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Invasive and noninvasive hemodynamic assessment in adults with Fontan palliation
Alexander C Egbe1, Heidi M Connolly1, Nathaniel W Taggart2
1The Department of Cardiovascular Medicine, Mayo Clinic Rochester, MN 55906, United States.
Insights
Echocardiographic-Doppler cardiac index (CI) is feasible in Fontan patients and predicts outcomes. Lower Doppler CI values (<2.5 L/min/m²) are associated with Fontan failure in patients without cirrhosis.
Area of Science:
- Cardiology
- Congenital Heart Disease
- Echocardiography
Background:
- Echocardiographic-Doppler cardiac index (CI) is standard for heart failure management in biventricular circulation.
- Its utility in the Fontan population remains understudied.
Purpose of the Study:
- To correlate Doppler CI with cardiac catheterization CI in Fontan patients.
- To assess the association between Doppler CI and Fontan failure.
Main Methods:
- Retrospective review of adult Fontan patients (1994-2015) with concurrent echocardiogram and cardiac catheterization.
- Fontan failure defined as mortality, heart transplant listing, or palliative care.
Main Results:
- A positive correlation (r=0.52) was found between Doppler CI and Fick CI.
- Lower Doppler CI (<2.5 L/min/m²) predicted Fontan failure in patients without cirrhosis (OR 1.43).
- Patients with cirrhosis showed higher Doppler and Fick CI compared to those without.
Conclusions:
- Doppler CI assessment is feasible and predictive of clinical outcomes in select Fontan patients.
- Further research is needed for its application in systemic right ventricles.
Background/Objectives:
Although echocardiographic-Doppler cardiac index (CI) assessment is widely used to guide heart failure management in patients with biventricular circulation, this application has not been studied in the Fontan population. The objective of this study was to: (1) determine the correlation between Doppler and cardiac catheterization CI calculation; (2) determine the association between Doppler CI and the occurrence of Fontan failure.
Methods:
Retrospective review of adult Fontan patients followed at Mayo Clinic Adult Congenital Heart Disease program, 1994-2015. Inclusion criteria were: systemic left ventricle and echocardiogram and cardiac catheterization performed within the same week. Fontan failure was defined as a composite of all-cause mortality, heart transplantation listing, and palliative care.
Results:
59 patients (age 29±6years; men 32[54%]) underwent 97 studies. Of the 59, 41[69%] had atriopulmonary Fontan and 12 (20%) had cirrhosis. Compared to patients without cirrhosis, patients with cirrhosis had higher Doppler CI (3.6±0.6 vs 2.8±0.4L/min∗m2, p=0.039); Fick CI (3.3 [2.5-3.7] vs 2.4 [1.6-3.1] L/min/m2, p=0.028); lower systemic vascular resistance (20±3 vs 25±4 WU∗m2, p=0.04). There was a positive correlation between Doppler and Fick CI (r=0.52; p<0.0001). Fontan failure occurred in 13 patients (22%) within 7.5±2.1years. In patients without cirrhosis, Fick CI and Doppler CI <2.5L/min/m2 were associated with Fontan failure (odds ratio [OR] 1.58, p=0.046) and (OR 1.43, p=0.051) respectively.
Conclusions:
Doppler CI assessment in feasible in a selected group of Fontan patients and it is predictive of clinical outcomes. The application of this concept in systemic right ventricles deserves further research.
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