{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T12:53:21Z","timestamp":1787748801522,"version":"build-2784847793"},"reference-count":31,"publisher":"MDPI AG","issue":"10","license":[{"start":{"date-parts":[[2022,5,12]],"date-time":"2022-05-12T00:00:00Z","timestamp":1652313600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJERPH"],"abstract":"<jats:p>Objective: To propose and evaluate an adapted NYHA classification for children with congenital heart disease (CHD) as a feasible clinical tool for classifying patients\u2019 fitness, cardiorespiratory efficiency and functional limitations during their ordinary daily activities, which are also characterized by vigorous and competitive physical exercise among peers. Methods: This cross-sectional investigation analyzed 332 patients (13.1 \u00b1 3.01 y\/o) who underwent surgical repair of CHD and performed Cardiopulmonary Exercise Testing (CPET). Patients were divided into NYHA class I, IIA and IIB by specific questioning regarding functional limitation and performance compared to peers and at strenuous intensity. Class IIA was characterized by slight exercise limitation only for strenuous\/competitive activities, whereas IIB for already ordinary physical activities. These NYHA classes were compared with maximal CPET on treadmill. Results: Patients\u2019 exercise capacity (exercise time, METs), aerobic capacity (VO2peak) and chronotropic response were found progressively impaired when NYHA class I was compared with IIA and IIB. Indeed, ventilatory-perfusion mismatch (PETCO2, VE\/VCO2) significantly worsened from NYHA class I to IIA, while no difference was found between IIA and IIB. Conclusion: This adapted NYHA-CHD classification could allow regular functional evaluations and accurate assessments by clinicians, leading to facilitated clinical management and timely medical interventions.<\/jats:p>","DOI":"10.3390\/ijerph19105907","type":"journal-article","created":{"date-parts":[[2022,5,12]],"date-time":"2022-05-12T21:46:53Z","timestamp":1652392013000},"page":"5907","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":12,"title":["Exercise Capacity and Cardiorespiratory Fitness in Children with Congenital Heart Diseases: A Proposal for an Adapted NYHA Classification"],"prefix":"10.3390","volume":"19","author":[{"given":"Daniel","family":"Neunhaeuserer","sequence":"first","affiliation":[{"name":"Sports and Exercise Medicine Division, Department of Medicine, University of Padova, Via Giustiniani 2, 35128 Padova, Italy"},{"name":"Clinical Network of Sports and Exercise Medicine of the Veneto Region, 35131 Padova, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0760-1354","authenticated-orcid":false,"given":"Francesca","family":"Battista","sequence":"additional","affiliation":[{"name":"Sports and Exercise Medicine Division, Department of Medicine, University of Padova, Via Giustiniani 2, 35128 Padova, Italy"},{"name":"Clinical Network of Sports and Exercise Medicine of the Veneto Region, 35131 Padova, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Barbara","family":"Mazzucato","sequence":"additional","affiliation":[{"name":"Sports and Exercise Medicine Division, Department of Medicine, University of Padova, Via Giustiniani 2, 35128 Padova, Italy"},{"name":"Clinical Network of Sports and Exercise Medicine of the Veneto Region, 35131 Padova, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2395-4977","authenticated-orcid":false,"given":"Marco","family":"Vecchiato","sequence":"additional","affiliation":[{"name":"Sports and Exercise Medicine Division, Department of Medicine, University of Padova, Via Giustiniani 2, 35128 Padova, Italy"},{"name":"Clinical Network of Sports and Exercise Medicine of the Veneto Region, 35131 Padova, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giulia","family":"Meneguzzo","sequence":"additional","affiliation":[{"name":"Sports and Exercise Medicine Division, Department of Medicine, University of Padova, Via Giustiniani 2, 35128 Padova, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5653-275X","authenticated-orcid":false,"given":"Giulia","family":"Quinto","sequence":"additional","affiliation":[{"name":"Sports and Exercise Medicine Division, Department of