Peripheral venous pressure changes during exercise are associated with adverse Fontan outcomes

Area of Science:

• Cardiology
• Pediatric Cardiology
• Physiology

Background:

• Elevated central venous pressure (CVP) is a known risk factor for adverse outcomes in individuals with a Fontan circulation.
• Peripheral venous pressure (PVP) has been established as a reliable surrogate for CVP in Fontan patients.

Purpose of the Study:

• To investigate the association between peripheral venous pressure (PVP) during exercise and the prevalence of adverse outcomes in adult Fontan patients.
• To determine if PVP response during cardiopulmonary exercise testing (CPET) can predict Fontan morbidity.

Main Methods:

• Adult Fontan patients underwent CPET with upper extremity PVP monitoring between 2015 and 2018.
• PVP was measured at rest, during unloaded cycling, and at peak exercise.
• PVP values were compared between patients with and without adverse outcomes, including arrhythmias, hospital admissions, heart failure, reintervention, heart transplantation, and death.

Main Results:

• Forty-six adult Fontan patients were analyzed (mean age 26.9 years).
• PVP significantly increased during exercise, reaching 23.0±5.5 mm Hg at peak exercise.
• Higher PVP during unloaded and peak exercise showed a strong association with adverse Fontan outcomes (e.g., composite outcome: unloaded PVP OR 6.1, peak PVP OR 4.0).
• Specific PVP cut-offs (unloaded ≥18 mm Hg, peak ≥25 mm Hg) demonstrated high specificity for predicting the composite adverse outcome.

Conclusions:

• Increased PVP during unloaded and peak exercise is strongly correlated with a higher incidence of adverse outcomes in Fontan patients.
• Minimally invasive PVP monitoring during CPET is a valuable tool for risk stratification in individuals with a Fontan circulation.