European Heart Journal Advance Access published online on August 18, 2009
European Heart Journal, doi:10.1093/eurheartj/ehp305
Exercise capacity, quality of life, and daily activity in the long-term follow-up of patients with univentricular heart and total cavopulmonary connection
1 Department of Pediatric Cardiology and Congenital Heart Disease, Deutsches Herzzentrum München, Technische Universität München, Lazarettstr. 36, D-80636 München, Germany
2 Department of Cardiovascular Surgery, Deutsches Herzzentrum München, Technische Universität München, München, Germany
Received 16 December 2008; revised 13 May 2009; accepted 12 June 2009 * Corresponding author. Tel: +49 89 1218 3009, Fax: +49 89 1218 3003, Email: muellerjan{at}dhm.mhn.de
Aims: Patients with congenital heart disease usually show diminished exercise capacity and quality of life. However, there is only little information about daily activity, a marker for lifestyle, exercise capacity, and the prevention of arteriosclerosis. This study investigated exercise capacity, quality of life, daily activity, and their interaction with univentricular heart physiology after total cavopulmonary connection (TCPC).
Methods and results: Fifty-seven patients (18 females, 39 males, age 8–52 years) after TCPC (lateral tunnel 28, extra-cardiac conduit 29) who underwent surgery during 1994–2001 were examined in our institution. They performed a symptom-limited cardiopulmonary exercise test. Those patients 14 years of age and older filled in the health-related quality-of-life questionnaire SF-36, and those who were 8–13 years of age, the CF-87. Daily activity parameters were obtained by using a triaxial accelerometer over the next three consecutive days. Exercise capacity was severely reduced after TCPC (25.0 mL/min/kg corresponding to 59.7% of age- and sex-related reference values). Daily activity was within the recommendations of the United Kingdom Expert Consensus Group (
60 min, 3 metabolic equivalent, 5 days/week) in 72% of the investigated patients. It was reduced in older patients (Spearman r = – 0.506, P < 0.001) and patients with a lower peak oxygen uptake (Spearman r = 0.432, P = 0.001). In children <14 years, mental health was related to daily activity.
Conclusion: Despite their diminished exercise capacity, patients after TCPC show a fairly normal activity pattern. However, their activity depends not only on age, but also on exercise capacity, which, in contrast to healthy people, decreases already from early adolescence on.
Key Words: Congenital heart disease • Exercise capacity • Total cavopulmonary connection • Long-term follow-up • Quality of life • Daily activity