Medicine, University of Padova, Via Giustiniani 2, 35128 Padova, Italy"},{"name":"Clinical Network of Sports and Exercise Medicine of the Veneto Region, 35131 Padova, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2811-9041","authenticated-orcid":false,"given":"Josef","family":"Niebauer","sequence":"additional","affiliation":[{"name":"Institute of Sports Medicine, Prevention and Rehabilitation, Paracelsus Medical University of Salzburg, Lindhofstra\u00dfe 20, 5020 Salzburg, Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrea","family":"Gasperetti","sequence":"additional","affiliation":[{"name":"Sports and Exercise Medicine Division, Department of Medicine, University of Padova, Via Giustiniani 2, 35128 Padova, Italy"},{"name":"Clinical Network of Sports and Exercise Medicine of the Veneto Region, 35131 Padova, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1829-0259","authenticated-orcid":false,"given":"Vladimiro","family":"Vida","sequence":"additional","affiliation":[{"name":"Pediatric and Congenital Cardiac Surgery, Department of Cardio-Thoracic-Vascular Sciences and Public Health, University of Padova, Via Giustiniani 2, 35128 Padova, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0305-0113","authenticated-orcid":false,"given":"Giovanni","family":"Di Salvo","sequence":"additional","affiliation":[{"name":"Pediatric Cardiology Unit, Department of Woman and Child\u2019s Health, University of Padova, Via Giustiniani 2, 35128 Padova, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maurizio","family":"Varnier","sequence":"additional","affiliation":[{"name":"Sports and Exercise Medicine Division, Department of Medicine, University of Padova, Via Giustiniani 2, 35128 Padova, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0546-1514","authenticated-orcid":false,"given":"Andrea","family":"Ermolao","sequence":"additional","affiliation":[{"name":"Sports and Exercise Medicine Division, Department of Medicine, University of Padova, Via Giustiniani 2, 35128 Padova, Italy"},{"name":"Clinical Network of Sports and Exercise Medicine of the Veneto Region, 35131 Padova, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2022,5,12]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"2264","DOI":"10.1161\/CIRCULATIONAHA.110.946343","article-title":"Temporal Trends in Survival to Adulthood among Patients Born with Congenital Heart Disease from 1970 to 1992 in Belgium","volume":"122","author":"Moons","year":"2010","journal-title":"Circulation"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"438","DOI":"10.1136\/heart.85.4.438","article-title":"Survival with Congenital Heart Disease and Need for Follow up in Adult Life","volume":"85","author":"Wren","year":"2001","journal-title":"Heart"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"26","DOI":"10.1016\/j.ijcard.2010.08.030","article-title":"Measures of Exercise Capacity in Adults with Congenital Heart Disease","volume":"153","author":"Buys","year":"2011","journal-title":"Int. J. Cardiol."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"51","DOI":"10.1093\/ehjqcco\/qcx031","article-title":"New York Heart Association (NYHA) Classification in Adults with Congenital Heart Disease: Relation to Objective Measures of Exercise and Outcome","volume":"4","author":"Bredy","year":"2018","journal-title":"Eur. Heart J. Qual. Care Clin. Outcomes"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"563","DOI":"10.1093\/eurheartj\/ehaa554","article-title":"2020 ESC Guidelines for the Management of Adult Congenital Heart Disease","volume":"42","author":"Baumgartner","year":"2021","journal-title":"Eur. Heart J."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"4200","DOI":"10.1093\/eurheartj\/ehaa614","article-title":"Recommendations for Advance Care Planning in Adults with Congenital Heart Disease: A Position Paper from the ESC Working Group of Adult Congenital Heart Disease, the Association of Cardiovascular Nursing and Allied Professions (ACNAP), the European Association for Palliative Care (EAPC), and the International Society for Adult Congenital Heart Disease (ISACHD)","volume":"41","author":"Schwerzmann","year":"2020","journal-title":"Eur. Heart J."