© 2008 European Society of Cardiology
Prognostic value of cardiopulmonary exercise testing in children with heart failure secondary to idiopathic dilated cardiomyopathy in a non-β-blocker therapy setting
InCor - Instituto do Coração - HC/FMUSP São Paulo, Brazil
* Corresponding author. InCor - Rua Dr. Baeta Neves, 98 - 05444-050, São Paulo, Brazil. Tel.: +55 11 3069 5419; fax: +55 11 3069–5502. E-mail address: gvguima{at}usp.br
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Abstract |
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Background: Peak oxygen consumption and resting left ventricular ejection fraction (LVEF) are independent predictors of survival in adult heart failure (HF) patients. Aim: To evaluate these factors in children.
Methods: We prospectively studied 31 children with NYHA class I to III HF (mean LVEF 26±10%; mean age 8.6±1.9 years). All had dilated cardiomyopathy and were awaiting heart transplantation. A cardiopulmonary treadmill exercise test was performed and LVEF determined by radionuclide ventriculography.
Results: During a median follow-up of 1282 days, 20 children reached at least one end-point (death or heart transplantation). Clinical data from the 11 children without events and the 20 children with events are as follows: NYHA class 1±0 vs. 2±0.9 (p<0.01); SBP 118± vs. 102±16 (p=0.01); DBP 70± vs. 61±10 (p=0.02); heart rate 165± vs. 148±22 (NS); double-product 19±4 vs. 15±4 (p=0.01); end-tidal carbon dioxide tension (PetCO2) 35±5 vs. 30±6 (NS); oxygen consumption (VO2) 22±5.4 vs. 18.3±5.7 (NS); exercise time 19±4 vs. 13±6 (p<0.003), and LVEF 31±8 vs. 22±10 (p=0.02). These variables all correlated with prognosis on univariate analysis. In multivariate analysis, only decreasing exercise time and LVEF were predictive of events during follow-up (p<0.001 and 0.04).
Conclusion: These findings suggest that reduction in LVEF and exercise tolerance in children with heart failure is predictive of functional status.
Key Words: Heart failure • Exercise • Oxygen consumption • Children
Received January 30, 2008; Accepted April 15, 2008
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