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Appropriate heart rate during exercise in Fontan patients

Published online by Cambridge University Press:  17 April 2020

Eva R. Hedlund Open the ORCID record for Eva R. Hedlund [Opens in a new window] ,
Liselott Söderström  and
Bo Lundell
Eva R. Hedlund*
Affiliation:
Department of Women’s and Children’s Health, Karolinska Institutet, Stockholm, Sweden
Liselott Söderström
Affiliation:
Department of Women’s and Children’s Health, Karolinska Institutet, Stockholm, Sweden
Bo Lundell
Affiliation:
Department of Women’s and Children’s Health, Karolinska Institutet, Stockholm, Sweden
*
Author for correspondence: E. R. Hedlund, MD, PhD, Karolinska University Hospital, Astrid Lindgren Children’s Hospital Solna, Barnhjärtcentrum, Eugeniavägen 23, C8:34, S-171 76Stockholm, Sweden. Tel: +46-707421285; Fax: +46-8-51777778; E-mail: eva.rylander-hedlund@sll.se
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Abstract

Objective:

To evaluate heart rate against workload and oxygen consumption during exercise in Fontan patients.

Method:

Fontan patients (n = 27) and healthy controls (n = 25) underwent cardiopulmonary exercise testing with linear increase of load. Heart rate and oxygen uptake were measured during tests. Heart rate recovery was recorded for 10 minutes.

Results:

Heart rate at midpoint (140 ± 14 versus 153 ± 11, p < 0.001) and at maximal effort (171 ± 14 versus 191 ± 10 beats per minute, p < 0.001) of test was lower for patients than controls. Heart rate recovery was similar between groups. Heart rate in relation to workload was higher for patients than controls both at midpoint and maximal effort. Heart rate in relation to oxygen uptake was similar between groups throughout test. Oxygen pulse, an indirect surrogate measure of stroke volume, was reduced at maximal effort in patients compared to controls (6.6 ± 1.1 versus 7.5 ± 1.4 ml·beat−1·m−2, p < 0.05) and increased significantly less from midpoint to maximal effort for patients than controls (p < 0.05).

Conclusions:

Heart rate is increased in relation to workload in Fontan patients compared with controls. At higher loads, Fontan patients seem to have reduced heart rate and smaller increase in oxygen pulse, which may be explained by inability to further increase stroke volume and cardiac output. Reduced ability to increase or maintain stroke volume at higher heart rates may be an important limiting factor for maximal cardiac output, oxygen uptake, and physical performance.

Keywords

Heart rateexerciseoxygen consumptionoxygen pulseFontan patients
Type
Original Article
Information
Cardiology in the Young , Volume 30 , Issue 5 , May 2020 , pp. 674 - 680
Copyright
© The Author(s), 2020. Published by Cambridge University Press

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