Living at an altitude adversely affects exercise capacity in Fontan patients

Jeffrey R. Darst, Marko Vezmar, Brian W. McCrindle, Cedric Manlhiot, Amy Taylor, Jennifer Russell, Angela T Yetman

Research output: Contribution to journalArticle

12 Citations (Scopus)

Abstract

Background: Data assessing the effect of altitude on Fontan haemodynamics are limited to experimental models and case reports. Both suggest a detrimental impact. This study describes exercise performance in patients with Fontan circulation and matched controls at a low altitude versus at sea level. We sought to assess the impact of increasing altitude on functional capacity in patients with Fontan palliation.Methods A retrospective review of 22 patients at low altitude (1602 metres) and 119 patients at sea level with Fontan circulation, as well as age-, gender-, and altitude-matched controls, underwent maximal cardiopulmonary exercise testing. Linear regression models were created to determine the influence of altitude on differences in exercise variables between Fontan patients and their matched controls.Results Peak oxygen consumption was 28.4 millilitres per kilogram per minute (72% predicted) for the sea-level cohort and 24.2 millilitres per kilogram per minute (63% predicted) for the moderate altitude cohort. The matched case-control differences for patients at moderate altitude were greater for peak oxygen consumption (29% against 13%, p = 0.04), anaerobic threshold (36% against 5%, p = 0.001), and oxygen pulse (35% against 18%, p = 0.007) when compared with patients living at sea level. When compared to institution-matched controls, the same parameters fell by 3%, 8.9%, and 4.2%, respectively, for each increase of 1000 feet in residential altitude (p = 0.03, p = 0.001, and p = 0.05, respectively). Conclusions Patients with Fontan circulation at a higher altitude have impairment in aerobic capacity when compared with patients at sea level. Reduction in exercise capacity is associated with a reduction in stroke volume, likely related to increased pulmonary vascular resistance.

Original languageEnglish (US)
Pages (from-to)593-601
Number of pages9
JournalCardiology in the Young
Volume20
Issue number6
DOIs
StatePublished - Dec 1 2010

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Exercise
Oceans and Seas
Oxygen Consumption
Linear Models
Anaerobic Threshold
Vascular Resistance
Stroke Volume
Theoretical Models
Hemodynamics
Oxygen

Keywords

  • Elevation
  • anaerobic threshold
  • oxygen consumption

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Pediatrics, Perinatology, and Child Health

Cite this

Darst, J. R., Vezmar, M., McCrindle, B. W., Manlhiot, C., Taylor, A., Russell, J., & Yetman, A. T. (2010). Living at an altitude adversely affects exercise capacity in Fontan patients. Cardiology in the Young, 20(6), 593-601. https://doi.org/10.1017/S1047951109990357

Living at an altitude adversely affects exercise capacity in Fontan patients. / Darst, Jeffrey R.; Vezmar, Marko; McCrindle, Brian W.; Manlhiot, Cedric; Taylor, Amy; Russell, Jennifer; Yetman, Angela T.

In: Cardiology in the Young, Vol. 20, No. 6, 01.12.2010, p. 593-601.

Research output: Contribution to journalArticle

Darst, JR, Vezmar, M, McCrindle, BW, Manlhiot, C, Taylor, A, Russell, J & Yetman, AT 2010, 'Living at an altitude adversely affects exercise capacity in Fontan patients', Cardiology in the Young, vol. 20, no. 6, pp. 593-601. https://doi.org/10.1017/S1047951109990357
Darst JR, Vezmar M, McCrindle BW, Manlhiot C, Taylor A, Russell J et al. Living at an altitude adversely affects exercise capacity in Fontan patients. Cardiology in the Young. 2010 Dec 1;20(6):593-601. https://doi.org/10.1017/S1047951109990357
Darst, Jeffrey R. ; Vezmar, Marko ; McCrindle, Brian W. ; Manlhiot, Cedric ; Taylor, Amy ; Russell, Jennifer ; Yetman, Angela T. / Living at an altitude adversely affects exercise capacity in Fontan patients. In: Cardiology in the Young. 2010 ; Vol. 20, No. 6. pp. 593-601.
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abstract = "Background: Data assessing the effect of altitude on Fontan haemodynamics are limited to experimental models and case reports. Both suggest a detrimental impact. This study describes exercise performance in patients with Fontan circulation and matched controls at a low altitude versus at sea level. We sought to assess the impact of increasing altitude on functional capacity in patients with Fontan palliation.Methods A retrospective review of 22 patients at low altitude (1602 metres) and 119 patients at sea level with Fontan circulation, as well as age-, gender-, and altitude-matched controls, underwent maximal cardiopulmonary exercise testing. Linear regression models were created to determine the influence of altitude on differences in exercise variables between Fontan patients and their matched controls.Results Peak oxygen consumption was 28.4 millilitres per kilogram per minute (72{\%} predicted) for the sea-level cohort and 24.2 millilitres per kilogram per minute (63{\%} predicted) for the moderate altitude cohort. The matched case-control differences for patients at moderate altitude were greater for peak oxygen consumption (29{\%} against 13{\%}, p = 0.04), anaerobic threshold (36{\%} against 5{\%}, p = 0.001), and oxygen pulse (35{\%} against 18{\%}, p = 0.007) when compared with patients living at sea level. When compared to institution-matched controls, the same parameters fell by 3{\%}, 8.9{\%}, and 4.2{\%}, respectively, for each increase of 1000 feet in residential altitude (p = 0.03, p = 0.001, and p = 0.05, respectively). Conclusions Patients with Fontan circulation at a higher altitude have impairment in aerobic capacity when compared with patients at sea level. Reduction in exercise capacity is associated with a reduction in stroke volume, likely related to increased pulmonary vascular resistance.",
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