Volume 28, Issue 4 e14772

ORIGINAL ARTICLE

Effect of body mass index on exercise capacity following pediatric heart transplantation

Alan P. Wang,

Corresponding Author

Alan P. Wang

[email protected]

orcid.org/0000-0001-8512-4894

Division of Pediatric Cardiology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA

Correspondence

Alan P. Wang, Division of Pediatric Cardiology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA.

Email: [email protected]

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Kendra Ward,

Kendra Ward

orcid.org/0009-0009-0012-7750

Division of Pediatric Cardiology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA

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Garett Griffith,

Garett Griffith

Department of Physical Therapy and Human Movement Sciences, Northwestern University, Evanston, IL, USA

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Katheryn Gambetta,

Katheryn Gambetta

Division of Pediatric Cardiology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA

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Alan P. Wang,

Corresponding Author

Alan P. Wang

[email protected]

orcid.org/0000-0001-8512-4894

Division of Pediatric Cardiology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA

Correspondence

Alan P. Wang, Division of Pediatric Cardiology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA.

Email: [email protected]

Search for more papers by this author

Kendra Ward,

Kendra Ward

orcid.org/0009-0009-0012-7750

Division of Pediatric Cardiology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA

Search for more papers by this author

Garett Griffith,

Garett Griffith

Department of Physical Therapy and Human Movement Sciences, Northwestern University, Evanston, IL, USA

Search for more papers by this author

Katheryn Gambetta,

Katheryn Gambetta

Division of Pediatric Cardiology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA

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First published: 03 May 2024

https://doi.org/10.1111/petr.14772

Citations: 1

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Abstract

Background

Obesity and impaired exercise tolerance following heart transplantation increase the risk of post-transplant morbidity and mortality. The aim of this study was to evaluate the effect of body mass index on markers of exercise capacity in pediatric heart transplant recipients and compare this effect with a healthy pediatric cohort.

Methods

A retrospective analysis of cardiopulmonary exercise test data between 2004 and 2022 was performed. All patients exercised on a treadmill using the Bruce protocol. Inclusion criteria included patients aged 6–21 years, history of heart transplantation (transplant cohort) or no cardiac diagnosis (control cohort) at the time of testing, and a maximal effort test. Patients were further stratified within these two cohorts as underweight, normal, overweight, and obese based on body mass index groups. Two-way analyses of variance were performed with diagnosis and body mass index category as the independent variables.

Results

A total of 250 exercise tests following heart transplant and 1963 exercise tests of healthy patients were included. Heart transplant patients across all body mass index groups had higher resting heart rate and lower maximal heart rate, heart rate recovery at 1 min, exercise duration, and peak aerobic capacity (VO_2peak). Heart transplant patients in the normal and overweight body mass index categories had higher VO_2peak and exercise duration when compared to underweight and obese patients.

Conclusion

Underweight status and obesity are strongly associated with lower VO_2peak and exercise duration in heart transplant patients. Normal and overweight heart transplant patients had the best markers of exercise capacity.

CONFLICT OF INTEREST STATEMENT

The authors of this current study have no conflicts of interest to disclose.

Open Research

DATA AVAILABILITY STATEMENT

The data that support the findings of this study are available from the corresponding author upon reasonable request.

