IJCS | Volume 32, Nº1, January/ February 2019

DOI: 10.5935/2359-4802.20180073 41 ORIGINAL ARTICLE International Journal of Cardiovascular Sciences. 2019;32(1)41-47 Mailing Address: Pablo Marino Corrêa Nascimento Rua das Laranjeiras, 374. Postal Code: 22240-006, Laranjeiras, Rio de Janeiro, RJ - Brazil. E-mail: marino_pablo@yahoo.com.br , pablomarino@cardiol,br Hemodynamic, Metabolic and Ventilatory Responses to Exercise in Adults with Congenital Heart Disease Pablo Marino Corrêa Nascimento, 1 D aniel Arkader Kopiler, 1 Fernando Cesar de Castro e Souza, 1 Maria Carolina Terra Cola, 1 Marina Pereira Coelho, 1 Gabriella de Oliveira Lopes, 1 Eduardo Tibiriçá 2 Instituto Nacional de Cardiologia, INC, 1 RJ - Brazil Instituto Oswaldo Cruz, FIOCRUZ, 2 RJ - Brazil Manuscript received November 16, 2017, revised manuscript May 08, 2018, accepted May 14, 2018. Abstract Background: Congenital heart disease in adults shares some features with heart failure (HF), including exercise intolerance, ventilatory inefficiency, inflammatory and neurohormonal activation, cardiac arrhythmias and myocardial fibrosis. Over the last years, cardiopulmonary exercise test has gained importance in the diagnostic and prognostic evaluation of congenital heart diseases, as has already occurred in HF. Objective: To describe the behavior of hemodynamic, metabolic and ventilatory parameters in response to exercise in adults with congenital heart disease. Methods: Observational cross-sectional study evaluating 31 adults with congenital acyanotic or cyanotic heart disease, treated clinically, surgically or percutaneously, referred for cardiopulmonary exercise test. A descriptive analysis of the data was performed. Results: Patients aged 35.7 ± 14.2 years were included. Oxygen consumption (VO 2 ) was 44.86 ± 18.01% of predicted at peak exercise and 36.92 ± 12.93% of predicted maximal VO 2 at anaerobic threshold. We found an oxygen uptake efficiency slope (OUES) of 1.49 ± 0.89 (61.43 ± 26.63% of predicted), oxygen pulse of 58.90 ± 22.24% and increment in systolic arterial pressure during exercise was 31.42 ± 21.60 mmHg. Conclusion: Adults with congenital heart disease had similar responses to heart failure patients during exercise – reduced aerobic capacity, ventilatory inefficiency for oxygen consumption and limited inotropic response to exercise, characterized by reduced oxygen pulse and small increase in systolic arterial pressure. (Int J Cardiovasc Sci. 2019;32(1)41-47) Keywords: Heart Defects, Congenital; Exercise; Adults; Exercise Test; Cyanosis; Hemodynamics; Metabolism. Introduction Congenital heart diseases are abnormalities in the structure of the heart at birth that may involve the interior surface of the walls of the heart, cardiac valves or blood vessels that carry blood to and from the heart to the body. 1 The incidence of congenital heart disease is eight cases per 1,000 live births and the estimated prevalence is more than 1,000,000 of adults in the USA. 1,2 The prevalence of congenital heart disease in adults has increased in the last five decades due to significant progression in the treatment of these conditions during childhood. 3 These patients, however, have decreased functional capacity 4-7 and higher morbidity and mortality rates as compared with healthy individuals. 8-14 Congenital heart diseases in adults have characteristics similar to heart failure (HF) caused by other etiologies, such as exercise intolerance, 8-11 ventricular dysfunction (right or left), 15 cardiac arrhythmias, 16 myocardial fibrosis, 17 ventilatory inefficiency, 3,11,18 increased inflammatory cytokines, 19 and neurohormonal activation. 20