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OBJECTIVE MEASUREMENT OF PHYSICAL ACTIVITY AND SEDENTARY BEHAVIOUR IN CHILDREN WITH CONGENITAL HEART DISEASE
Abstracts
acted as a confounding variable in this cohort. However, use of an activity tracker inspired interest in PA over the winter months and may have blunted the seasonal decline in PA that has been previously established in this age group. Subjects currently enrolled will provide the opportunity to compare the efficacy of the intervention across various seasons. The success of recruitment and high rates of compliance indicate that pediatric patients (and their families) are aware of the importance of PA and are seeking assurance regarding current activity habits and, for some, actuation to improve upon them. Heart and Stroke Foundation, BC & Yukon
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p¼.001) than girls (95% CI: 31.7, 42.5 mins/day). Bypass exposure and hospital length of stay (none, 10 days, > 10 days) were not related to Peabody or daily activity scores. Locomotor scores among 3-year olds (TGMD-2) increased with age (beta¼0.240.09/month, p<.01, partial eta2¼0.12) and bypass exposure (beta¼1.780.82, p¼.04, partial eta2¼0.08). CONCLUSION: Children treated in the current surgical era are not at risk for motor development delays from exposure to cardiopulmonary bypass. Sex differences observed for fine motor skill and daily physical activity are similar to population data. Daily physical activity participation was only 75% of the 180 minutes/day recommended for this age. Young children with CHD have the skills needed for physical activity, but the reason for their limited participation remains unknown.
112 PHYSICAL INACTIVITY IN VERY YOUNG CHILDREN WITH CONGENITAL HEART DEFECTS CANNOT BE EXPLAINED BY MOTOR DEVELOPMENT, HOSPITALIZATION OR CARDIOPULMONARY BYPASS EXPOSURE PE Longmuir, N Cinanni, N D’Alimonte, E Ertel, R Dillenburg, G Shanmugam, K Adamo, N Barrowman, MS Tremblay, BW Timmons, S Lee Ottawa, Ontario BACKGROUND:
Motor development delays among children with complex congenital heart defects (CHD) have been attributed to cardiopulmonary bypass exposure. In healthy children, motor skill deficits are associated with sedentary lifestyles. This study evaluated the associations between motor development and physical activity among young children with simple and complex CHD. METHODS: Children, 12 to 47 months, were recruited through two tertiary pediatric cardiac clinics. Assessments were the Peabody Motor Development Scale and 7-day physical activity via omni-directional accelerometer. Children 36 months also completed the Test of Gross Motor Development-2. Medical chart review determined total days of hospitalization and cardiopulmonary bypass exposure. RESULTS: 141 toddlers (75 males (53%), varying from 12 to 51 months in age (mean 30.9 11.0 mos) were enrolled in 5 study groups: innocent murmur (n¼30), CHD not requiring treatment (n¼40), CHD repaired without surgery (N¼20), surgical repair of CHD without cardiopulmonary bypass (n¼15), or surgical CHD repair with bypass (n¼36). Visual motor development was lower among those repaired without surgery (F¼2.7, p¼.04; 95% CI: 8.1, 10.3). Moderate and vigorous intensity daily activity (F¼2.9, p¼.03) was lowest among innocent murmur patients (95% CI: 26.0, 43.6 mins/ day) and highest among children with non-surgical repair (95% CI: 44.6, 70.0). Fine motor skills were better among girls (F¼9.6, p¼.002), and not related to study group (p¼.56). Children performed 135 48 minutes of physical activity daily (range: 8 to 289 mins). Boys (95% CI: 45.5, 58.4 mins/day) were significantly more active (F¼11.7,
Heart and Stroke Foundation of Ontario
113 OBJECTIVE MEASUREMENT OF PHYSICAL ACTIVITY AND SEDENTARY BEHAVIOUR IN CHILDREN WITH CONGENITAL HEART DISEASE SL Duncombe, C Voss, PH Dean, AM De Souza, KC Harris Vancouver, British Columbia BACKGROUND:
Physical activity is paramount for healthy growth and development, but it has been suggested that children with congenital heart disease (CHD) are less active than their healthy peers. Few studies have objectively measured physical activity in children across the CHD spectrum, and none have investigated sedentary behaviour - an independent cardio-metabolic risk factor. Our aim was to objectively assess physical activity and sedentary behaviour across a wide age range and the CHD spectrum. METHODS: We recruited patients with CHD, aged 9-19 years, from pediatric cardiology clinics (BC Children’s Hospital or province-wide specialist travelling clinics). Participants were fitted with an accelerometer (GT3X+ or GT9XLink;
S132
ActiGraph LLC; 60s epoch) and instructed to wear it over the right hip over the next 7 days. We included accelerometry files if they had 3 days with 600 min/day wear time, and calculated mean daily minutes of moderate-to-vigorous physical activity (MVPA; 2296CPM) and mean daily % sedentary time (%Sedentary¼sedentary min (<100CPM)/ wear time min). We classified CHD disease complexity as mild, moderate, severe, or cardiac transplant based on Bethesda guidelines; we used multiple linear regression to assess the association between physical activity, disease complexity and relevant participant characteristics. RESULTS: We included 62 patients (13.72.5yrs; 56% male) with valid accelerometry data, of which 12 had mild CHD, 24 moderate CHD, 20 severe CHD and 6 had received a cardiac transplant. In multiple linear regression analyses, age was inversely related to daily mins of MVPA (p<0.05) and there was a significant association between disease complexity and MVPA: compared with mild CHD, children with severe CHD were significantly less active (p<0.05). Overall, median daily mins of MVPA was 29 min/day (interquartile range (IQR): 18.0-41.8 min) and only 15% met physical activity guidelines of 60 min of MVPA/day. Overall, median %Sedentary was 62% (IQR: 5269%). %Sedentary was higher in girls than in boys (p<0.05) and was positively related to age (p<0.001); there was no association between %Sedentary and disease complexity. BMI z-score was not associated with either MVPA or %Sedentary. CONCLUSION: Children with more severe CHD have lower levels of physical activity than those with mild CHD. Children with CHD also exhibit age- and sex-related patterns in physical activity and sedentary behaviour as expected for healthy children, suggesting that socio-cultural determinants are also at play.
Canadian Journal of Cardiology Volume 32 2016
Children’s Hospital, or possible coarctation of the aorta diagnosed in the University of Alberta or Alberta Children’s Hospital Fetal Cardiology programs with births between 2004 and 2015. Using medical record and echocardiographic review we established fetal diagnosis, requirement for and timing of operation. Cases with operation at greater than one year of age or incomplete data were excluded. RESULTS: There were 149 cases of possible coarctation of the aorta detected with complete data. 133 had a coarctation repair at less than 12 months of age. Fetal detection rate overall was 34.5% (46/133). There was no change in fetal diagnosis of coarctation of the aorta immediately following the 2009 Canadian guidelines: fetal diagnosis occurred in 28% of cases from 2004 - 2009 and also 28% from 2010 - 2010. However from 2013 - 2015 49% of cases were diagnosed during fetal life. Of critical cases (requiring intervention in the first month), 33% were diagnosed prenatally from 2004 2009, 39% from 2010 - 2012 and 53% from 2013 to 2015. There were 16 false positive cases of fetal coarctation during the study period, and 1 false negative. CONCLUSIONS: Fetal diagnosis of coarctation of the aorta has increased significantly, however remains approximately half of all infant cases. Diagnosis of critical coarctation now occurs prenatally in 53%. Further improvement in prenatal diagnosis will likely require mandated imaging of the three-vessel view and aortic isthmus.
