title: Exercise assessment in infants after cardiac transplantation.
abstract: BACKGROUND
  Few data describe exercise performance after cardiac transplantation during infancy. The aim of this study was to compare the cardiorespiratory response to exercise in healthy subjects with that of subjects who had undergone heart transplantation during infancy to treat hypoplastic left heart syndrome.
  
  
  METHODS
  Subjects (24 heart transplant recipients and 25 healthy controls) exercised on a treadmill using pediatric ramp protocols. We measured heart rate (HR), blood pressure, and metabolic data. Median age at transplantation was 20 days (range, 4 to 97 days). Age of recipients at exercise testing was 9.7 +/- 2.3 years and in healthy subjects was 10.5 +/- 1.4 years (p=not significant [NS]).
  
  
  RESULTS
  Exercise duration was similar in both groups (10.3 +/- 2.0 minutes in recipients vs 11.1 +/- 1.5 minutes in healthy subjects, (p=NS). Heart rate at rest was greater in recipients (94 +/- 15 beats per minute [bpm] vs 85 +/- 11 bpm, p=0.02). Peak HR also was less in the recipient group (158 +/- 15 bpm vs 189 +/- 12 bpm, p <0.001). Peak oxygen consumption was 14% less in the recipients (32.3 +/- 5.6 ml/kg/min vs 36.8 +/- 5.5 ml/kg/min, p <0.01). Ventilatory anaerobic threshold was decreased in recipients, 27.6 +/- 9.6 vs 32.8 +/- 6.0, p <0.05. Respiratory exchange ratio at peak exercise was equal in both groups (1.06 +/- 0.06 vs 1.06 +/- 0.08). Oxygen pulse index did not differ significantly, 5.5 +/- 1.1 ml/beat/m2 in recipients and 6.1 +/- 1.7 ml/beat/m2 in healthy subjects (p=NS).
  
  
  CONCLUSIONS
  Overall, children who undergo cardiac transplantation in infancy have exercise capacities within the normal range. These recipients have a decreased heart rate reserve that may account for the differences in peak oxygen consumption when compared with healthy subjects.
authors.affiliation: Department of Pediatrics, Loma Linda Children's Hospital, Loma Linda University, Loma Linda, California 92354, USA.
authors.forename: Ginnie
authors.initials: G
authors.lastname: Abarbanell
authors.forename: Neda
authors.initials: N
authors.lastname: Mulla
authors.forename: Richard
authors.initials: R
authors.lastname: Chinnock
authors.forename: Ranae
authors.initials: R
authors.lastname: Larsen
mesh_terms: D015308:Anaerobic Threshold; D001794:Blood Pressure; D002648:Child; D005080:Exercise Test; D005260:Female; D005500:Follow-Up Studies; D006339:Heart Rate; D016027:Heart Transplantation; D006801:Humans; D018636:Hypoplastic Left Heart Syndrome / Q000601:surgery; D007223:Infant; D008297:Male; D010101:Oxygen Consumption; D011659:Pulmonary Gas Exchange