Vecchiato Marco, Ermolao Andrea, Zanardo Emanuele, Battista Francesca, Ruvoletto Giacomo, Palermi Stefano, Quinto Giulia, Degano Gino, Gasperetti Andrea, Padalino Massimo A, Di Salvo Giovanni, Neunhaeuserer Daniel
Sports and Exercise Medicine Division, Department of Medicine, University of Padova, 35128 Padova, Italy.
Clinical Network of Sports and Exercise Medicine of the Veneto Region, 35131 Padova, Italy.
Children (Basel). 2023 Mar 7;10(3):521. doi: 10.3390/children10030521.
The overshoot of the respiratory exchange ratio (RER) after exercise is reduced in patients with heart failure.
The present study aimed to investigate the presence of this phenomenon in young patients with congenital heart disease (CHD), who generally present reduced cardiorespiratory fitness.
In this retrospective study, patients with CHD underwent a maximal cardiopulmonary exercise testing (CPET) assessing the RER recovery parameters: the RER at peak exercise, the maximum RER value reached during recovery, the magnitude of the RER overshoot and the linear slope of the RER increase after the end of the exercise.
In total, 117 patients were included in this study. Of these, there were 24 healthy age-matched control subjects and 93 young patients with CHD (transposition of great arteries, Fontan procedure, aortic coarctation and tetralogy of Fallot). All patients presented a RER overshoot during recovery. Patients with CHD showed reduced aerobic capacity and cardiorespiratory efficiency during exercise, as well as a lower RER overshoot when compared to controls. RER magnitude was higher in the controls and patients with aortic coarctation when compared to those with transposition of great arteries, previous Fontan procedure, and tetralogy of Fallot. The RER magnitude was found to be correlated with the most relevant cardiorespiratory fitness and efficiency indices.
The present study proposes new recovery indices for functional evaluation in patients with CHD. Thus, the RER recovery overshoots analysis should be part of routine CPET evaluation to further improve prognostic risk stratifications in patients with CHD.
心力衰竭患者运动后呼吸交换率（RER）的峰值降低。
本研究旨在调查先天性心脏病（CHD）年轻患者中这种现象的存在情况，这类患者通常心肺适能降低。
在这项回顾性研究中，CHD患者接受了最大心肺运动试验（CPET），评估RER恢复参数：运动峰值时的RER、恢复过程中达到的最大RER值、RER峰值的幅度以及运动结束后RER增加的线性斜率。
本研究共纳入117例患者。其中有24名年龄匹配的健康对照者和93名CHD年轻患者（大动脉转位、Fontan手术、主动脉缩窄和法洛四联症）。所有患者在恢复过程中均出现RER峰值。与对照组相比，CHD患者在运动期间表现出有氧能力和心肺效率降低，以及RER峰值较低。与大动脉转位、既往Fontan手术和法洛四联症患者相比，对照组和主动脉缩窄患者的RER幅度更高。发现RER幅度与最相关的心肺适能和效率指标相关。
本研究提出了用于CHD患者功能评估的新恢复指标。因此，RER恢复峰值分析应成为常规CPET评估的一部分，以进一步改善CHD患者的预后风险分层。
