Hostname: page-component-76fb5796d-vvkck Total loading time: 0 Render date: 2024-04-26T23:48:27.010Z Has data issue: false hasContentIssue false
  • English
  • Français

Chronotropic incompetence in paediatric heart transplant recipients with prior congenital heart disease

Published online by Cambridge University Press:  06 June 2019

Nikki M. Singh Open the ORCID record for Nikki M. Singh [Opens in a new window] ,
Rohit S. Loomba ,
Joshua R. Kovach  and
Steven J. Kindel
Nikki M. Singh*
Affiliation:
Division of Pediatric Cardiology, Children’s Hospital of Wisconsin/Medical College of Wisconsin, Milwaukee, WI, USA
Rohit S. Loomba
Affiliation:
Advocate Children’s Heart Institute, Advocate Children’s Hospital, Oak Lawn, IL, USA
Joshua R. Kovach
Affiliation:
Division of Pediatric Cardiology, Children’s Hospital of Wisconsin/Medical College of Wisconsin, Milwaukee, WI, USA
Steven J. Kindel
Affiliation:
Division of Pediatric Cardiology, Children’s Hospital of Wisconsin/Medical College of Wisconsin, Milwaukee, WI, USA
*
Author for correspondence: Nikki M. Singh, MD, Division of Pediatric Cardiology, Children’s Hospital of Wisconsin/Medical College of Wisconsin, 9000 W. Wisconsin Ave Milwaukee, WI 53226 Tel: +1 513-636-2385; E-mail: Nikki.Singh@cchmc.org
Get access Rights & Permissions [Opens in a new window]

Abstract

Background:

Cardiopulmonary exercise testing has been used to measure functional capacity in children who have undergone a heart transplant. Cardiopulmonary exercise testing results have not been compared between children transplanted for a primary diagnosis of CHD and those with a primary diagnosis of cardiomyopathy despite differences in outcomes. This study is aimed to compare cardiopulmonary exercise testing performance between these two groups.

Methods:

Patients who underwent heart transplant with subsequent cardiopulmonary exercise testing at least 6 months after transplant at our institution were identified. They were then divided into two groups based on primary cardiac diagnosis: CHD or cardiomyopathy. Patient characteristics, echocardiograms, cardiac catheterisations, outcomes, and cardiopulmonary exercise test results were compared between the two groups.

Results:

From the total of 35 patients, 15 (43%) had CHD and 20 (57%) had cardiomyopathy. Age at transplant, kidney disease, lung disease, previous rejection, coronary vasculopathy, catheterisation, and echocardiographic data were similar between the groups. Mean time from transplant to cardiopulmonary exercise testing, exercise duration, and maximum oxygen consumption were similar in both groups. There was a difference in heart rate response with CHD heart rate response of 63 beats per minute compared to cardiomyopathy group of 78 (p = 0.028). Patients with CHD had more chronotropic incompetence than those with cardiomyopathy (p = 0.036).

Conclusion:

Primary diagnosis of CHD is associated with abnormal heart rate response and more chronotropic incompetence compared to those transplanted for cardiomyopathy.

