タケウチ　ダイジ   TAKEUCHI Daiji   竹内　大二    所属   医学部 医学科（東京女子医科大学病院）    職種   講師
言語種別	英語
発表タイトル	Bioelectrical impedance parameters are determinants for exercise capacity in the patients with adult congenital heart disease
会議名	European society of cardiology(ESC) congress 2018
学会区分	国際学会及び海外の学会
発表形式	ポスター掲示
講演区分	一般
発表者・共同発表者	Masaki Sato, Kei Inai, Hiroki Mori, Gen Harada, Seiji Asagai, Eriko Shimada, Mikiko Shimizu, Daiji Takeuchi, Keiko Toyohara, Tokuko Shinohara, Hirofumi Tomimatsu, Hisashi Sugiyama, Toshio Nakanishi
発表年月日	2018/08/26
開催地 （都市, 国名）	Munich, Germany
概要	Introduction Patients with adult congenital heart disease (ACHD) reportedly have reduced exercise capacity. Underlying cardiac anatomy, chronotropic incompetence, and decreased lung function are thought to be associated with exercise impairment. However, little has been reported regarding the relationship between quantitative body composition and exercise capacity. Bioelectrical impedance analysis (BIA) is a safe and rapid assessment method and has been widely used in clinical research. We hypothesized that bioelectrical impedance parameters are determinants of exercise capacity in patients with ACHD. Methods We performed a prospective single-center study of 305 consecutive patients (median age, 26 years [range 12-60]; 48% males; 50% single ventricular morphology; 9% cyanotic) with CHD who were admitted to our institute between April 2014 and December 2017. We determined body composition using BIA and reviewed medical records to assess the association with bioelectrical impedance parameters, including the edema index (EI, ratio of extracellular water to total body water), skeletal muscle index (SMI, skeletal muscle massi divided by square of height), mineral index (MI, mineral mass divided by square of height), percent body fat (%BF), and exercise capacity (peak oxygen consumption [peakVO2], measured with a cardiopulmonary exercise test [CPX]). We compared bioelectrical impedance parameters in patients with single ventricular morphology with those in patients with biventricular morphology. Results A significant correlation was found between peakVO2 and EI (r=0.54, p<0.001), SMI (r=0.52, p<0.001), and MI (r=0.44, p<0.001) in multivariate analysis. Receiver operating characteristic curve analysis showed that the EI cutoff point for peakVO2 <20 (ml/kg/min) was 0.386 (area under the curve [AUC], 0.78; sensitivity, 0.67; specificity 0.76). With the same analysis, the SMI cutoff point was 7.6 (kg/m2) (AUC, 0.78; sensitivity, 0.76; specificity 0.75) and the MI cutoff point was 0.96 (kg/m2) (AUC, 0.77; sensitivity, 0.72; specificity 0.86). Patients with single ventricular morphology had higher EI (mean, 0.387 vs. 0.381, p=0.002), lower SMI (7.8 vs. 8.3, p=0.009), and lower MI (1.03 vs. 1.07, p=0.015) than patients with biventricular morphology, resulting in lower peakVO2 (20.4 vs. 27.3, p<0.001) in patients with single ventricular morphology. Conclusion Bioelectrical impedance parameters are determinants of exercise capacity in patients with ACHD. Higher EI, lower SMI, and lower MI in patients with single ventricular morphology account for reduced exercise intolerance compared with patients with biventricular morphology.