Future direction for evidence based research in congenital heart disease: assessment of the cardiorespiratory system.

Lyudmila A. Glushko, Leo A. Bockeria , Olga A. Bockeria , Anna Y. Zavarina, Valentina N. Shvedunova, Niyole A. Putyato, Leysan I. Mustafina, Anna A. Tokovenko

Federal State Budget Institution «A.N. Bakulev National Medical Research Center for Cardiovascular Surgery» of the Ministry of Healthcare of the Russian Federation, Moscow, Russia

Date, time and location: 2018.05.26 13:30, Exhibition area, 1st Floor. Zone – D

Abstract

Objective. To analyze the results of computer spirometry (CS) and the cardio-pulmonary exercise test (CPET) in patients with congenital heart disease (CHD) after surgical procedures for evidence based assessment of functional state and impact of cardiorespiratory rehabilitation.

Methods. 24 operated patients with congenital heart disease (mean follow up was 7.24±4.30 years): after the Fontane operation (n=7), with tetralogy of Fallot (n=3),aortic valve disease (n=2),pulmonary stenosis (n=3), partial AV Canal (n=1),mitral valve disease (n=1), Ebstein anomaly (n=2), septal defect (n=5) were tested before and after cardiorespiratory rehabilitation (exercise training, water aerobics, massage, gallotherapy, «dry» carbonics bath, enteric oxygen therapy). An incentive CS was performed to all patients twice (n=48) and CPET twice to patients with height >130 cm (n=32) on Ramp protocol with cycle ergometer. The average age was 10.76±2.97 years, the average BMI -17.3 ± 2.7 kg/m², 54.1% (n = 13) were male patients. The study was performed by system for exercise testing Ultima CardiO2 (MedicalGraphics,USA). Incentive CS was performed for assessment of FVC, FEV1 and MVV (in % of predicted values). We also evaluated externed work (WR,W),anaerobic threshold (AT,ml/kg/min),peak oxygen consumption of VO₂(peakVO₂, ml/kg/min), oxygen pulse (VO2/HR, ml/beat) and ventilatory equivalent for carbon dioxide (VE/VCO₂).

Results. There was statistically improvements (p<0,05) of average spirometric and CPET parameters (FVC from 68.3 ± 9.5 to 77,1± 8.4 %, FEV1 from 72.2 ± 11.4 to 86.7 ± 8.5%, MVV from 85.5 ± 5.1 to 97.7± 6.3%, of VO₂ AT – 22.4±7.8 to 28.7±8.3 ml/kg/min, peak VO₂ – 27.7±8.9 to 31.8±8.3ml/kg/min after performed rehabilitation (mean duration was 8.4±2.1 days). There was no statistically difference in external work (86.1±34.0 to 87.3±33.5), oxygen pulse(7.06±3.0 to 7.1±2.9), VE/VCO₂ (31.5±4.2 to 30.1±4.2) (p>0,05).

Conclusions. Performing of CS and CPET enables evidence-based assessment of the cardiorespiratory system of operated patients with CHD during cardiorespiratory rehabilitation.