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The VE/VCO2 slope: A useful tool to evaluate the physiological status of children with congenital heart disease - 14/08/21

Doi : 10.1016/j.acvdsp.2021.06.027 
Arthur Gavotto, MD a, b, , Sophie Guillaumont, MD a, c, Stefan Matecki, MD, PhD b, d, Pascal Amedro, MD, PhD a, b
a Paediatric and Congenital Cardiology Department, M3C Regional Reference CHD Centre, University Hospital, Montpellier, France 
b PhyMedExp, CNRS, inserm, University of Montpellier, Montpellier, France 
c Paediatric Cardiology and Rehabilitation Unit, St-Pierre Institute, Palavas-Les-Flots, France 
d Paediatric Functional Exploration Laboratory, Physiology Department, University Hospital, Montpellier, France 

Corresponding author at: Paediatric and Congenital Cardiology Department, Montpellier University Hospital, 371, avenue du Doyen Giraud, 34295 Montpellier, France.Paediatric and Congenital Cardiology Department, Montpellier University Hospital371, avenue du Doyen GiraudMontpellier34295France

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Resumen

Introduction

Cardio-pulmonary exercise test (CPET) is becoming a key examination to assess physical capacity and disease severity in paediatric cardiology. The VE/VCO2 slope has been increasingly used as a surrogate marker for morbidity and mortality in adult heart failure, pulmonary arterial hypertension and for adult patients with CHD. Nevertheless, the use of the VE/VCO2 slope in children remains limited in the absence of reference values and clearly identified clinical determinants. This study aimed to compare the VE/VCO2 slope in a paediatric cohort with CHD to that of age- and gender-adjusted healthy controls. We also intended to identify the clinical and CPET variables associated with VE/VCO2 slope in this population.

Methods

This cross-sectional study was carried out between November 2010 and September 2015 in two tertiary care paediatric cardiology reference centres.

Results

A total of 700 children were enrolled (399 CHD and 301 healthy controls). The mean VE/VCO2 slope was significantly higher in CHD than in healthy subjects (31.6±4.8 vs. 29.3±4.8; P<0.001). When considering CHD sub-groups, the VE/VCO2 slope was impaired in single ventricle, complex anomalies of ventriculo-arterial connections, anomalies of the atrioventricular junctions and valves. The VE/VCO2 slope according to the CHD physiological status was illustrated in the Fig. 1, it was higher in children with significant pulmonary regurgitation, tricuspid regurgitation, right ventricular hypertension and right ventricle outflow tract (RVOT) obstacle. In the CHD group, VE/VCO2 slope increase was associated with BMI, the presence of a RVOT obstacle, the number of cardiac catheter procedures, as well as low age, FVC, tidal volume, and PetCO2 (Fig. 1).

Conclusion

Increased VE/VCO2 slope was predominantly in children with single ventricle and/or residual right heart abnormalities suggesting that maldistribution of pulmonary blood flow during exercise is an important CHD-unique determinant of VE/VCO2 slope.

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Keywords : Cardio-pulmonary exercise test, Congenital heart disease, Ventilatory efficiency, VE/VCO2 slope, Paediatrics


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© 2021  Publicado por Elsevier Masson SAS.
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Vol 13 - N° 4

P. 286 - septembre 2021 Regresar al número
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