Korean J Sports Med.  2022 Jun;40(2):86-93. 10.5763/kjsm.2022.40.2.86.

Association between Physical Activity and Chronotropic Incompetence in Patients with Complex Congenital Heart Disease

• Kim HJ
• Yoon JK
• Kim CH
• Kim SH
• Franklin BA
• Jae SY

• KMID: 2530311
• DOI: http://doi.org/10.5763/kjsm.2022.40.2.86

Abstract

Purpose
Although chronotropic incompetence (CI) is common in patients with complex congenital heart disease (CHD) and is associated with adverse cardiovascular outcomes, few data are available regarding modifiable predictors of CI in this escalating patient population. We tested the hypothesis that higher levels of physical activity (PA) are associated with a lower prevalence of CI in patients with complex CHD and evaluated the receiver operating characteristic curve to identify the PA level that best predicted CI.
Methods
We evaluated 111 adolescents with complex CHD. CI was defined as the failure to achieve 80% of the chronotropic response index during peak cardiopulmonary exercise test. Self-reported habitual activity was obtained using a global PA questionnaire.
Results
CI was identified in 45 of the 111 cases (40.5%). After adjusting for potential confounding variables, the high PA group demonstrated a lower odds ratio for having CI (odds ratios, 0.25; 95% confidence interval, 0.06‒0.99) compared with the low PA group. The most accurate cut-point for PA to predict the prevalence of CI was 15 metabolic equivalents (METs)-hours/week (areas under the curve, 0.71; 95% confidence interval, 0.61‒0.81; sensitivity, 71%; specificity, 69%).
Conclusion
Our findings demonstrate that higher levels of PA are associated with a lower prevalence of CI, independent of potential confounders, and that 15 METs-hours/week of PA provides a cut-point for accurately predicting the presence of CI in adolescents with complex CHD.

Keyword

Chronotropic incompetence; Physical activity; Exercise test; Congenital heart disease

Figure

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  Fig. 1 The receiver operating characteristic curve to identify the optimal physical activity level for the prediction of confidence interval. MET, metabolic equivalent.

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