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Cardiopulmonary Response to Exercise at High Altitude in Adolescents with Congenital Heart Disease

Congenital Heart Disease 2021年第6期16卷 597-608页

作者： Lukas Minder Markus Schwerzmann Thomas Radtke hugo saner Prisca Eser Matthias Wilhelm Jean-Paul Schmid Department of Cardiology Bern University Hospital and University of BernBernSwitzerland Center for Congenital Heart Disease Department of CardiologyBern University Hospital and University of BernBernSwitzerland Epidemiology Biostatistics and Prevention InstituteUniversity of ZurichZurichSwitzerland Department of Cardiology Clinic BarmelweidBarmelweidSwitzerland

Objective:To extend our knowledge on tolerance of acute high-altitude exposure and hemodynamic response to exercise in adolescents with congenital heart disease(AscCHD)without meaningful clinical or functional restriction.Methods:A symptom limited cardiopulmonary exercise stress test and a non-invasive cardiac output measurement during steady state exercise were performed at 540 m and at 3454 m a.s.l.Symptoms of acute mountain sickness were noted.Results:We recruited 21 healthy controls and 16 AscCHD(59%male,mean age 14.7±1.1 years).Three subjects(2 controls,1 AscCHD)presented light symptoms of acute mountain sickness(dizziness and headache).During the symptom limited exercise test at lowland,control subjects showed a significantly higher power to weight index(3.5±0.6 W/kg vs.3.0±0.7 W/kg,p<0.001),heart rate(188.8±10.41/min vs.179.4±13.11/min,p<0.050)and ventilation(92.8±22.9 l/min vs.75.4±18.6 l/min,<0.050).At altitude,power to weight index only remained significantly higher in the control group(2.8±0.6 W/kg vs.2.6±0.6 W/kg,p<0.001).Pulmonary blood flow(PBF)at lowland showed no difference between the control and the AscCHD group,neither at rest(5.4±0.8 l/min vs.5.1±0.9 l/min,p=0.308),nor during the steady state test(10.6±2.4 l/min vs.10.5±2.0 l/min,p=0.825).At high altitude,PBF increased by 110%and 112%,respectively(12.8±2.32 l/min vs.12.5±3.0 l/min;intergroup difference:p=0.986).Conclusions:High altitude exposure was well tolerated in an unselected group of AscCHD.No significant difference in the cardio-pulmonary adaptation to a control group was noted during a steady state exercise.Symptoms of minor acute mountain sickness did occur,which should however not be misinterpreted as signs of hemodynamic maladaptation.

关键词： Adolescents with congenital heart disease high altitude non-invasive cardiac output measurement exercise

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