115 PRE NATAL MANIFESTATIONS OF HYPERTHYROIDISM A Méndez Santos, J Bigras, J Déry, M Raboisson
114 IMPROVING RATE OF FETAL DIAGNOSIS OF COARCTATION OF THE AORTA IN ALBERTA. DOES IT RELATE TO OBSTETRIC SCREENING GUIDELINES? LG Eckersley, MM Houshmandi, LK Hornberger Edmonton, Alberta BACKGROUND:
Coarctation of the aorta is one of the most difficult congenital cardiac lesions to detect in the fetus, and despite postnatal oximetry screening programs, remains the critical heart defect most likely to be undetected prior to neonatal discharge from hospital after birth. Since 2009 new formal Canadian obstetric ultrasound guidelines have been implemented that mandate evaluation of the ventricular outflow tracts and encourage views of the great arteries and arches. In 2013, the International Society of Ultrasound in Obstetrics and Gynaecology recommended further imaging where the ventricular outflow tracts could not be confirmed as normal. The rate of fetal detection of coarctation of the aorta in Alberta has not been audited over this era. METHODS: We conducted a retrospective analysis of cases of simple coarctation of the aorta diagnosed at the Stollery
Montréal, Québec BACKGROUND:
Cardiac manifestations of thyrotoxicosis have been described in neonates and adults but fetal descriptions are scarce. METHODS: We report two fetuses referred for cardiomegaly that were diagnosed with thyrotoxicosis after cardiac ultrasound. RESULTS: First fetus was seen at thirty weeks of gestation with sinus tachycardia at 180 bpm and moderate tricuspid regurgitation. The mother had been treated previously for Grave’s disease but thyroid stimulating immunoglobulins were still high. Second fetus was seen at twenty-four weeks of gestation with normal heart rate (150 bpm) and pericardial effusion. Right ventricle was dilated and hypertrophic with abnormal filling. Tricuspid valve was thickened with moderate regurgitation. Superior vena cava (SVC) was dilated and aortic isthmus diameter at the inferior limit of normal. Doppler velocities of the aortic isthmus Doppler was abnormal with diastolic retrograde flow mimicking cerebral vasodilatation. Cerebral circulation was normal but cervical color Doppler showed an hypervascular structure corresponding to thyrotoxic goitre measured 21mm. This mother was treated for thyrotoxicosis years before but was lost at follow up. After
acted as a confounding variable in this cohort. However, use of an activity tracker inspired interest in PA over the winter months and may have blunted the seasonal decline in PA that has been previously established in this age group. Subjects currently enrolled will provide the opportunity to compare the efficacy of the intervention across various seasons. The success of recruitment and high rates of compliance indicate that pediatric patients (and their families) are aware of the importance of PA and are seeking assurance regarding current activity habits and, for some, actuation to improve upon them. Heart and Stroke Foundation, BC & Yukon
S131
p¼.001) than girls (95% CI: 31.7, 42.5 mins/day). Bypass exposure and hospital length of stay (none, 10 days, > 10 days) were not related to Peabody or daily activity scores. Locomotor scores among 3-year olds (TGMD-2) increased with age (beta¼0.240.09/month, p<.01, partial eta2¼0.12) and bypass exposure (beta¼1.780.82, p¼.04, partial eta2¼0.08). CONCLUSION: Children treated in the current surgical era are not at risk for motor development delays from exposure to cardiopulmonary bypass. Sex differences observed for fine motor skill and daily physical activity are similar to population data. Daily physical activity participation was only 75% of the 180 minutes/day recommended for this age. Young children with CHD have the skills needed for physical activity, but the reason for their limited participation remains unknown.