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"310","DOI":"10.1016\/S0002-9149(00)01364-3","article-title":"Aerobic Capacity in Adults with Various Congenital Heart Diseases","volume":"87","author":"Fredriksen","year":"2001","journal-title":"Am. J. Cardiol."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"4191","DOI":"10.1093\/eurheartj\/ehaa501","article-title":"Recommendations for Participation in Competitive Sport in Adolescent and Adult Athletes with Congenital Heart Disease (CHD): Position Statement of the Sports Cardiology Exercise Section of the European Association of Preventive Cardiology (EAPC), the European Society of Cardiology (ESC) Working Group on Adult Congenital Heart Disease and the Sports Cardiology, Physical Activity and Prevention Working Group of the Association for European Paediatric and Congenital Cardiology (AEPC)","volume":"41","author":"Budts","year":"2020","journal-title":"Eur. Heart J."},{"key":"ref_9","first-page":"1037","article-title":"2016 ESC Guidelines for the Diagnosis and Treatment of Acute and Chronic Heart Failure","volume":"74","author":"Ponikowski","year":"2016","journal-title":"Eur. Heart J."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"1137","DOI":"10.1136\/hrt.2003.025270","article-title":"Clinical Epidemiology of Heart Failure","volume":"93","author":"Mosterd","year":"2007","journal-title":"Heart"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"367","DOI":"10.1016\/j.cardfail.2012.01.016","article-title":"IIIB or Not IIIB: A Previously Unanswered Question","volume":"18","author":"Thibodeau","year":"2012","journal-title":"J. Card. Fail."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"2147","DOI":"10.1161\/CIR.0b013e318293688f","article-title":"Promotion of Physical Activity for Children and Adults with Congenital Heart Disease: A Scientific Statement from the American Heart Association","volume":"127","author":"Longmuir","year":"2013","journal-title":"Circulation"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"1016","DOI":"10.1016\/0735-1097(95)00242-7","article-title":"Cardiopulmonary function in adult patients late after Fontan repair","volume":"26","author":"Harrison","year":"1995","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"828","DOI":"10.1161\/CIRCULATIONAHA.104.529800","article-title":"Exercise Intolerance in Adult Congenital Heart Disease: Comparative Severity, Correlates, and Prognostic Implication","volume":"112","author":"Diller","year":"2005","journal-title":"Circulation"},{"key":"ref_15","doi-asserted-by":"crossref","unstructured":"Vecchiato, M., Neunhaeuserer, D., Quinto, G., Bettini, S., Gasperetti, A., Battista, F., Vianello, A., Vettor, R., Busetto, L., and Ermolao, A. (2021). Cardiopulmonary exercise testing in patients with moderate-severe obesity: A clinical evaluation tool for OSA?. Sleep Breath., 1\u20139.","DOI":"10.1007\/s11325-021-02475-0"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"1567","DOI":"10.1016\/S0735-1097(96)00412-3","article-title":"Oxygen Uptake Efficiency Slope: A New Index of Cardiorespiratory Functional Reserve Derived from the Relation between Oxygen Uptake and Minute Ventilation during Incremental Exercise","volume":"28","author":"Baba","year":"1996","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"S53","DOI":"10.1513\/AnnalsATS.201610-818FR","article-title":"Prognostic Role of Cardiopulmonary Exercise Testing in Clinical Practice. In Proceedings of the Annals of the American Thoracic Society","volume":"14","author":"Paolillo","year":"2017","journal-title":"Am. Thorac. Soc."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"150","DOI":"10.1016\/j.cardfail.2009.08.010","article-title":"Patients\u2019 Self-Assessed Functional Status in Heart Failure by New York Heart Association Class: A Prognostic Predictor of Hospitalizations, Quality of Life and Death","volume":"16","author":"Holland","year":"2010","journal-title":"J. Card. Fail."