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Living at an altitude adversely affects exercise capacity in Fontan patients

Published online by Cambridge University Press:  20 September 2010

Jeffrey R. Darst ,
Marko Vezmar ,
Brian W. McCrindle ,
Cedric Manlhiot ,
Amy Taylor ,
Jennifer Russell  and
Anji T. Yetman
Jeffrey R. Darst*
Affiliation:
The Heart Institute, The Children’s Hospital, Aurora, Colorado, United States of America
Marko Vezmar
Affiliation:
Labatt Family Heart Centre, The Hospital for Sick Children, Toronto, Ontario, Canada
Brian W. McCrindle
Affiliation:
Labatt Family Heart Centre, The Hospital for Sick Children, Toronto, Ontario, Canada
Cedric Manlhiot
Affiliation:
Labatt Family Heart Centre, The Hospital for Sick Children, Toronto, Ontario, Canada
Amy Taylor
Affiliation:
The Heart Institute, The Children’s Hospital, Aurora, Colorado, United States of America
Jennifer Russell
Affiliation:
Labatt Family Heart Centre, The Hospital for Sick Children, Toronto, Ontario, Canada
Anji T. Yetman
Affiliation:
The Heart Center, Primary Children’s Hospital, Salt Lake City, Utah, United States of America
*
Correspondence to: J. R. Darst, MD, The Children’s Hospital B-100, 13123 E 16th Avenue, Aurora, Colorado 80045, United States of America. Tel: +01 720 777 1949; Fax: +01 720 777 7372; E-mail: [email protected]
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Abstract

Background

Data assessing the effect of altitude on Fontan haemodynamics are limited to experimental models and case reports. Both suggest a detrimental impact. This study describes exercise performance in patients with Fontan circulation and matched controls at a low altitude versus at sea level. We sought to assess the impact of increasing altitude on functional capacity in patients with Fontan palliation.

Methods

A retrospective review of 22 patients at low altitude (1602 metres) and 119 patients at sea level with Fontan circulation, as well as age-, gender-, and altitude-matched controls, underwent maximal cardiopulmonary exercise testing. Linear regression models were created to determine the influence of altitude on differences in exercise variables between Fontan patients and their matched controls.

Results

Peak oxygen consumption was 28.4 millilitres per kilogram per minute (72% predicted) for the sea-level cohort and 24.2 millilitres per kilogram per minute (63% predicted) for the moderate altitude cohort. The matched case–control differences for patients at moderate altitude were greater for peak oxygen consumption (−29% against −13%, p = 0.04), anaerobic threshold (−36% against −5%, p = 0.001), and oxygen pulse (−35% against −18%, p = 0.007) when compared with patients living at sea level. When compared to institution-matched controls, the same parameters fell by 3%, 8.9%, and 4.2%, respectively, for each increase of 1000 feet in residential altitude (p = 0.03, p = 0.001, and p = 0.05, respectively).

Conclusions

Patients with Fontan circulation at a higher altitude have impairment in aerobic capacity when compared with patients at sea level. Reduction in exercise capacity is associated with a reduction in stroke volume, likely related to increased pulmonary vascular resistance.

Keywords

Elevationoxygen consumptionanaerobic threshold
Type
Original Articles
Information
Cardiology in the Young , Volume 20 , Issue 6 , December 2010 , pp. 593 - 601
Copyright
Copyright © Cambridge University Press 2010

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Footnotes

*

These authors contributed equally to the formation of the manuscript and are considered co−first authors.

