Document Detail


Living at an altitude adversely affects exercise capacity in Fontan patients.
MedLine Citation:
PMID:  20849678     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
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.
Authors:
Jeffrey R Darst; Marko Vezmar; Brian W McCrindle; Cedric Manlhiot; Amy Taylor; Jennifer Russell; Anji T Yetman
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Publication Detail:
Type:  Journal Article; Research Support, N.I.H., Extramural     Date:  2010-09-20
Journal Detail:
Title:  Cardiology in the young     Volume:  20     ISSN:  1467-1107     ISO Abbreviation:  Cardiol Young     Publication Date:  2010 Dec 
Date Detail:
Created Date:  2010-10-26     Completed Date:  2011-02-10     Revised Date:  2012-09-24    
Medline Journal Info:
Nlm Unique ID:  9200019     Medline TA:  Cardiol Young     Country:  England    
Other Details:
Languages:  eng     Pagination:  593-601     Citation Subset:  IM    
Affiliation:
The Heart Institute, The Children's Hospital, Aurora, Colorado, USA. darst.jeffrey@tchden.org
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MeSH Terms
Descriptor/Qualifier:
Adolescent
Altitude*
Anaerobic Threshold
Blood Pressure
Case-Control Studies
Child
Exercise Tolerance*
Female
Fontan Procedure*
Heart Rate
Humans
Male
Oxygen Consumption
Respiration
Grant Support
ID/Acronym/Agency:
U01 HL068288/HL/NHLBI NIH HHS; U01 HL068288-09/HL/NHLBI NIH HHS
Comments/Corrections

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