Application of european society of cardiology guidelines 2020 on competitive sports eligibility in a large population of subjects with surgically corrected congenital heart disease
Authors: Battista F , Mazzucato B , Vecchiato M , Quinto G , Foccardi G , Gasperetti A , Vida V , Di Salvo G , Neunhaeuserer D , Ermolao A 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Congenital heart disease (CHD) affects approximately 0.5-1% of the general population. Thanks to the improvement of medical and surgical techniques, in developed countries 90% of individuals with CHD reach adulthood and, consequently, the demand for participation in sporting activities also increases. Recently, the European Society of Cardiology have given recommendations on participation in recreational and competitive sports (ESC 2020) based on a clinical and functional algorithm.

Purpose
To show the prevalence of the eligibility for competitive sports proposed by ESC 2020 in a real CHD population and the prevalence of real engagement in physical activity (both competitive and non-competitive). Also, to evaluate the difference in cardiorespiratory fitness (CRF) and the impact of training among different sport eligibility classes.

Methods
Retrospective study of 401 patients with surgically corrected CHD and followed up with cardiopulmonary exercise test (CPET) performed on treadmill or cycle ergometer until patients’ exhaustion. Subjects were divided in 4 classes according with ESC 2020 guidelines and corresponding to the eligibility for all competitive sport (A), all except endurance specialties (B), only for skill disciplines (C) or not eligible (D).

Results
Median (IQR) age was 18.0(13.0; 21.5) years; 266 patients (66.3%) were males. 34% were in class D, 13% in class B, 25% in class C and 28% in class A. Within the entire population, 179 subjects (44.6%) carried out structured exercise training, corresponding to 60.7% of subjects in class A, 45.1% of those in class B, 41.7% of those in class C and 41.1% of those in class D. VO2peak/Kg was similar between class A [39.2 (33.6-44.4) mL/Kg/min] and B [37.9 (30.6-42.6) mL/Kg/min], but significantly different between class A vs. class C [33.3 (28.3-41.4) mL/Kg/min p&lt;.0001] and class D [32.2 (27.6-39.3) mL/Kg/min p&lt;.0001]. Also, functional impairment, defined as &lt;85% of the predicted for age and sex, resulted significantly higher in patients in the lower classes of sport eligibility (C and D) than in the higher ones, with a prevalence of impaired CRF of 22.5% in class A, 42.5% in class B, 55.1% in class C and 57.0% in class D (p &lt;.0001). Paired comparison showed significant differences in CRF (VO2peak/Kg) between trained and untrained subjects both within and across ESC 2020 classes, while there was no significant difference between paired groups of different classes who presented the same level of physical activity (Figure 1).

Conclusions
Subjects in class A had better functional capacity than those in C and D classes, but exercise training (competitive or non-competitive) can have a significant impact on CRF level. Figure 1 shows that trained people in D class had higher CRF than untrained in A class, supporting that functional evaluation and an individualized exercise prescription may recruit functional "reserve" by improving the VO2peak as key prognostic component.