REFERENCES

1Tsoi MF, Li HL, Feng Q, Cheung CL, Cheung TT, Cheung BMY. Prevalence of childhood obesity in the United States in 1999–2018: a 20-year analysis. Obes Facts. 2022; 15(4): 560-569. doi:10.1159/000524261
10.1159/000524261
PubMed Web of Science® Google Scholar
2Rossano JW, Grenier MA, Dreyer WJ, et al. Effect of body mass index on outcome in pediatric heart transplant patients. J Heart Lung Transplant. 2007; 26(7): 718-723. doi:10.1016/j.healun.2007.05.001
10.1016/j.healun.2007.05.001
PubMed Web of Science® Google Scholar
3Bondi BC, Banh TM, Vasilevska-Ristovska J, et al. Incidence and risk factors of obesity in childhood solid-organ transplant recipients. Transplantation. 2020; 104(8): 1644-1653. doi:10.1097/TP.0000000000003025
10.1097/TP.0000000000003025
CAS PubMed Web of Science® Google Scholar
4Bogle C, Cantor R, Koehl D, et al. Obesity and dyslipidemia predict cardiac allograft vasculopathy and graft loss in children and adolescents post-heart transplant: a PHTS multi-institutional analysis. Pediatr Transplant. 2022; 26(5):e14244. doi:10.1111/petr.14244
10.1111/petr.14244
CAS PubMed Web of Science® Google Scholar
5Dipchand AI, Manlhiot C, Russell JL, Gurofsky R, Kantor PF, McCrindle BW. Exercise capacity improves with time in pediatric heart transplant recipients. J Heart Lung Transplant. 2009; 28(6): 585-590. doi:10.1016/j.healun.2009.01.025
10.1016/j.healun.2009.01.025
PubMed Web of Science® Google Scholar
6Godown J, Donohue JE, Yu S, Friedland-Little JM, Gajarski RJ, Schumacher KR. Differential effect of body mass index on pediatric heart transplant outcomes based on diagnosis. Pediatr Transplant. 2014; 18(7): 771-776. doi:10.1111/petr.12352
10.1111/petr.12352
CAS PubMed Web of Science® Google Scholar
7Ryan TD, Zafar F, Siegel RM, Villa CR, Bryant R 3rd, Chin C. Obesity class does not further stratify outcome in overweight and obese pediatric patients after heart transplantation. Pediatr Transplant. 2018; 22(2). doi:10.1111/petr.13161
10.1111/petr.13161
Web of Science® Google Scholar
8Rosenbaum AN, Kremers WK, Schirger JA, et al. Association between early cardiac rehabilitation and long-term survival in cardiac transplant recipients. Mayo Clin Proc. 2016; 91(2): 149-156. doi:10.1016/j.mayocp.2015.12.002
10.1016/j.mayocp.2015.12.002
PubMed Web of Science® Google Scholar
9McMahon SR, Ades PA, Thompson PD. The role of cardiac rehabilitation in patients with heart disease. Trends Cardiovasc Med. 2017; 27(6): 420-425. doi:10.1016/j.tcm.2017.02.005
10.1016/j.tcm.2017.02.005
PubMed Web of Science® Google Scholar
10Patel JN, Kavey RE, Pophal SG, Trapp EE, Jellen G, Pahl E. Improved exercise performance in pediatric heart transplant recipients after home exercise training. Pediatr Transplant. 2008; 12(3): 336-340. doi:10.1111/j.1399-3046.2007.00806.x
10.1111/j.1399-3046.2007.00806.x
PubMed Web of Science® Google Scholar
11Davis JA, McBride MG, Chrisant MR, Patil SM, Hanna BD, Paridon SM. Longitudinal assessment of cardiovascular exercise performance after pediatric heart transplantation. J Heart Lung Transplant. 2006; 25(6): 626-633. doi:10.1016/j.healun.2006.02.011
10.1016/j.healun.2006.02.011
PubMed Web of Science® Google Scholar
12Bovard JM, DE Souza AM, Harris KC, et al. Physiological responses to exercise in pediatric heart transplant recipients. Med Sci Sports Exerc. 2019; 51(5): 850-857. doi:10.1249/MSS.0000000000001889
