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Article: Cardiopulmonary function in patients with congenital scoliosis: an observational study

TitleCardiopulmonary function in patients with congenital scoliosis: an observational study
Authors
Keywordsadolescent
adult
breathing
cardiopulmonary exercise test
cardiopulmonary function
Issue Date2019
PublisherLippincott, Williams & Wilkins. The Journal's web site is located at http://www.jbjs.org
Citation
Journal of Bone and Joint Surgery, 2019, v. 101 n. 12, p. 1109-1118 How to Cite?
AbstractBACKGROUND: Patients with congenital scoliosis often have restrictive pulmonary dysfunction on static pulmonary function testing (PFT). Although frequently asymptomatic during daily activities, these patients are generally assumed to have reduced exercise capacity. The aim of this study was to use dynamic cardiopulmonary exercise testing (CPET) to investigate exercise capacity and its association with spinal deformity in patients with congenital scoliosis. METHODS: Sixty patients with congenital scoliosis who underwent preoperative spinal radiography, PFT, and CPET were included from January 2014 to November 2017. The impact of thoracic spinal deformity and rib anomalies on pulmonary function and physical capacity was investigated. RESULTS: A significant deterioration in pulmonary function with increases in the severity of the major thoracic curve was demonstrated by the forced expiratory volume in 1 second (FEV1), forced vital capacity (FVC), and total lung capacity (all p < 0.001). The ratio of FEV1 to FVC was similar regardless of thoracic curve severity. A smaller tidal volume during exercise testing reflected restrictive dysfunction in the patients with the most severe curves. CPET also revealed a significant trend of faster breathing by patients with a severe thoracic curve (p < 0.001). Exercise capacity indicators such as work rate (p = 0.019), heart rate (p = 0.015), and oxygen saturation (p = 0.006) were significantly reduced only in patients with a thoracic curve of >100°. Pulmonary dysfunction was the major contributor to exercise intolerance. Compared with mild pulmonary dysfunction, moderate and severe dysfunction was associated with an abnormal breathing pattern and lower work rate (p = 0.032) and peak oxygen intake (p = 0.042), indicating worse exercise tolerance. CONCLUSIONS: Congenital scoliosis leads to restrictive pulmonary dysfunction, which reduces the tidal volume and forces patients to accelerate respiratory rates during exercise. Patients with a thoracic curve of >100° are unable to compensate and have significantly reduced exercise capacity. LEVEL OF EVIDENCE: Prognostic Level II. See Instructions for Authors for a complete description of levels of evidence.
Persistent Identifierhttp://hdl.handle.net/10722/277500
ISSN
2019 Impact Factor: 4.578
2015 SCImago Journal Rankings: 2.938

 

DC FieldValueLanguage
dc.contributor.authorLin, Y-
dc.contributor.authorShen, J-
dc.contributor.authorChen, L-
dc.contributor.authorYuan, W-
dc.contributor.authorCong, H-
dc.contributor.authorLuo, J-
dc.contributor.authorKwan, KY-
dc.date.accessioned2019-09-20T08:52:15Z-
dc.date.available2019-09-20T08:52:15Z-
dc.date.issued2019-
dc.identifier.citationJournal of Bone and Joint Surgery, 2019, v. 101 n. 12, p. 1109-1118-
dc.identifier.issn0021-9355-
dc.identifier.urihttp://hdl.handle.net/10722/277500-
dc.description.abstractBACKGROUND: Patients with congenital scoliosis often have restrictive pulmonary dysfunction on static pulmonary function testing (PFT). Although frequently asymptomatic during daily activities, these patients are generally assumed to have reduced exercise capacity. The aim of this study was to use dynamic cardiopulmonary exercise testing (CPET) to investigate exercise capacity and its association with spinal deformity in patients with congenital scoliosis. METHODS: Sixty patients with congenital scoliosis who underwent preoperative spinal radiography, PFT, and CPET were included from January 2014 to November 2017. The impact of thoracic spinal deformity and rib anomalies on pulmonary function and physical capacity was investigated. RESULTS: A significant deterioration in pulmonary function with increases in the severity of the major thoracic curve was demonstrated by the forced expiratory volume in 1 second (FEV1), forced vital capacity (FVC), and total lung capacity (all p < 0.001). The ratio of FEV1 to FVC was similar regardless of thoracic curve severity. A smaller tidal volume during exercise testing reflected restrictive dysfunction in the patients with the most severe curves. CPET also revealed a significant trend of faster breathing by patients with a severe thoracic curve (p < 0.001). Exercise capacity indicators such as work rate (p = 0.019), heart rate (p = 0.015), and oxygen saturation (p = 0.006) were significantly reduced only in patients with a thoracic curve of >100°. Pulmonary dysfunction was the major contributor to exercise intolerance. Compared with mild pulmonary dysfunction, moderate and severe dysfunction was associated with an abnormal breathing pattern and lower work rate (p = 0.032) and peak oxygen intake (p = 0.042), indicating worse exercise tolerance. CONCLUSIONS: Congenital scoliosis leads to restrictive pulmonary dysfunction, which reduces the tidal volume and forces patients to accelerate respiratory rates during exercise. Patients with a thoracic curve of >100° are unable to compensate and have significantly reduced exercise capacity. LEVEL OF EVIDENCE: Prognostic Level II. See Instructions for Authors for a complete description of levels of evidence.-
dc.languageeng-
dc.publisherLippincott, Williams & Wilkins. The Journal's web site is located at http://www.jbjs.org-
dc.relation.ispartofJournal of Bone and Joint Surgery-
dc.rightsThis is a non-final version of an article published in final form in (provide complete journal citation)-
dc.subjectadolescent-
dc.subjectadult-
dc.subjectbreathing-
dc.subjectcardiopulmonary exercise test-
dc.subjectcardiopulmonary function-
dc.titleCardiopulmonary function in patients with congenital scoliosis: an observational study-
dc.typeArticle-
dc.identifier.emailKwan, KY: kyhkwan@hku.hk-
dc.identifier.authorityKwan, KY=rp02014-
dc.description.naturelink_to_subscribed_fulltext-
dc.identifier.doi10.2106/JBJS.18.00935-
dc.identifier.pmid31220028-
dc.identifier.scopuseid_2-s2.0-85068493553-
dc.identifier.hkuros305963-
dc.identifier.volume101-
dc.identifier.issue12-
dc.identifier.spage1109-
dc.identifier.epage1118-
dc.publisher.placeUnited States-

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