112 PHYSICAL INACTIVITY IN VERY YOUNG CHILDREN WITH CONGENITAL HEART DEFECTS CANNOT BE EXPLAINED BY MOTOR DEVELOPMENT, HOSPITALIZATION OR CARDIOPULMONARY BYPASS EXPOSURE PE Longmuir, N Cinanni, N D’Alimonte, E Ertel, R Dillenburg, G Shanmugam, K Adamo, N Barrowman, MS Tremblay, BW Timmons, S Lee Ottawa, Ontario BACKGROUND:
Motor development delays among children with complex congenital heart defects (CHD) have been attributed to cardiopulmonary bypass exposure. In healthy children, motor skill deficits are associated with sedentary lifestyles. This study evaluated the associations between motor development and physical activity among young children with simple and complex CHD. METHODS: Children, 12 to 47 months, were recruited through two tertiary pediatric cardiac clinics. Assessments were the Peabody Motor Development Scale and 7-day physical activity via omni-directional accelerometer. Children 36 months also completed the Test of Gross Motor Development-2. Medical chart review determined total days of hospitalization and cardiopulmonary bypass exposure. RESULTS: 141 toddlers (75 males (53%), varying from 12 to 51 months in age (mean 30.9 11.0 mos) were enrolled in 5 study groups: innocent murmur (n¼30), CHD not requiring treatment (n¼40), CHD repaired without surgery (N¼20), surgical repair of CHD without cardiopulmonary bypass (n¼15), or surgical CHD repair with bypass (n¼36). Visual motor development was lower among those repaired without surgery (F¼2.7, p¼.04; 95% CI: 8.1, 10.3). Moderate and vigorous intensity daily activity (F¼2.9, p¼.03) was lowest among innocent murmur patients (95% CI: 26.0, 43.6 mins/ day) and highest among children with non-surgical repair (95% CI: 44.6, 70.0). Fine motor skills were better among girls (F¼9.6, p¼.002), and not related to study group (p¼.56). Children performed 135 48 minutes of physical activity daily (range: 8 to 289 mins). Boys (95% CI: 45.5, 58.4 mins/day) were significantly more active (F¼11.7,
Heart and Stroke Foundation of Ontario
113 OBJECTIVE MEASUREMENT OF PHYSICAL ACTIVITY AND SEDENTARY BEHAVIOUR IN CHILDREN WITH CONGENITAL HEART DISEASE SL Duncombe, C Voss, PH Dean, AM De Souza, KC Harris Vancouver, British Columbia BACKGROUND:
Physical activity is paramount for healthy growth and development, but it has been suggested that children with congenital heart disease (CHD) are less active than their healthy peers. Few studies have objectively measured physical activity in children across the CHD spectrum, and none have investigated sedentary behaviour - an independent cardio-metabolic risk factor. Our aim was to objectively assess physical activity and sedentary behaviour across a wide age range and the CHD spectrum. METHODS: We recruited patients with CHD, aged 9-19 years, from pediatric cardiology clinics (BC Children’s Hospital or province-wide specialist travelling clinics). Participants were fitted with an accelerometer (GT3X+ or GT9XLink;
S132
ActiGraph LLC; 60s epoch) and instructed to wear it over the right hip over the next 7 days. We included accelerometry files if they had 3 days with 600 min/day wear time, and calculated mean daily minutes of moderate-to-vigorous physical activity (MVPA; 2296CPM) and mean daily % sedentary time (%Sedentary¼sedentary min (<100CPM)/ wear time min). We classified CHD disease complexity as mild, moderate, severe, or cardiac transplant based on Bethesda guidelines; we used multiple linear regression to assess the association between physical activity, disease complexity and relevant participant characteristics. RESULTS: We included 62 patients (13.72.5yrs; 56% male) with valid accelerometry data, of which 12 had mild CHD, 24 moderate CHD, 20 severe CHD and 6 had received a cardiac transplant. In multiple linear regression analyses, age was inversely related to daily mins of MVPA (p<0.05) and there was a significant association between disease complexity and MVPA: compared with mild CHD, children with severe CHD were significantly less active (p<0.05). Overall, median daily mins of MVPA was 29 min/day (interquartile range (IQR): 18.0-41.8 min) and only 15% met physical activity guidelines of 60 min of MVPA/day. Overall, median %Sedentary was 62% (IQR: 5269%). %Sedentary was higher in girls than in boys (p<0.05) and was positively related to age (p<0.001); there was no association between %Sedentary and disease complexity. BMI z-score was not associated with either MVPA or %Sedentary. CONCLUSION: Children with more severe CHD have lower levels of physical activity than those with mild CHD. Children with CHD also exhibit age- and sex-related patterns in physical activity and sedentary behaviour as expected for healthy children, suggesting that socio-cultural determinants are also at play.