10.1249/MSS.0000000000001889
PubMed Web of Science® Google Scholar
13Peterson S, Su JA, Szmuszkovicz JR, Johnson R, Sargent B. Exercise capacity following pediatric heart transplantation: a systematic review. Pediatr Transplant. 2017; 21(5). doi:10.1111/petr.12922
10.1111/petr.12922
PubMed Web of Science® Google Scholar
14Fox SM 3rd, Naughton JP, Haskell WL. Physical activity and the prevention of coronary heart disease. Ann Clin Res. 1971; 3(6): 404-432.
PubMed Web of Science® Google Scholar
15Griffith GJ, Wang AP, Liem RI, Carr MR, Corson T, Ward K. A reference equation for VO(2peak) for pediatric patients undergoing treadmill cardiopulmonary exercise testing. Am J Cardiol. 2023; 212: 41-47. doi:10.1016/j.amjcard.2023.11.061
10.1016/j.amjcard.2023.11.061
PubMed Web of Science® Google Scholar
16Griffith GJ, Wang AP, Liem RI, Carr MR, Corson T, Ward K. Reference values for cardiorespiratory fitness in patients aged 6 to 18 years. J Pediatr. 2023; 264:113770. doi:10.1016/j.jpeds.2023.113770
10.1016/j.jpeds.2023.113770
PubMed Web of Science® Google Scholar
17Vanderlaan RD, Conway J, Manlhiot C, McCrindle BW, Dipchand AI. Enhanced exercise performance and survival associated with evidence of autonomic reinnervation in pediatric heart transplant recipients. Am J Transplant. 2012; 12(8): 2157-2163. doi:10.1111/j.1600-6143.2012.04046.x
10.1111/j.1600-6143.2012.04046.x
CAS PubMed Web of Science® Google Scholar
18Giardini A, Fenton M, Derrick G, Burch M. Impairment of heart rate recovery after peak exercise predicts poor outcome after pediatric heart transplantation. Circulation. 2013; 128(11 Suppl 1): S199-S204. doi:10.1161/CIRCULATIONAHA.112.000369
10.1161/CIRCULATIONAHA.112.000369
PubMed Web of Science® Google Scholar
19Pozza RD, Kleinmann A, Bechtold S, Fuchs A, Netz H. Reinnervation after heart transplantation in children: results of short-time heart rate variability testing. Pediatr Transplant. 2006; 10(4): 429-433. doi:10.1111/j.1399-3046.2006.00485.x
10.1111/j.1399-3046.2006.00485.x
PubMed Web of Science® Google Scholar
20Singh TP, Gauvreau K, Rhodes J, Blume ED. Longitudinal changes in heart rate recovery after maximal exercise in pediatric heart transplant recipients: evidence of autonomic re-innervation? J Heart Lung Transplant. 2007; 26(12): 1306-1312. doi:10.1016/j.healun.2007.08.013
10.1016/j.healun.2007.08.013
PubMed Web of Science® Google Scholar
21Singh NM, Loomba RS, Kovach JR, Kindel SJ. Chronotropic incompetence in paediatric heart transplant recipients with prior congenital heart disease. Cardiol Young. 2019; 29(5): 667-671. doi:10.1017/S1047951119000714
10.1017/S1047951119000714
PubMed Web of Science® Google Scholar
22Rhodes J, Ubeda Tikkanen A, Jenkins KJ. Exercise testing and training in children with congenital heart disease. Circulation. 2010; 122(19): 1957-1967. doi:10.1161/CIRCULATIONAHA.110.958025
10.1161/CIRCULATIONAHA.110.958025
PubMed Web of Science® Google Scholar
23Pierce GL, Magyari PM, Aranda JM Jr, et al. Effect of heart transplantation on skeletal muscle metabolic enzyme reserve and fiber type in end-stage heart failure patients. Clin Transplant. 2007; 21(1): 94-100. doi:10.1111/j.1399-0012.2006.00589.x
10.1111/j.1399-0012.2006.00589.x
PubMed Web of Science® Google Scholar
24Schaufelberger M, Eriksson BO, Lonn L, Rundqvist B, Sunnerhagen KS, Swedberg K. Skeletal muscle characteristics, muscle strength and thigh muscle area in patients before and after cardiac transplantation. Eur J Heart Fail. 2001; 3(1): 59-67. doi:10.1016/s1388-9842(00)00114-8
