Open Access

ARTICLE

Chronic Fatigue in Adolescents: The Role of Congenital Heart Disease vs. Psychosocial Factors

Elena Likhomanova¹, Olga Shevaldova^1,2,*, Anastasia Kovaleva¹, Anna Zavarina²

1 Federal Research Center for Innovator and Emerging Biomedical and Pharmaceutical Technologies, Baltiyskaya str., 8, Moscow, Russia
2 A.N. Bakulev National Medical Research Center for Cardiovascular Surgery of the Russian Ministry of Health, Rublyovskoye shosse, 135, Moscow, Russia

* Corresponding Author: Olga Shevaldova. Email:

(This article belongs to the Special Issue: Mental Health & Behaviour in CHD)

Structural and Congenital Heart Disease 2026, 21(4), 7 https://doi.org/10.32604/schd.2026.079461

Received 21 January 2026; Accepted 18 September 2026; Issue published 30 September 2026

Abstract

Background: Fatigue is a prevalent clinical complaint in adolescence, but its determinants—particularly in congenital heart disease (CHD)—remain poorly understood. Objective: This study aimed to compare the severity and multidimensional profile of fatigue symptoms between adolescents with corrected CHD and school-based peers without reported chronic disease, and to evaluate the independent contributions of cardiac severity indices, echocardiographic parameters, and physical work capacity to fatigue severity. Methods: In a cross-sectional comparative study, 229 adolescents (11–17 years), including 154 with corrected CHD (simple, moderate, complex defects) and 75 controls, completed the validated Russian “Degree of Chronic Fatigue” questionnaire. All CHD patients underwent echocardiography (left ventricular ejection fraction (LVEF), valvular gradients, and regurgitation grades) and bicycle ergometry (W/kg). Between-group differences were analyzed using nonparametric tests, false discovery rate (FDR) correction, multivariate analysis of covariance (MANCOVA), and linear regression with heteroscedasticity-consistent (HC3) robust standard errors. Null results were verified by post-hoc power analysis, Bayesian model comparison, equivalence testing. Results: The CHD group reported significantly lower fatigue on four of five domains compared with controls recruited from an academically selective school. Within the CHD cohort, neither CHD complexity, the New York Heart Association (NYHA) class, heart failure stage, nor any echocardiographic parameter correlated with fatigue. Physical work capacity showed only a weak association that did not survive multiple-testing correction. Female sex was the most consistent predictor of higher fatigue across both groups. Conclusions: Cardiac disease severity did not predict fatigue in this cohort. Fatigue appears multifactorial, with sex, functional capacity, and psychosocial context potentially playing greater roles than cardiac anatomy alone. The unexpectedly high fatigue in controls from a highly selective school limits generalizability. Replication in representative samples is needed.

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