Decreased Exercise Performance with Age in Children with Hypoplastic Left Heart Syndrome

Objective

Children born with hypoplastic left heart syndrome (HLHS) may experience cardiac dysfunction after staged surgery or transplantation, which may worsen with age. We examined the hypothesis that exercise testing can address cardiovascular capacity and suggest interventions to improve quality of life.

Study design

Children with HLHS ≥8 years old performed treadmill or bicycle ergometric testing at 4 centers. Results were compared with norms for age and sex.

Results

Of the 42 participants, the mean age was 12.9 years (range, 8.5-17.0 years), 64% were boys, 20 had staged surgery, and 34 completed metabolic assessment. The percent of predicted maximal oxygen uptake (mVO2) was higher in younger children. Children aged 8 to 12 years achieved 70% of predicted mVO2; children aged 13 to 17 years achieved 60% of predicted mVO2 (P = .02). The percent of predicted peak heart rate trended higher in younger patients (83% versus 75%, P = .07). Electrocardiographic changes were more common in older children. In treadmill testing, patients who had a transplant had better exercise performance than patients who underwent staged surgery in percent of predicted exercise time (82% versus 54%, P < .0001) and peak rate-pressure product (241 × 10³ versus 195 × 10³, P = .02). The percent of predicted mVO2 did not differ between patients who had a transplant (66%) and patients who underwent staged surgery (61%, P = .25).

Conclusion

Children with HLHS showed considerable age-related decline in exercise performance, regardless of surgical strategy.

Abbreviations: CHQ-CF87, Child Health Questionnaire-Child Form 87, CHQ-PF50, Child Health Questionnaire-Parent Form 50, ECG, Electrocardiographic, HLHS, Hypoplastic left heart syndrome, mVO2, Maximal oxygen uptake, RER, Respiratory exchange ratio