10.1016/S1388-9842(00)00114-8
CAS PubMed Web of Science® Google Scholar
25Kourek C, Karatzanos E, Nanas S, Karabinis A, Dimopoulos S. Exercise training in heart transplantation. World J Transplant. 2021; 11(11): 466-479. doi:10.5500/wjt.v11.i11.466
10.5500/wjt.v11.i11.466
PubMed Google Scholar
26Regamey J, Monney P, Yerly P, et al. Body composition and maximal exercise capacity after heart transplantation. ESC Heart Fail. 2022; 9(1): 122-132. doi:10.1002/ehf2.13642
10.1002/ehf2.13642
PubMed Web of Science® Google Scholar
27Wong CY, O'Moore-Sullivan T, Leano R, Byrne N, Beller E, Marwick TH. Alterations of left ventricular myocardial characteristics associated with obesity. Circulation. 2004; 110(19): 3081-3087. doi:10.1161/01.CIR.0000147184.13872.0F
10.1161/01.CIR.0000147184.13872.0F
PubMed Web of Science® Google Scholar
28Wong CY, O'Moore-Sullivan T, Leano R, Hukins C, Jenkins C, Marwick TH. Association of subclinical right ventricular dysfunction with obesity. J Am Coll Cardiol. 2006; 47(3): 611-616. doi:10.1016/j.jacc.2005.11.015
10.1016/j.jacc.2005.11.015
PubMed Web of Science® Google Scholar
29Lavie CJ, Alpert MA, Arena R, Mehra MR, Milani RV, Ventura HO. Impact of obesity and the obesity paradox on prevalence and prognosis in heart failure. JACC Heart Fail. 2013; 1(2): 93-102. doi:10.1016/j.jchf.2013.01.006
10.1016/j.jchf.2013.01.006
PubMed Web of Science® Google Scholar
30Doumouras BS, Fan CS, Mueller B, et al. The effect of pre-heart transplant body mass index on posttransplant outcomes: an analysis of the ISHLT registry data. Clin Transplant. 2019; 33(7):e13621. doi:10.1111/ctr.13621
10.1111/ctr.13621
PubMed Web of Science® Google Scholar
31Davies RR, Haldeman S, McCulloch MA, Gidding SS, Pizarro C. Low body mass index is associated with increased waitlist mortality among children listed for heart transplant. J Heart Lung Transplant. 2015; 34(11): 1462-1470. doi:10.1016/j.healun.2015.05.023
10.1016/j.healun.2015.05.023
PubMed Web of Science® Google Scholar
32Jha SR, Hannu MK, Chang S, et al. The prevalence and prognostic significance of frailty in patients with advanced heart failure referred for heart transplantation. Transplantation. 2016; 100(2): 429-436. doi:10.1097/TP.0000000000000991
10.1097/TP.0000000000000991
PubMed Web of Science® Google Scholar
33Bellumkonda L, Tyrrell D, Hummel SL, Goldstein DR. Pathophysiology of heart failure and frailty: a common inflammatory origin? Aging Cell. 2017; 16(3): 444-450. doi:10.1111/acel.12581
10.1111/acel.12581
CAS PubMed Web of Science® Google Scholar

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Volume28, Issue4

June 2024

e14772

Effect of body mass index on exercise capacity following pediatric heart transplantation

Abstract

Background

Methods

Results

Conclusion

CONFLICT OF INTEREST STATEMENT

Open Research

DATA AVAILABILITY STATEMENT

REFERENCES

Citing Literature

References

Information

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Effect of body mass index on exercise capacity following pediatric heart transplantation

Abstract

Background

Methods

Results

Conclusion

CONFLICT OF INTEREST STATEMENT

Open Research

DATA AVAILABILITY STATEMENT

REFERENCES

Citing Literature

References

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