Exercise Performance in Adolescents With Fontan Physiology (from the Pediatric Heart Network Fontan Public Data Set)

https://doi.org/10.1016/j.amjcard.2021.03.018Get rights and content

In the pediatric population, exercise capacity differs between females and males and the gap widens through adolescence. However, specific age- and sex-based changes in adolescents with congenital heart disease and Fontan palliation have not been reported. The purpose of the current study is to identify age- and sex-specific changes in exercise performance at peak and ventilatory anaerobic threshold (AT) for adolescents with Fontan physiology. Retrospective review of the Pediatric Heart Network Fontan cross sectional study (Fontan 1) public use dataset. Comparisons were made for peak and AT exercise parameters for females and males at 2-year age intervals. In addition, normative values were generated by sex and age at 2-year intervals. χ2 test was used for comparison for categorical variables. Changes in exercise parameters between age groups by sex were compared by ANOVA with post-hoc analysis. Exercise testing was performed in 411 patients. AT was reached in 317 subjects (40% female), of whom, 166 (43% female) reached peak exercise. Peak oxygen consumption decreased 32% through adolescence in females and did not have the typical increase through adolescence for males. Oxygen consumption at AT also decreased with age in both sexes. In conclusion, age- and sex-based exercise performance for adolescents with Fontan physiology are predictably low, but there are additional significant decreases through adolescence for this population, especially in females. We have established normative exercise values for several parameters for this population which will better identify at risk patients and allow for earlier intervention.

Section snippets

Methods

The Pediatric Heart Network (PHN) was established in 2001 by the National Heart, Lung and Blood Institute to facilitate multisite clinical research for children with congenital heart disease. Their Fontan observational study enrolled 546 children 6 to 18 years old who had undergone Fontan surgery.12 We performed a retrospective study using the PHN Fontan dataset released for public use (downloaded from the PHN website, www.pediatricheartnetwork.org),13 with approval from the University of

Results

Demographics and clinical characteristics for subjects with Fontan physiology who achieved peak exercise and AT with comparisons between females and males are shown in Table 1. There were no demographic or clinical differences between males and females with Fontan physiology. The only sex-based difference between the groups reaching AT was a higher rate of paced cardiac rhythm in females (13% vs 7%, p = 0.047).

Table 2 shows the exercise parameters at peak exercise broken down by sex and 2-year

Discussion

Using a large, prospectively collected dataset of exercise performance parameters for children and adolescents with Fontan physiology, we were able to generate normative values for the most clinically relevant exercise parameters for the population of children and adolescents with Fontan physiology. In contrast to increases in peak VO2 through adolescence in the general population, our data demonstrate a plateau or decreases in peak VO2 through adolescence for patients with Fontan physiology.

Author contributions

Michael D. Seckeler: Conceptualization, Formal analysis, Methodology, Writing – original draft Brent J. Barber: Methodology, Writing – review & editing Jamie N. Colombo: Conceptualization, Methodology, Writing – review & editing Alyssa M. Bernardi: Conceptualization, Writing – review & editing Andrew W. Hoyer: Writing – review & editing Jennifer G. Andrews: Methodology, Writing – review & editing Scott E. Klewer: Writing – review & editing.

Disclosures

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

References (26)

Cited by (2)

  • Cardiac Concerns in the Pediatric Athlete

    2022, Clinics in Sports Medicine
    Citation Excerpt :

    With the absence of a subpulmonary ventricle, patients with Fontan physiology are known to have a markedly impaired response to physical activity and low oxygen consumption at peak exercise and anaerobic threshold. Chronic elevation of central venous pressure leads to decreased preload and low cardiac output.66–69 Despite a global reduction in exercise capacity, each patient with Fontan physiology is different, making thorough cardiovascular evaluation of the utmost importance before participation in sports.

View full text