Chronotropic Response Predicts Exercise Performance in Children and Adolescents with Repaired Tetralogy of Fallot

The determinants of exercise performance in tetralogy of Fallot (TOF) are not well understood. The research team retrospectively analyzed a cross-sectional cohort of patients with TOF and evaluated the association of heart rate reserve with measures of exercise performance in a cohort of 152 patients with TOF, ages 8 to 18 years, who were studied prospectively by cardiac magnetic resonance and exercise stress test. The analysis showed that greater heart rate reserve was associated with better percent-predicted maximum oxygen consumption (%mVO2) and percent-predicted maximum work. This association remained significant after adjusting for indexed right ventricle end diastolic volume and left ventricular stroke volume. In the analysis of subjects that achieved a maximal effort on exercise testing, the only significant predictor of %mVO2 was left ventricular stroke volume. Heart rate reserve is an important contributor to exercise performance in patients with TOF during submaximal exercise, independent of right ventricle volume. Shivani M. Bhatt, et al. "Chronotropic Response Predicts Exercise Performance in Children and Adolescents with Repaired Tetralogy of Fallot," presented at the American College of Cardiology 67th Annual Scientific Session & Expo 2018.


Comparing Resource Utilization Among Pediatric Heart Transplant Indications Using a Novel, Merged Data Set

The recent UNOS-PHIS database merger enables novel analyses of inpatient management for pediatric heart transplant recipients. This study evaluated the variation in resource utilization among differing transplant indications using UNOS-PHIS data. The research team retrospectively analyzed a merged UNOS-PHIS cohort of pediatric heart transplant recipients from participating centers between 2004 and 2015. Patients were categorized as congenital heart disease (CHD), myocarditis and cardiomyopathy based on the UNOS-defined primary indication for first heart transplant. Of 2,264 pediatric heart transplants (1,106 CHD, 106 myocarditis, 1,039 cardiomyopathy), CHD recipients were younger and less likely to have a ventricular assist device at the time of transplant. Most transplants (86 percent) occurred at centers performing more than 10 pediatric heart transplants annually. Post-transplant length of stay, ICU resource utilization and mechanical ventilation were all longer in CHD than myocarditis or cardiomyopathy. Post-transplant costs were higher for CHD compared to myocarditis and cardiomyopathy, primarily driven by longer length of stay. Congenital heart disease is associated with increased resource utilization and costs during the first year post-HTx compared to cardiomyopathy and myocarditis. Danielle Burstein et al. "Comparing resource utilization among pediatric heart transplant indications using a novel, merged data set from the United Network for Organ Sharing and the Pediatric Health Information Systems (UNOS-PHIS) databases," presented at the American College of Cardiology 67th Annual Scientific Session & Expo 2018.

Children's Hospital of Philadelphia: Children's Hospital of Philadelphia was founded in 1855 as the nation's first pediatric hospital. Through its long-standing commitment to providing exceptional patient care, training new generations of pediatric healthcare professionals, and pioneering major research initiatives, Children's Hospital has fostered many discoveries that have benefited children worldwide. Its pediatric research program is among the largest in the country. In addition, its unique family-centered care and public service programs have brought the 546-bed hospital recognition as a leading advocate for children and adolescents. For more information, visit http://www.chop.edu

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