使用新的儿科 VO2max 参考方程评估超重或肥胖先天性心脏病儿童的有氧适能。

Use of new paediatric VO2max reference equations to evaluate aerobic fitness in overweight or obese children with congenital heart disease.

机构信息

Paediatric and Congenital Cardiology Department, M3C National Reference Centre, Bordeaux University Hospital, Bordeaux, France.

IHU Liryc, Electrophysiology and Heart Modelling Institute, INSERM 1045, Bordeaux University Foundation, Pessac, France.

出版信息

Eur J Prev Cardiol. 2023 Nov 30;30(17):1865-1873. doi: 10.1093/eurjpc/zwad201.

DOI:10.1093/eurjpc/zwad201

PMID:37314435

Abstract

AIMS

Overweight and obesity in children with congenital heart disease (CHD) represent an alarming cardiovascular risk. Promotion of physical activity and cardiac rehabilitation in this population requires assessing the level of aerobic fitness (VO2max) by a cardiopulmonary exercise test (CPET). Nevertheless, the interpretation of CPET in overweight/obese children with CHD remains challenging as VO2max is affected by both the cardiac condition and the body mass index (BMI). The new paediatric VO2max Z-score reference equations, based on a logarithmic function of VO2max, height and BMI, were applied to overweight/obese children with a CHD and compared with overweight/obese children without any other chronic condition.

METHODS AND RESULTS

In this cross-sectional controlled study, 344 children with a BMI > 85th percentile underwent a CPET (54% boys; mean age 11.5 ± 3.1 years; 100 CHD; 244 controls). Using the VO2max Z-score equations, aerobic fitness was significantly lower in obese/overweight CHD children than that in matched obese/overweight control children (-0.43 ± 1.27 vs. -0.01 ± 1.09; P = 0.02, respectively), and the proportion of children with impaired aerobic fitness was significantly more important in obese/overweight CHD children than in matched controls (17% vs.6%, P = 0.02, respectively). The paediatric VO2max Z-score reference equations also identified specific complex CHD at risk of aerobic fitness impairment (univentricular heart and right outflow tract anomalies). Using Cooper's weight- and height-based linear equations, similar matched-comparisons analyses found no significant group differences.

CONCLUSIONS

As opposed to the existing linear models, the new paediatric VO2max Z-score equations can discriminate the aerobic fitness of obese/overweight children with CHD from that of obese/overweight children without any chronic disease.

REGISTRATION

ClinicalTrials.gov NCT04815577.

摘要

目的

儿童先天性心脏病（CHD）患者超重和肥胖是一个令人警醒的心血管风险因素。为了促进该人群的体力活动和心脏康复，需要通过心肺运动试验（CPET）来评估有氧适能（VO2max）水平。然而，由于 VO2max 受到心脏状况和体重指数（BMI）的双重影响，因此超重/肥胖的 CHD 患儿的 CPET 解读仍然具有挑战性。新的儿童 VO2max Z 评分参考方程是基于 VO2max、身高和 BMI 的对数函数建立的，本研究将其应用于超重/肥胖的 CHD 患儿，并与无其他慢性疾病的超重/肥胖患儿进行比较。

方法和结果

在这项横断面对照研究中，344 名 BMI＞第 85 百分位数的患儿接受了 CPET（54%为男性；平均年龄 11.5±3.1 岁；100 例 CHD；244 例对照）。使用 VO2max Z 评分方程，肥胖/超重 CHD 患儿的有氧适能明显低于匹配的肥胖/超重对照组患儿（-0.43±1.27 与-0.01±1.09；P=0.02），肥胖/超重 CHD 患儿中存在有氧适能受损的患儿比例明显高于匹配的对照组（17%与 6%；P=0.02）。儿童 VO2max Z 评分参考方程还可识别出存在有氧适能受损风险的特定复杂 CHD（单心室心脏和右流出道异常）。使用库珀的体重和身高线性方程进行类似的匹配比较分析，未发现组间有显著差异。