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Interpretaion of ergospirometry in congenital heart

Interpretaion of ergospirometry in congenital heart. Prof. Dr. T. Reybrouck Departments of Pediatric Cardiology and Cardiovascular Rehabilitation Gasthuisberg University Hospital 3000 Leuven, Belgium. Exercise testing in children with congenital heart disease (CHD).

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Interpretaion of ergospirometry in congenital heart

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  1. Interpretaion of ergospirometry in congenital heart Prof. Dr. T. Reybrouck Departments of Pediatric Cardiology and Cardiovascular Rehabilitation Gasthuisberg University Hospital 3000 Leuven, Belgium

  2. Exercise testing in children with congenital heart disease (CHD) • Exercise testing in adult cardiac patients is focused mainly on ischemic heart disease • Exercise ECG is helpful in diagnosing the presence or absence of ischemic heart disease

  3. Exercise testing in children with CH (cont’d ) • In children with heart diseases, the type of pathology is different • The majority of children will present with congenital heart disease. Ischemic heart disease is very rare

  4. Usefulness of exercise testing with gas exchange measurents • Exercise testing is much more sensitive in assessing exercise performance than history taking or questionnaires on physical activity • Functional capacity can objectively be assessed by exercise testing with gas exchange measurements (ergospirometry) • Exercise tests are preferentially performed on a treadmill (advantageous for young children) or on cycle ergometer (for older children and adolescents)

  5. Integration of oxygen transport system Wasserman et al,1994

  6. Breath-by-breath measurements of gas exchange Nowadays gas exchange is measured on a breath-by-breath basis with computerised systems Beaver et al, 1983

  7. Measurement of gas exchange • Gas exchange can also be measured by a mixing box, but this device does not allow to study gas exchange kinetics. Wilmore et al, 1974

  8. Devices and analysers Wasserman et al, 2004

  9. Conventional parameters to assess functional capacity • Maximal oxygen uptake (VO2 max, or VO2 peak) • Ventilatory anaerobic threshold • Ventilatory efficiency: VE/VO2, VE/VCO2 (VD/VT can be estimated from PETCO2)

  10. Typical example

  11. Comparison parameters gas exchange vs heart rate response Reybrouck et al, Ped Cardiol, 1986

  12. Application of ergospirometry in Pediatric Cardiology Follow up gegevens Eur J Ped Reybrouck et al, Eur J Ped 1995

  13. New concepts in ergospirometry • Slope of VO2 vs exercise intensisty • Slope VCO2 vs VO2 • Slope VE vs VCO2

  14. Slope VO2 vs exercise intensity Eyskens et al, 2000

  15. Slope VCO2 vs VO2 Reybrouck et al, J Appl 1996

  16. Physiological dead space ventilation Ventilation (l/min) Exercise intensity (VO2) Wasserman et al, 1999

  17. Efficiency of gas exchange Since children with CHD can exercise well at moderate levels of exercise but develop exercise intolerance at higher levels of exercise we studied the difference between alveolar and total ventilation, which represents the dead space ventilation.

  18. NL Fontan TF TGA Total ventilation, alveolar ventilation and dead space ventilation in CHD

  19. Ventilatory efficiency in TGA

  20. Conclusions • Ergospirometry is a useful tool to assess functional capacity, since it gives objective information about the exercise tolerance of the patients. • New concepts such as slope of VO2 vs exercise intensity or VCO2 vs VO2 give information about the cardiorespiratory exercise function and mechanisms of exercise intolerance

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