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"554","DOI":"10.1017\/S1047951102001002","article-title":"Aerobic Capacity in Adults with Tetralogy of Fallot","volume":"12","author":"Fredriksen","year":"2002","journal-title":"Cardiol. Young"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"368","DOI":"10.1378\/chest.125.2.368","article-title":"Assessment of Symptoms and Exercise Capacity in Cyanotic Patients with Congenital Heart Disease","volume":"125","author":"Opitz","year":"2004","journal-title":"Chest"},{"key":"ref_21","first-page":"412","article-title":"Exercise Testing in Adults after Repair of Aortic Coarctation Evaluation of Cardiopulmonary Exercise Capacity and B-Type Natriuretic Protein Levels","volume":"34","author":"Trojnarska","year":"2007","journal-title":"Clin. Investig."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"192","DOI":"10.5114\/aoms.2010.13893","article-title":"Evaluation of Exercise Capacity with Cardiopulmonary Exercise Testing and BNP Levels in Adult Patients with Single or Systemic Right Ventricles","volume":"6","author":"Trojnarska","year":"2010","journal-title":"Arch. Med. Sci."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"1007","DOI":"10.1016\/j.amjcard.2009.05.046","article-title":"Determinants of Exercise Capacity After Arterial Switch Operation for Transposition of the Great Arteries","volume":"104","author":"Giardini","year":"2009","journal-title":"Am. J. Cardiol."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"230","DOI":"10.1016\/j.ijcard.2019.06.030","article-title":"Factors Associated with Exercise Capacity in Patients with a Systemic Right Ventricle","volume":"292","author":"Gavotto","year":"2019","journal-title":"Int. J. Cardiol."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"S24","DOI":"10.1016\/j.ahj.2009.07.017","article-title":"New York Heart Association Functional Class Predicts Exercise Parameters in the Current Era","volume":"158","author":"Russell","year":"2009","journal-title":"Am. Heart J."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"1868","DOI":"10.1016\/j.amjcard.2019.02.053","article-title":"Relation Between New York Heart Association Functional Class and Objective Measures of Cardiopulmonary Exercise in Adults with Congenital Heart Disease","volume":"123","author":"Das","year":"2019","journal-title":"Am. J. Cardiol."},{"key":"ref_27","first-page":"441","article-title":"NYHA Class II subgrouping: Correlation with left ventricular dysfunction questionnaire (LVD-36) and ejection fraction","volume":"58","author":"Spoladore","year":"2010","journal-title":"Minerva Cardioangiol."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"2045894018822985","DOI":"10.1177\/2045894018822985","article-title":"Assessment of quality of life in pediatric patients with pulmonary hypertension","volume":"9","author":"Handler","year":"2019","journal-title":"Pulm. Circ."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"560","DOI":"10.1016\/j.ejheart.2008.04.009","article-title":"Prognostic value of cardiopulmonary exercise testing in children with heart failure secondary to idiopathic dilated cardiomyopathy in a non-beta-blocker therapy setting","volume":"10","author":"Camargo","year":"2008","journal-title":"Eur. J. Heart Fail."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"2261","DOI":"10.1161\/CIR.0b013e31826fb946","article-title":"Clinical Recommendations for Cardiopulmonary Exercise Testing Data Assessment in Specific Patient Populations","volume":"126","author":"Guazzi","year":"2012","journal-title":"Circulation"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"1375","DOI":"10.1111\/sms.13457","article-title":"Comparison of Cardiovascular Screening Guidelines for Middle-Aged\/Older Adults","volume":"29","author":"Ermolao","year":"2019","journal-title":"Scand. J. Med. Sci. Sports"}],"container-title":["International Journal of Environmental Research and Public Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1660-4601\/19\/10\/5907\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T23:10:01Z","timestamp":1760137801000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1660-4601\/19\/10\/5907"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,5,12]]},"references-count":31,"journal-issue":{"issue":"10","published-online":{"date-parts":[[2022,5]]}},"alternative-id":["ijerph19105907"],"URL":"https:\/\/doi.org\/10.3390\/ijerph19105907","relation":{},"ISSN":["1660-4601"],"issn-type":[{"value":"1660-4601","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,5,12]]}}}