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Cardiopulmonary Response to Exercise at High Altitude in Adolescents with Congenital Heart Disease

Lukas Minder1, Markus Schwerzmann1,2, Thomas Radtke1,3, Hugo Saner1, Prisca Eser1, Matthias Wilhelm1, Jean-Paul Schmid1,4,*
1 Department of Cardiology, Bern University Hospital and University of Bern, Bern, Switzerland
2 Center for Congenital Heart Disease, Department of Cardiology, Bern University Hospital and University of Bern, Bern, Switzerland
3 Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
4 Department of Cardiology, Clinic Barmelweid, Barmelweid, Switzerland
* Corresponding Author: Jean-Paul Schmid. Email:

Congenital Heart Disease 2021, 16(6), 597-608. https://doi.org/10.32604/CHD.2021.016031

Received 02 February 2021; Accepted 11 March 2021; Issue published 08 July 2021

Abstract

Objective: To extend our knowledge on tolerance of acute high-altitude exposure and hemodynamic response to exercise in adolescents with congenital heart disease (AscCHD) without meaningful clinical or functional restriction. Methods: A symptom limited cardiopulmonary exercise stress test and a non-invasive cardiac output measurement during steady state exercise were performed at 540 m and at 3454 m a.s.l. Symptoms of acute mountain sickness were noted. Results: We recruited 21 healthy controls and 16 AscCHD (59% male, mean age 14.7 ± 1.1 years). Three subjects (2 controls, 1 AscCHD) presented light symptoms of acute mountain sickness (dizziness and headache). During the symptom limited exercise test at lowland, control subjects showed a significantly higher power to weight index (3.5 ± 0.6 W/kg vs. 3.0 ± 0.7 W/kg, p < 0.001), heart rate (188.8 ± 10.4 1/min vs. 179.4 ± 13.1 1/min, p < 0.050) and ventilation (92.8 ± 22.9 l/min vs. 75.4 ± 18.6 l/min, <0.050). At altitude, power to weight index only remained significantly higher in the control group (2.8 ± 0.6 W/kg vs. 2.6 ± 0.6 W/kg, p < 0.001). Pulmonary blood flow (PBF) at lowland showed no difference between the control and the AscCHD group, neither at rest (5.4 ± 0.8 l/min vs. 5.1 ± 0.9 l/min, p = 0.308), nor during the steady state test (10.6 ± 2.4 l/min vs. 10.5 ± 2.0 l/min, p = 0.825). At high altitude, PBF increased by 110% and 112%, respectively (12.8 ± 2.32 l/min vs. 12.5 ± 3.0 l/min; intergroup difference: p = 0.986). Conclusions: High altitude exposure was well tolerated in an unselected group of AscCHD. No significant difference in the cardio-pulmonary adaptation to a control group was noted during a steady state exercise. Symptoms of minor acute mountain sickness did occur, which should however not be misinterpreted as signs of hemodynamic maladaptation.

Keywords

Adolescents with congenital heart disease; high altitude; non-invasive cardiac output measurement; exercise

Cite This Article

Minder, L., Schwerzmann, M., Radtke, T., Saner, H., Eser, P. et al. (2021). Cardiopulmonary Response to Exercise at High Altitude in Adolescents with Congenital Heart Disease. Congenital Heart Disease, 16(6), 597–608.



This work is licensed under a Creative Commons Attribution 4.0 International License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
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