Panchangam Chaitanya, White David A, Goudar Suma, Birnbaum Brian, Malloy-Walton Lindsey, Gross-Toalson Jami, Reid Kimberly J, Shirali Girish, Parthiban Anitha
Department of Child Health, University of Missouri Health Care, Columbia, MO, USA.
University of Missouri-Columbia, 500 N Keene St, Suite 207, Columbia, MO, 65201, USA.
Pediatr Cardiol. 2020 Jun;41(5):1031-1041. doi: 10.1007/s00246-020-02354-7. Epub 2020 May 6.
Children and adolescents with cardiac disease (CCD) have significant morbidity and lower quality of life. However, there are no broadly applicable tools similar to the frailty score as described in the elderly, to define functional phenotype in terms of physical capability and psychosocial wellbeing in CCD. The purpose of this study is to investigate the domains of the frailty in CCD. We prospectively recruited CCD (8-17.5 years old, 70% single ventricle, 27% heart failure, 12% pulmonary hypertension; NYHA classes I, II and III) and age and gender matched healthy controls (total n = 56; CCD n = 34, controls n = 22; age 12.6 ± 2.6 years; 39.3% female). We measured the five domains of frailty: slowness, weakness, exhaustion, body composition and physical activity using developmentally appropriate methods. Age and gender-based population norms were used to obtain Z scores and percentiles for each measurement. Two-tailed t-tests were used to compare the two groups. The CCD group performed significantly worse in all five domains of frailty compared to healthy controls. Slowness: 6-min walk test with Z score -3.9 ± 1.3 vs -1.4 ± 1.3, p < 0.001; weakness: handgrip strength percentile 18.9 ± 20.9 vs 57.9 ± 26.0, p < 0.001; exhaustion: multidimensional fatigue scale percentile 63.7 ± 13.5 vs 83.3 ± 14.4, p < 0.001; body composition: height percentile 43.4 ± 29.5 vs 71.4 ± 25.2, p < 0.001, weight percentile 46.0 ± 36.0 vs 70.9 ± 24.3, p = 0.006, BMI percentile 48.4 ± 35.5 vs 66.9 ± 24.2, p = 0.04, triceps skinfold thickness 41.0 ± 24.0 vs 54.4 ± 22.1, p = 0.04; physical activity: pediatric activity questionnaire score 2 ± 0.6 vs 2.7 ± 0.6, p < 0.001. The domains of frailty can be quantified in children using developmentally appropriate methods. CCD differ significantly from controls in all five domains, supporting the concept of quantifying the domains of frailty. Larger longitudinal studies are needed to study frailty in CCD and examine if it predicts adverse health outcomes.Clinical Trial Registration: The ClinicalTrials.gov identification number is NCT02999438. https://clinicaltrials.gov/ct2/show/NCT02999438.
患有心脏病（CCD）的儿童和青少年有较高的发病率且生活质量较低。然而，目前还没有像老年人中所描述的虚弱评分那样广泛适用的工具，来根据身体能力和心理社会幸福感定义CCD患者的功能表型。本研究的目的是调查CCD患者虚弱的相关领域。我们前瞻性招募了CCD患者（年龄8 - 17.5岁，70%为单心室，27%为心力衰竭，12%为肺动脉高压；纽约心脏协会心功能分级为I、II和III级）以及年龄和性别匹配的健康对照（共n = 56；CCD患者n = 34，对照n = 22；年龄12.6±2.6岁；39.3%为女性）。我们使用适合其发育阶段的方法测量了虚弱的五个领域：行动迟缓、虚弱、疲惫、身体组成和身体活动。使用基于年龄和性别的人群标准来获取每项测量的Z分数和百分位数。采用双尾t检验比较两组。与健康对照相比，CCD组在所有五个虚弱领域的表现均显著更差。行动迟缓：6分钟步行试验的Z分数为 - 3.9±1.3对比 - 1.4±1.3，p < 0.001；虚弱：握力百分位数为18.9±20.9对比57.9±26.0，p < 0.001；疲惫：多维疲劳量表百分位数为63.7±13.5对比83.3±14.4，p < 0.001；身体组成：身高百分位数为43.4±29.5对比71.4±25.2，p < 0.001，体重百分位数为46.0±36.0对比70.9±24.3，p = 0.006，体重指数百分位数为48.4±35.5对比66.9±24.2，p = 0.04，肱三头肌皮褶厚度为41.0±24.0对比54.4±22.1，p = 0.04；身体活动：儿童活动问卷得分2±0.6对比2.7±0.6，p < 0.001。可以使用适合其发育阶段的方法对儿童的虚弱领域进行量化。CCD患者在所有五个领域与对照组有显著差异，支持对虚弱领域进行量化的概念。需要开展更大规模的纵向研究来研究CCD患者的虚弱情况，并检验其是否能预测不良健康结局。临床试验注册：ClinicalTrials.gov识别号为NCT02999438。https://clinicaltrials.gov/ct2/show/NCT
