys the biomechanical concept formerly proposed by Julius Wolff to describe the structural adaptation of skeletal elements to their functional biomechanical environment [5, 6]. Frost’s concept may not explain all aspects of bone biology in all respects [7, 8], but recently published reports described that this concept may accurately distinguish between primary and secondary bone diseases [9,10,11,12]. Primary bone diseases are characterized by a decreased ratio of bone strength to maximal muscle force in contrast to secondary bone diseases described by a normal ratio in combination with reduced bone mass (fig.…”