Department of Congenital Heart Disease and Pediatric Cardiology, Deutsches Herzzentrum München, Technische Universität München, München, Germany (Ms Willinger and Drs Hock, Hager, Oberhoffer-Fritz, Ewert, and Müller); Institute of Preventive Pediatrics, Technische Universität München, München, Germany (Ms Willinger and Drs Oberhoffer-Fritz and Müller); and DZHK (German Centre for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany (Dr Ewert).
J Cardiopulm Rehabil Prev. 2023 Jul 1;43(4):277-281. doi: 10.1097/HCR.0000000000000763. Epub 2022 Dec 26.
Psychological distress and anxiety are increased among adults with congenital heart disease (CHD). However, heart-focused anxiety (HFA) and its impact on peak oxygen uptake (V˙ o2peak ) have not yet been studied in this patient cohort. This study investigates HFA in adults with CHD and whether HFA is associated with V˙ o2peak in these patients.
In this cross-sectional study, HFA was assessed in 984 adults with various CHD (34.2 ± 11.2 yr, 44% female) by the cardiac anxiety questionnaire. In 708 of those (33.5 ± 10.6 yr, 42% female), additional cardiopulmonary exercise testing was performed to assess exercise capacity by measurement of V˙ o2peak .
Compared with the general population, this adult CHD population showed higher HFA in the total cardiac anxiety questionnaire score ( z score; 1.32 ± 1.17; P < .001), as well as in the three subdomains anxiety, avoidance, and attention (all P < .001). The higher the HFA, the lower was the V˙ o2peak % predicted ( r = -0.280, P < .001) independent of CHD diagnosis, CHD severity, and surgical status. The V˙ o2peak % predicted significantly differed between patients with no (85.9 ± 18.4% predicted), slight (80.4 ± 18.4% predicted), and severe HFA (74.2 ± 18.4% predicted) independent of CHD diagnosis, CHD severity, and surgical status ( P < .001).
This study shows that HFA is a common sequela in adults with CHD, and high HFA is associated with reduced V˙ o2peak . Psychological screening and counseling for HFA therefore seem indicated in the aftercare of adults with CHD.
心理困扰和焦虑在先天性心脏病（CHD）患者中更为常见。然而，在该患者群体中，尚未研究心脏相关焦虑（HFA）及其对峰值摄氧量（V˙o2peak）的影响。本研究旨在探讨 CHD 成人中的 HFA，以及 HFA 是否与这些患者的 V˙o2peak 相关。
在这项横断面研究中，通过心脏焦虑问卷评估了 984 名患有各种 CHD 的成年人（34.2 ± 11.2 岁，44%为女性）的 HFA。在其中的 708 名患者（33.5 ± 10.6 岁，42%为女性）中，还进行了心肺运动测试以通过测量 V˙o2peak评估运动能力。
与一般人群相比，该成年 CHD 人群的总心脏焦虑问卷评分的 HFA 更高（z 评分；1.32 ± 1.17；P<.001），以及在焦虑、回避和注意力三个子领域中（均 P<.001）。HFA 越高，V˙o2peak预测值的百分比（r=-0.280，P<.001）越低，与 CHD 诊断、CHD 严重程度和手术状态无关。无论 CHD 诊断、CHD 严重程度和手术状态如何，无（85.9 ± 18.4%预测值）、轻度（80.4 ± 18.4%预测值）和严重 HFA（74.2 ± 18.4%预测值）的患者之间 V˙o2peak预测值的差异均有统计学意义（P<.001）。
本研究表明，HFA 是 CHD 成人的常见后遗症，且 HFA 较高与 V˙o2peak 降低相关。因此，在 CHD 成人的康复护理中，似乎需要对 HFA 进行心理筛查和咨询。