Keywords

Paediatricheart transplantcardiopulmonary exercise testchronotropic incompetenceCHD
Type
Original Article
Information
Cardiology in the Young , Volume 29 , Issue 5 , May 2019 , pp. 667 - 671
Copyright
© Cambridge University Press 2019 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Dipchand, AI. Current state of pediatric cardiac transplantation. Ann Cardiothorac Surg 2018; 7: 31–55.CrossRefGoogle ScholarPubMed
Alsoufi, B, Deshpande, S, McCracken, C, et al. Outcomes and risk factors for heart transplantation in children with congenital heart disease. J Thorac Cardiovasc Surg 2015; 150: 1455–1462.e3.CrossRefGoogle ScholarPubMed
Everitt, MD, Boyle, GJ, Schechtman, KB, et al. Early survival after heart transplant in young infants is lowest after failed single-ventricle palliation: a multi-institutional study. J Heart Lung Transplant 2012; 31: 509–516.CrossRefGoogle ScholarPubMed
Rossano, JW, Dipchand, AI, Edwards, LB, et al. The Registry of the International Society for Heart and Lung Transplantation: Nineteenth Pediatric Heart Transplantation Report-2016; Focus Theme: Primary Diagnostic Indications for Transplant. J Heart Lung Transplant 2016; 35: 1185–1195.CrossRefGoogle ScholarPubMed
Myers, J, Tan, SY, Abella, J, Aleti, V, Froelicher, VF. Comparison of the chronotropic response to exercise and heart rate recovery in predicting cardiovascular mortality. Eur J Cardiovasc Prev Rehabil 2007; 14: 215–221.CrossRefGoogle ScholarPubMed
Schwaiblmair, M, von Scheidt, W, Uberfuhr, P, Reichart, B, Vogelmeier, C. Lung function and cardiopulmonary exercise performance after heart transplantation: influence of cardiac allograft vasculopathy. Chest 1999; 116: 332–339.CrossRefGoogle ScholarPubMed
Chaudhry, S, Kumar, N, Behbahani, H, et al. Abnormal heart-rate response during cardiopulmonary exercise testing identifies cardiac dysfunction in symptomatic patients with non-obstructive coronary artery disease. Int J Cardiol 2017; 228: 114–121.CrossRefGoogle ScholarPubMed
Yardley, M, Havik, OE, Grov, I, Relbo, A, Gullestad, L, Nytroen, K. Peak oxygen uptake and self-reported physical health are strong predictors of long- term survival after heart transplantation. Clin Transplant 2015.CrossRefGoogle Scholar
Davis, JA, McBride, MG, Chrisant, MR, Patil, SM, Hanna, BD, Paridon, SM. Longitudinal assessment of cardiovascular exercise performance after pediatric heart transplantation. J Heart Lung Transplant 2006; 25: 626–633.CrossRefGoogle ScholarPubMed
Hsu, DT, Garofano, RP, Douglas, JM, et al. Exercise performance after pediatric heart transplantation. Circulation 1993; 88(5 Pt 2):II238–II242.Google ScholarPubMed
Nanas, JN, Anastasiou-Nana, MI, Sutton, RB, Tsagaris, TJ. Effect of acute allograft rejection on exercise hemodynamics in patients who have undergone cardiac transplantation. Chest 1995; 107: 1517–1521.CrossRefGoogle ScholarPubMed
Dipchand, AI, Manlhiot, C, Russell, JL, Gurofsky, R, Kantor, PF, McCrindle, BW. Exercise capacity improves with time in pediatric heart transplant recipients. J Heart Lung Transplant 2009; 28: 585–590.CrossRefGoogle ScholarPubMed
Liontou, C, Chrysohoou, C, Skoumas, J, Panagiotakos, DB, Pitsavos, C, Stefanadis, C. Chronotropic response during treadmill exercise and subclinical carotid atherosclerosis after adjusting for the calibrated SCORE risk classification: a cross-sectional study. Heart Vessels 2016; 31: 129–136.CrossRefGoogle ScholarPubMed
Diller, GP, Dimopoulos, K, Okonko, D, et al. Heart rate response during exercise predicts survival in adults with congenital heart disease. J Am Coll Cardiol 2006; 48: 1250–1256.CrossRefGoogle ScholarPubMed
Wu, YW, Yen, RF, Lee, CM, et al. Usefulness of progressive inhomogeneity of myocardial perfusion and chronotropic incompetence in detecting cardiac allograft vasculopathy: evaluation with dobutamine thallium-201 myocardial SPECT. Cardiology 2005; 104: 156–161.CrossRefGoogle ScholarPubMed
Pahl, E, Sundararaghavan, S, Strasburger, JF, et al. Impaired exercise parameters in pediatric heart transplant recipients: comparison of biatrial and bicaval techniques. Pediatr Transplant 2000; 4: 268–272.CrossRefGoogle ScholarPubMed
Abarbanell, G, Mulla, N, Chinnock, R, Larsen, R. Exercise assessment in infants after cardiac transplantation. J Heart Lung Transplant 2004; 23: 1334–1338.CrossRefGoogle ScholarPubMed
Giardini, A, Fenton, M, Derrick, G, Burch, M. Impairment of heart rate recovery after peak exercise predicts poor outcome after pediatric heart transplantation. Circulation 2013; 128 (Suppl 1): S199–S204.CrossRefGoogle ScholarPubMed
Singh, TP, Gauvreau, K, Rhodes, J, Blume, ED. Longitudinal changes in heart rate recovery after maximal exercise in pediatric heart transplant recipients: evidence of autonomic re-innervation? J Heart Lung Transplant 2007; 26: 1306–1312.CrossRefGoogle ScholarPubMed
Peterson, S, Su, JA, Szmuszkovicz, JR, Johnson, R, Sargent, B. Exercise capacity following pediatric heart transplantation: a systematic review. Pediatr Transplant 2017; 21: e12922. doi: 10.1111/petr.12922.CrossRefGoogle ScholarPubMed
Grupper, A, Gewirtz, H, Kushwaha, S. Reinnervation post-heart transplantation. Eur Heart J 2018; 39: 1799–1806.Google ScholarPubMed