Canadian Journal of Cardiology Volume 32 2016
Children’s Hospital, or possible coarctation of the aorta diagnosed in the University of Alberta or Alberta Children’s Hospital Fetal Cardiology programs with births between 2004 and 2015. Using medical record and echocardiographic review we established fetal diagnosis, requirement for and timing of operation. Cases with operation at greater than one year of age or incomplete data were excluded. RESULTS: There were 149 cases of possible coarctation of the aorta detected with complete data. 133 had a coarctation repair at less than 12 months of age. Fetal detection rate overall was 34.5% (46/133). There was no change in fetal diagnosis of coarctation of the aorta immediately following the 2009 Canadian guidelines: fetal diagnosis occurred in 28% of cases from 2004 - 2009 and also 28% from 2010 - 2010. However from 2013 - 2015 49% of cases were diagnosed during fetal life. Of critical cases (requiring intervention in the first month), 33% were diagnosed prenatally from 2004 2009, 39% from 2010 - 2012 and 53% from 2013 to 2015. There were 16 false positive cases of fetal coarctation during the study period, and 1 false negative. CONCLUSIONS: Fetal diagnosis of coarctation of the aorta has increased significantly, however remains approximately half of all infant cases. Diagnosis of critical coarctation now occurs prenatally in 53%. Further improvement in prenatal diagnosis will likely require mandated imaging of the three-vessel view and aortic isthmus.
115 PRE NATAL MANIFESTATIONS OF HYPERTHYROIDISM A Méndez Santos, J Bigras, J Déry, M Raboisson
114 IMPROVING RATE OF FETAL DIAGNOSIS OF COARCTATION OF THE AORTA IN ALBERTA. DOES IT RELATE TO OBSTETRIC SCREENING GUIDELINES? LG Eckersley, MM Houshmandi, LK Hornberger Edmonton, Alberta BACKGROUND:
Coarctation of the aorta is one of the most difficult congenital cardiac lesions to detect in the fetus, and despite postnatal oximetry screening programs, remains the critical heart defect most likely to be undetected prior to neonatal discharge from hospital after birth. Since 2009 new formal Canadian obstetric ultrasound guidelines have been implemented that mandate evaluation of the ventricular outflow tracts and encourage views of the great arteries and arches. In 2013, the International Society of Ultrasound in Obstetrics and Gynaecology recommended further imaging where the ventricular outflow tracts could not be confirmed as normal. The rate of fetal detection of coarctation of the aorta in Alberta has not been audited over this era. METHODS: We conducted a retrospective analysis of cases of simple coarctation of the aorta diagnosed at the Stollery
Montréal, Québec BACKGROUND:
Cardiac manifestations of thyrotoxicosis have been described in neonates and adults but fetal descriptions are scarce. METHODS: We report two fetuses referred for cardiomegaly that were diagnosed with thyrotoxicosis after cardiac ultrasound. RESULTS: First fetus was seen at thirty weeks of gestation with sinus tachycardia at 180 bpm and moderate tricuspid regurgitation. The mother had been treated previously for Grave’s disease but thyroid stimulating immunoglobulins were still high. Second fetus was seen at twenty-four weeks of gestation with normal heart rate (150 bpm) and pericardial effusion. Right ventricle was dilated and hypertrophic with abnormal filling. Tricuspid valve was thickened with moderate regurgitation. Superior vena cava (SVC) was dilated and aortic isthmus diameter at the inferior limit of normal. Doppler velocities of the aortic isthmus Doppler was abnormal with diastolic retrograde flow mimicking cerebral vasodilatation. Cerebral circulation was normal but cervical color Doppler showed an hypervascular structure corresponding to thyrotoxic goitre measured 21mm. This mother was treated for thyrotoxicosis years before but was lost at follow up. After