The role for cardiopulmonary exercise testing in patients with atrial septal defects: A review

Barron, Anthony; Wensel, Roland; Francis, Dárrel P.; Malik, Iqbal

doi:10.1016/j.ijcard.2011.09.006

Cited by 9 publications

(10 citation statements)

References 42 publications

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“…Exercise capacity of patients with unrepaired ASDs depends on the importance of the shunt, the right ventricular (RV) function and volume overload, the level of pulmonary arterial pressure, and the occurrence of arrhythmias. For repaired ASDs, exercise capacity also depends on the delay before closure and the type of procedure (catheter or surgery) (15).…”

Section: Review Articlementioning

confidence: 99%

“…The large majority of reported studies found a significant improvement in exercise capacity after ASD closure, with both surgical and catheter procedures (15,39). The peak VO2 gradually improves after the procedure (30,(40)(41)(42), and sometimes reaches normal values in the long term (31).…”

Section: Cpet In Repaired Asdsmentioning

confidence: 99%

“…A right-to-left shunt at exercise will lead to desaturation and decrease in PetCO 2 . Therefore, CPET may identify patients who would benefit or not from ASD closure, regarding the risk of developing pulmonary arterial vasculopathy (15). Indeed, the deoxygenated venous blood shunting to the systemic circulation causes a disproportionate rise in CO 2 levels and a reflex increase in ventilation (18).…”

Section: Cpet and Comorbidities Related To Asdsmentioning

confidence: 99%

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Atrial septal defect and exercise capacity: value of cardio-pulmonary exercise test in assessment and follow-up

Amédro¹,

Guillaumont²,

Bredy³

et al. 2018

J. Thorac. Dis.

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Nearly four decades ago, the World Health Organization stated that functional capacity explorations best reflected the impact of a chronic disease on quality of life. Today, cardio-pulmonary exercise test (CPET) is recommended in the follow-up of patients with congenital heart diseases (CHDs). Indeed, the maximum oxygen uptake (VO 2max) and the ventilatory efficiency (VE/VCO 2 slope) correlate with both the prognosis and the quality of life in this population. Atrial septal defects (ASDs) represent the second most frequent CHD and are usually considered as simple CHDs. However, the exercise capacity of ASD patients may be impaired. Therefore, the CPET provides important information in assessment and followup of patients with ASDs, for both children and adults. Exercise capacity of patients with unrepaired ASDs depends on the importance of the shunt, the right ventricular (RV) function and volume overload, the level of pulmonary arterial pressure, and the occurrence of arrhythmias. For repaired ASDs, exercise capacity also depends on the delay before closure and the type of procedure (catheter or surgery). In most cases, the exercise capacity is nearly normal and CPET contributes to promote sports participation. In addition, a regular CPET follow-up is necessary to evaluate the occurrence, severity and physiological mechanisms of comorbidities, i.e., heart failure, pulmonary hypertension and arrhythmia. Furthermore, CPET follow-up in patients with ASDs may detect early onset of muscular deconditioning, for which cardiac rehabilitation may be considered.

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Section: Review Articlementioning

confidence: 99%

Section: Cpet In Repaired Asdsmentioning

confidence: 99%

Section: Cpet and Comorbidities Related To Asdsmentioning

confidence: 99%

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Atrial septal defect and exercise capacity: value of cardio-pulmonary exercise test in assessment and follow-up

Amédro¹,

Guillaumont²,

Bredy³

et al. 2018

J. Thorac. Dis.

View full text Add to dashboard Cite

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“…21 As concluded in a literature review, doubt remains if asymptomatic patients with very small shunts would improve exercise function following ASD closure. 22 These patients who have been diagnosed with a small ASD in early life and later discharged without further follow-up have never been examined systematically until now. Compared with other patients in the spectrum of adults with congenital heart disease, the exercise impairment found in our patients is comparable with the ones in patients with coarctation of the aorta and collective of patients with various valvular lesions.…”

Section: Discussionmentioning

confidence: 99%

“…As concluded in a literature review, doubt remains if asymptomatic patients with very small shunts would improve exercise function following ASD closure . These patients who have been diagnosed with a small ASD in early life and later discharged without further follow‐up have never been examined systematically until now.…”

Section: Discussionmentioning

confidence: 99%

Small unrepaired atrial septal defects display impaired exercise capacity compared with healthy peers

Udholm

Rex

Eckerström

et al. 2018

Congenital Heart Disease

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Objective: Adult patients with small, unrepaired atrial septal defects have an increased risk of pneumonia, atrial fibrillation, and stroke. Furthermore, they have higher late mortality than the background population. The functional capacity is unknown in these patients. Therefore, our objective was to determine exercise capacity in adult patients diagnosed with an unrepaired atrial septal defect compared to healthy controls. Design: A cross-sectional study.Patients: Adult patients with small, unrepaired atrial septal defects, aged 18-65, diagnosed between 1953 and 2011.Interventions: Cardiopulmonary exercise test was performed using an incremental bicycle test and gas exchange was measured using breath-by-breath technique.Outcome measures: Primary outcome was peak oxygen uptake, secondary outcome was maximal workload and ventilatory anaerobic threshold. Results:We included 32 patients previously diagnosed with a small, unrepaired atrial septal defect and 16 healthy, age-and gender-matched controls (age 36.3 ± 13 years).Patients were divided into two groups based on whether the atrial septal defect was open (age 36.3 ± 11 years) or spontaneously closed (age 36.8 ± 14 years) since time of diagnosis. No differences in demographic characteristics or weekly exercise levels were found. Both patient groups reached lower peak oxygen uptake (open: 31.7 ± 11 mL/kg/min; spontaneously closed: 29.7 ± 6.9 mL/kg/min) compared with controls (42.6 ± 6.1 mL/kg/min; P = .0001). Workload (open: 2.6 ± 1.0 watt/kg; spontaneously closed: 2.5 ± 0.6 watt/kg) and aerobic capacity (open: 21.4 ± 8.7 mL/ kg/min; spontaneously closed: 22.5 ± 6.5 mL/kg/min) was also poorer in patients compared to controls (workload: 3.5 ± 0.5 watt/kg; P = .0006, aerobic capacity: 31.3 ± 6.8 mL/kg/min; P = .0007). Conclusion:Adult patients with a diagnosis of small, unrepaired atrial septal defect have significantly impaired exercise capacity when compared to healthy controls.The impairment was present even if, by the time of assessment, the defect had closed spontaneously. The pathophysiological mechanisms behind the impaired exercise capacity demonstrated in these patients remain unexplained and will be a target for future work.

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Atrial Septal Defects

Hahurij,

Bökenkamp

2023

Pediatric Cardiology

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The role for cardiopulmonary exercise testing in patients with atrial septal defects: A review

Cited by 9 publications

References 42 publications

Atrial septal defect and exercise capacity: value of cardio-pulmonary exercise test in assessment and follow-up

Atrial septal defect and exercise capacity: value of cardio-pulmonary exercise test in assessment and follow-up

Small unrepaired atrial septal defects display impaired exercise capacity compared with healthy peers

Atrial Septal Defects

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