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Chronotropic incompetence in paediatric heart transplant recipients with prior congenital heart disease

Published online by Cambridge University Press:  06 June 2019

Nikki M. Singh Open the ORCID record for Nikki M. Singh [Opens in a new window] ,
Rohit S. Loomba ,
Joshua R. Kovach  and
Steven J. Kindel
Nikki M. Singh*
Affiliation:
Division of Pediatric Cardiology, Children’s Hospital of Wisconsin/Medical College of Wisconsin, Milwaukee, WI, USA
Rohit S. Loomba
Affiliation:
Advocate Children’s Heart Institute, Advocate Children’s Hospital, Oak Lawn, IL, USA
Joshua R. Kovach
Affiliation:
Division of Pediatric Cardiology, Children’s Hospital of Wisconsin/Medical College of Wisconsin, Milwaukee, WI, USA
Steven J. Kindel
Affiliation:
Division of Pediatric Cardiology, Children’s Hospital of Wisconsin/Medical College of Wisconsin, Milwaukee, WI, USA
*
Author for correspondence: Nikki M. Singh, MD, Division of Pediatric Cardiology, Children’s Hospital of Wisconsin/Medical College of Wisconsin, 9000 W. Wisconsin Ave Milwaukee, WI 53226 Tel: +1 513-636-2385; E-mail: Nikki.Singh@cchmc.org
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Abstract

Background:

Cardiopulmonary exercise testing has been used to measure functional capacity in children who have undergone a heart transplant. Cardiopulmonary exercise testing results have not been compared between children transplanted for a primary diagnosis of CHD and those with a primary diagnosis of cardiomyopathy despite differences in outcomes. This study is aimed to compare cardiopulmonary exercise testing performance between these two groups.

Methods:

Patients who underwent heart transplant with subsequent cardiopulmonary exercise testing at least 6 months after transplant at our institution were identified. They were then divided into two groups based on primary cardiac diagnosis: CHD or cardiomyopathy. Patient characteristics, echocardiograms, cardiac catheterisations, outcomes, and cardiopulmonary exercise test results were compared between the two groups.

Results:

From the total of 35 patients, 15 (43%) had CHD and 20 (57%) had cardiomyopathy. Age at transplant, kidney disease, lung disease, previous rejection, coronary vasculopathy, catheterisation, and echocardiographic data were similar between the groups. Mean time from transplant to cardiopulmonary exercise testing, exercise duration, and maximum oxygen consumption were similar in both groups. There was a difference in heart rate response with CHD heart rate response of 63 beats per minute compared to cardiomyopathy group of 78 (p = 0.028). Patients with CHD had more chronotropic incompetence than those with cardiomyopathy (p = 0.036).

Conclusion:

Primary diagnosis of CHD is associated with abnormal heart rate response and more chronotropic incompetence compared to those transplanted for cardiomyopathy.

Keywords

Paediatricheart transplantcardiopulmonary exercise testchronotropic incompetenceCHD
Type
Original Article
Information
Cardiology in the Young , Volume 29 , Issue 5 , May 2019 , pp. 667 - 671
Copyright
© Cambridge University Press 2019 

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