Ventricular septal defects may decrease exercise capacity as patients age
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Adults with ventricular septal defects had poorer exercise capacity compared with adults without them, researchers found.
In the cross-sectional study, published in the Journal of the American Heart Association, the researchers also found that the difference between adults with ventricular septal defects and healthy adults increased with age, especially in those with operated defects.
“Most congenital heart defect patients are discharged from follow-up care as they reach adulthood, yet many experienced limitations during physical activity,” Marie Maagaard, MD, PhD, researcher at Aarhus University Hospital in Denmark, said in a press release. “These results underline the importance of keeping adults with ventricular septal defects in follow-up programs and including exercise tests in the assessment of their potential deteriorating functional capacity.”
Researchers analyzed data from 30 patients with ventricular septal defects that were surgically closed (mean age, 51 years; 50% men) and 30 matched healthy adults (mean age, 52 years, 50% men), in addition to 30 adults with small, unrepaired ventricular septal defects (mean age, 55 years; 43% men) and 30 matched controls (mean age, 55 years; 43% men). All participants underwent cardiopulmonary exercise testing with noninvasive gas measurement and incremental workload protocol.
The primary endpoint for this study was peak oxygen uptake, and a secondary endpoint included ventilatory anaerobic threshold.
Adults with closed ventricular septal defects had lower peak oxygen uptake compared with matched controls (24.3 mL/kg/min vs. 34.2 mL/kg/min; P < .01). This was also observed in those with unrepaired ventricular septal defects compared with matched controls (26 mL/kg/min vs. 32.9 mL/kg/min; P < .01). Adults with ventricular septal defects had lower oxygen intake starting at 20% of maximal workload compared with matched control groups (P < .01).
Those with surgically closed ventricular septal defects had lower peak ventilation compared with controls (1 L/min/kg vs. 1.4 L/min/kg; P < .01). This was similar in those with unrepaired ventricular septal defects vs. controls (1.2 L/min/kg vs. 1.3 L/min/kg; P = .13).
Exercise capacity was 29% lower in older adults with surgically closed ventricular septal defects and 28% lower in younger adults with surgically closed ventricular septal defects compared with healthy peers. For those with unrepaired ventricular septal defects, older adults had 21% lower exercise capacity and younger adults had 17% lower exercise capacity vs. matched controls.
“Not only do patients with either surgically closed or small unrepaired [ventricular septal defects] demonstrate poorer exercise capacity compared with matched control participants, their exercise capacity does not seem to normalize but rather deteriorates further with increasing age,” Maagaard and colleagues wrote. “Our novel findings warrant attention for aging patients with congenital [ventricular septal defects] and suggest continuous follow-up in specialized cardiology clinics.”
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