Exercise Capacity and Cardiorespiratory Fitness in Children with Congenital Heart Diseases: A Proposal for an Adapted NYHA Classification

Daniel Neunhaeuserer, Francesca Battista, Barbara Mazzucato, Marco Vecchiato, Giulia Meneguzzo, Giulia Quinto, Josef Niebauer, Andrea Gasperetti, Vladimiro Vida, Giovanni Di Salvo, Maurizio Varnier and Andrea Ermolao
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Daniel Neunhaeuserer: Sports and Exercise Medicine Division, Department of Medicine, University of Padova, Via Giustiniani 2, 35128 Padova, Italy
Francesca Battista: Sports and Exercise Medicine Division, Department of Medicine, University of Padova, Via Giustiniani 2, 35128 Padova, Italy
Barbara Mazzucato: Sports and Exercise Medicine Division, Department of Medicine, University of Padova, Via Giustiniani 2, 35128 Padova, Italy
Marco Vecchiato: Sports and Exercise Medicine Division, Department of Medicine, University of Padova, Via Giustiniani 2, 35128 Padova, Italy
Giulia Meneguzzo: Sports and Exercise Medicine Division, Department of Medicine, University of Padova, Via Giustiniani 2, 35128 Padova, Italy
Giulia Quinto: Sports and Exercise Medicine Division, Department of Medicine, University of Padova, Via Giustiniani 2, 35128 Padova, Italy
Josef Niebauer: Institute of Sports Medicine, Prevention and Rehabilitation, Paracelsus Medical University of Salzburg, Lindhofstraße 20, 5020 Salzburg, Austria
Andrea Gasperetti: Sports and Exercise Medicine Division, Department of Medicine, University of Padova, Via Giustiniani 2, 35128 Padova, Italy
Vladimiro Vida: Pediatric and Congenital Cardiac Surgery, Department of Cardio-Thoracic-Vascular Sciences and Public Health, University of Padova, Via Giustiniani 2, 35128 Padova, Italy
Giovanni Di Salvo: Pediatric Cardiology Unit, Department of Woman and Child’s Health, University of Padova, Via Giustiniani 2, 35128 Padova, Italy
Maurizio Varnier: Sports and Exercise Medicine Division, Department of Medicine, University of Padova, Via Giustiniani 2, 35128 Padova, Italy
Andrea Ermolao: Sports and Exercise Medicine Division, Department of Medicine, University of Padova, Via Giustiniani 2, 35128 Padova, Italy

IJERPH, 2022, vol. 19, issue 10, 1-10

Abstract: Objective: To propose and evaluate an adapted NYHA classification for children with congenital heart disease (CHD) as a feasible clinical tool for classifying patients’ fitness, cardiorespiratory efficiency and functional limitations during their ordinary daily activities, which are also characterized by vigorous and competitive physical exercise among peers. Methods: This cross-sectional investigation analyzed 332 patients (13.1 ± 3.01 y/o) who underwent surgical repair of CHD and performed Cardiopulmonary Exercise Testing (CPET). Patients were divided into NYHA class I, IIA and IIB by specific questioning regarding functional limitation and performance compared to peers and at strenuous intensity. Class IIA was characterized by slight exercise limitation only for strenuous/competitive activities, whereas IIB for already ordinary physical activities. These NYHA classes were compared with maximal CPET on treadmill. Results: Patients’ exercise capacity (exercise time, METs), aerobic capacity (VO 2 peak) and chronotropic response were found progressively impaired when NYHA class I was compared with IIA and IIB. Indeed, ventilatory-perfusion mismatch (PETCO 2 , VE/VCO 2 ) significantly worsened from NYHA class I to IIA, while no difference was found between IIA and IIB. Conclusion: This adapted NYHA-CHD classification could allow regular functional evaluations and accurate assessments by clinicians, leading to facilitated clinical management and timely medical interventions.

Keywords: cardiopulmonary exercise test; New York Heart Association classification; functional evaluation; physical activity (search for similar items in EconPapers)
JEL-codes: I I1 I3 Q Q5 (search for similar items in EconPapers)
Date: 2022
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