Journal of the American College of Cardiology vol:55 issue:10
ACC edition:.10 location:Atlanta date:14-16 March 2010
A 80 E749
Background: Patients with congenital heart disease overestimate their exercise capacity as measured by cardiopulmonary exercise testing
because of long-term adaptation. Most patients with atrial septal defect (ASD) type secundum present with New York Heart Association (NYHA)
classification I or II, making it difficult to estimate actual exercise capacity. Therefore, a perceived health status questionnaire (SF-36) may be more
sensitive to detect physical and mental limitations in ASD patients. This study investigated the correlation between perceived health status and
actual exercise capacity in open and closed ASDs.
Methods: At the outpatient clinic of adult congenital heart disease, 33 patients (20 female, median age 32.8 years, range 18-74 years) with ASD
type secundum were selected to be included in the study. Twelve patients had open ASD (4 female, median age 28.7 years, range 18-74 years),
21 patients (16 female, median age 33.2 years, range 19 - 70 years) had repaired ASD. Age and gender matched controls from a database of
normals were selected for each subgroup. All of the patients completed a perceived health status questionnaire. Afterwards, a symptom-limited,
incremental cardiopulmonary exercise test using an upright cycle ergometer was performed. Maximal exercise capacity was assessed by peak oxygen
Results: Both patients with open (vO2max 25,5 versus 36,7 mL/min.kg, P = 0.019) and repaired ASD (vO2max 26,1 versus 33,6 mL/min.kg, P =
0,004) showed limitations at exercise when compared to age and gender-matched controls. Only physical functioning (r = 0.795, P = 0.003) and
role limitation (r = 0.777, P = 0.005) showed significant correlation with vO2max in patients with open ASD. Physical functioning correlated less with
v02max in patients with repaired ASD (r = 0.552, P = 0.012), and did not reach statistical significance after adjustment for multiple testing.
Conclusions: Both patients with open and repaired ASD type secundum presented with impaired exercise capacity. Peak oxygen consumption
correlated with self-reported physical functioning in patients with open ASD. SF-36 was sensitive to detect reductions in physical functioning in
patients with open ASD.