Tsuda Takeshi, Kernizan Daphney, Glass Austin, D'Aloisio Gina, Hossain Jobayer, Quillen Joanne
Nemours Cardiac Center, Nemours Children's Health, 1600 Rockland Rd, Wilmington, DE, 19803, USA.
Department of Pediatrics, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA, 19107, USA.
Pediatr Cardiol. 2023 Feb;44(2):344-353. doi: 10.1007/s00246-022-02995-w. Epub 2022 Sep 8.
Late-onset cardiovascular complications are serious concerns for pediatric cancer survivors (PCS) including those who are asymptomatic. We investigated whether cardiopulmonary exercise testing (CPET) can delineate the underlying pathophysiology of preclinical cardiovascular abnormalities in PCS. We examined CPET data via cycle ergometer in asymptomatic PCS with normal echocardiogram and age-matched controls. Peak and submaximal parameters were analyzed. Fifty-three PCS and 60 controls were studied. Peak oxygen consumption (VO), peak work rate (WR), and ventilatory anaerobic threshold (VAT) were significantly lower in PCS than controls (1.86 ± 0.53 vs. 2.23 ± 0.61 L/min, 125 ± 45 vs. 154 ± 46 W, and 1.20 ± 0.35 vs. 1.42 ± 0.43 L/min, respectively; all p < 0.01), whereas peak heart rate (HR) and ventilatory efficiency (a slope of minute ventilation over CO production or ∆VE/∆VCO) were comparable. Peak respiratory exchange ratio (RER) was significantly higher in PCS (p = 0.0006). Stroke volume (SV) reserve was decreased in PCS, indicated by simultaneous higher dependency on HR (higher ∆HR/∆WR) and lower peak oxygen pulse (OP). Twelve PCS with high peak RER (≥ 1.3) revealed lower pVO and VAT than the rest of PCS despite higher ventilatory efficiency (lower ∆VE/∆VCO), suggesting fundamental deficiency in oxygen utilization in some PCS. Poor exercise performance in PCS may be mainly attributed to limited stroke volume reserve, but the underlying pathophysiology is multifactorial. Combined assessment of peak and submaximal CPET parameters provided critical information in delineating underlying exercise physiology of PCS.
迟发性心血管并发症是儿童癌症幸存者（PCS）面临的严重问题，包括那些无症状的幸存者。我们研究了心肺运动试验（CPET）是否能够描绘出PCS临床前期心血管异常的潜在病理生理学特征。我们通过自行车测力计检查了无症状且超声心动图正常的PCS以及年龄匹配的对照组的CPET数据。分析了峰值和次最大参数。共研究了53名PCS和60名对照组。PCS的峰值耗氧量（VO）、峰值工作率（WR）和通气无氧阈（VAT）显著低于对照组（分别为1.86±0.53对2.23±0.61L/分钟、125±45对154±46W以及1.20±0.35对1.42±0.43L/分钟；所有p<0.01），而峰值心率（HR）和通气效率（分钟通气量与二氧化碳产生量的斜率或∆VE/∆VCO）相当。PCS的峰值呼吸交换率（RER）显著更高（p=0.0006）。PCS的每搏输出量（SV）储备降低，表现为对HR的依赖性同时增加（更高的∆HR/∆WR）以及峰值氧脉搏（OP）更低。12名峰值RER高（≥1.3）的PCS尽管通气效率更高（更低的∆VE/∆VCO），但其pVO和VAT低于其余PCS，这表明部分PCS存在氧利用的根本缺陷。PCS运动表现不佳可能主要归因于每搏输出量储备有限，但其潜在病理生理学是多因素的。对CPET峰值和次最大参数的综合评估为描绘PCS潜在运动生理学提供了关键信息。