References

1. Fontan, F, Baudet, E. Surgical repair of tricuspid atresia. Thorax 1971; 26: 240–248.CrossRefGoogle ScholarPubMed
2. Driscoll, DJ, Offord, KP, Feldt, RH. Five to fifteen year follow-up after Fontan operation. Circulation 1992; 85: 469–496.CrossRefGoogle ScholarPubMed
3. Cruz-jibaja, J, Banchero, NF, Penaloza, D, Gamboa, R, Marticoren, AE. Correlation between pulmonary artery pressure and level of altitude. Dis Chest 1964; 46: 446–451.CrossRefGoogle ScholarPubMed
4. Hosseinpour, AR, Sudarshan, C, Davies, P, Nashef, SA, Barron, DJ, Brawn, WJ. The impact of altitude on early outcome following the Fontan operation. J Cardiothorac Surg 2006; 1: 31.CrossRefGoogle ScholarPubMed
5. Washington, RL, van Gundy, JC, Cohen, C, Sondheimer, HM, Wolfe, RR. Normal Aerobic and anaerobic exercise data for North American school-age children. J Pediatr 1988; 112: 223–233.CrossRefGoogle ScholarPubMed
6. Wasserman, K, Hansen, JE, Sue, DY, Casaburi, R, Whipp, BJ. Principles of Exercise Testing and Interpretation, 3rd edn. Lippincott, Philadelphia, 1999.Google Scholar
7. Yetman, AT, Taylor, AL, Doran, A, Ivy, DD. Utility of cardiopulmonary stress testing in assessing disease severity in children with pulmonary arterial hypertension. Am J Cardiol 2005; 95: 697–699.CrossRefGoogle ScholarPubMed
8. Lavie, CJ, Milani, RV, Mehra, MR. Peak exercise oxygen pulse and prognosis in chronic heart failure. Am J Cardiol 2004; 93: 588–593.CrossRefGoogle ScholarPubMed
9. Jones, NL. Clinical Exercise Testing, 4th edn. WB Saunders Company, Philadelphia, 1997.Google Scholar
10. Kouatli, AA, Garcia, JA, Zellers, TM, Weinstein, EM, Mahony, L. Enalapril does not enhance exercise capacity in patients after Fontan procedure. Circulation 1997; 96: 1507–1512.CrossRefGoogle Scholar
11. Ohuchi, H, Arakaki, Y, Yagihara, T, Kamiya, T. Cardiorespiratory responses to exercise after repair of the univentricular heart. Int J Cardiol 1997; 58: 17–30.CrossRefGoogle ScholarPubMed
12. Nunn, JF. Respiratory aspects of high altitude and space. In Nunn’s Applied Respiratory Physiology, 4th edn. Butterworth Heinemann, Oxford, Boston, 1997; 338–339.Google Scholar
13. Arslan, S, Arslan, N, Soylu, A, et al. High altitude and blood pressure in children. Yale J Biol Med 2003; 76: 145–148.Google ScholarPubMed
14. Senzaki, H, Masutani, S, Ishido, H, et al. Cardiac rest and reserve in patients with Fontan circulation. J Am Coll Cardiol 2006; 47: 2528–2535.CrossRefGoogle ScholarPubMed
15. Giannico, S, Hammad, F, Amodeo, A, et al. Clinical outcome of 193 extracardiac Fontan patients: the first 15 years. J Am Coll Cardiol 2006; 47: 2065–2073.CrossRefGoogle Scholar
16. Day, RW, Orsmond, GS, Sturtevant, JE, Hawkins, JA, Doty, DB, McGough, EC. Early and intermediate results of the Fontan procedure at moderately high altitude. Ann Thorac Surg 1994; 57: 170–176.CrossRefGoogle ScholarPubMed
17. McMahon, CJ, Hicks, JM, Dreyer, WJ. High-altitude precipitation and exacerbation of protein-losing enteropathy after a Fontan operation. Cardiol Young 2001; 11: 225–228.CrossRefGoogle ScholarPubMed
18. Durongpisitkul, K, Driscoll, DJ, Mahoney, DW, et al. Cardiorespiratory response to exercise after modified Fontan operation: determinants of performance. J Am Coll Cardiol 1997; 29: 785–790.CrossRefGoogle ScholarPubMed
19. Gewillig, MH, Lundstrom, UR, Bull, C, Wyse, RK, Deanfield, JE. Exercise responses in patients with congenital heart disease after Fontan repair: patterns and determinants of performance. J Am Coll Cardiol 1990; 15: 1424–1432.CrossRefGoogle ScholarPubMed
20. Garcia, JA, McMinn, SB, Zuckerman, JH, Fixler, DE, Levine, BD. The role of the right ventricle during hypobaric exercise: insights from patients after the Fontan operation. Med Sci Sports Exerc 1999; 31: 269–276.CrossRefGoogle ScholarPubMed
21. Day, RW, Denton, DM, Jackson, WD. Growth of children with a functionally single ventricle following palliation at moderately increased altitude. Cardiol Young 2000; 10: 193–200.CrossRefGoogle ScholarPubMed
22. Stromvall Larsson, E, Eriksson, BO. Haemodynamic adaptation during exercise in Fontan patients at a long-term follow-up. Scand Cardiovasc J 2003; 37: 107–112.CrossRefGoogle ScholarPubMed
23. Das, BB, Taylor, AL, Boucek, MM, Wolfe, RW, Yetman, AT. Exercise capacity in pediatric heart transplant candidates: is there any role for the 14 ml/kg/min guideline? Pediatr Cardiol 2006; 27: 226–229.CrossRefGoogle ScholarPubMed