title: Chronotropic incompetence in adolescents and adults with congenital heart disease after cardiac surgery.
abstract: BACKGROUND
  Chronotropic incompetence (CI) is one of the major problems in adults with congestive heart. Little is known about CI in adults with congenital heart disease (ACHD) after cardiac surgery. The purpose of our study was to investigate the presence and risk factors of CI in ACHD patients.
  
  
  RESULTS
  Clinical and echocardiographic data, NT-pro brain natriuretic peptide (N-BNP), and peak oxygen uptake (VO2peak) during spiroergometry were obtained in 345 consecutive ACHD patients. CI was defined as the failure to achieve > or = 80% of the predicted maximal heart rate. A total of 117 (34%) of study patients fulfilled the CI criterion. These patients were in a higher New York Heart Association class (1.7 +/- 0.06 versus 1.4 +/- 0.03, P < .0001; mean +/- SEM), had significantly higher N-BNP levels (230 +/- 31 versus 121 +/- 10 pg/mL, P < .0001) and a more pronounced impairment of VO2peak (23.8 +/- 0.6 versus 28.4 +/- 0.5 mL x kg x min, P < .0001) than those without CI. Elevated odds ratios for CI were found in patients with a single ventricle (4.03), Mustard operation for transposition of the great arteries (3.11), and aortic coarctation (2.14).
  
  
  CONCLUSIONS
  Our results indicate that CI in ACHD patients is a frequent problem and is related to the severity of the heart failure as measured by symptom assessment (New York Heart Association class), plasma N-BNP level and peak oxygen uptake.
authors.affiliation: Department of Paediatric Cardiology and Intensive Care Medicine, Medical School Hannover, Germany.
authors.forename: Kambiz
authors.initials: K
authors.lastname: Norozi
authors.forename: Armin
authors.initials: A
authors.lastname: Wessel
authors.forename: Valentin
authors.initials: V
authors.lastname: Alpers
authors.forename: Jan O
authors.initials: JO
authors.lastname: Arnhold
authors.forename: Lutz
authors.initials: L
authors.lastname: Binder
authors.forename: Siegfried
authors.initials: S
authors.lastname: Geyer
authors.forename: Monika
authors.initials: M
authors.lastname: Zoege
authors.forename: Reiner
authors.initials: R
authors.lastname: Buchhorn
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D006348:Cardiac Surgical Procedures / Q000706:statistics & numerical data; D003430:Cross-Sectional Studies; D005080:Exercise Test; D005260:Female; D005858:Germany / Q000453:epidemiology; D006330:Heart Defects, Congenital / Q000097:blood / Q000145:classification / Q000000981:diagnostic imaging / Q000401:mortality / Q000503:physiopathology* / Q000601:surgery*; D006339:Heart Rate; D006801:Humans; D008297:Male; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000097:blood; D016017:Odds Ratio; D010138:Pacemaker, Artificial / Q000706:statistics & numerical data; D010446:Peptide Fragments / Q000097:blood; D012307:Risk Factors; D012720:Severity of Illness Index; D016019:Survival Analysis; D014463:Ultrasonography
chemical_list: D010446:Peptide Fragments; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain