Does High-Intensity Exercise Cause Acute Liver Injury in Patients with Fontan Circulation? A Prospective Pilot Study
Alexis Gumm1,2, Salil Ginde3, George Hoffman4
1Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI, USA. agumm@mcw.edu.
Pediatric Cardiology
|May 23, 2023
Summary
High-intensity exercise in Fontan patients causes temporary drops in liver oxygen but no acute liver injury. Further research is needed to understand long-term effects on Fontan-associated liver disease (FALD).
Area of Science:
- Cardiology
- Hepatology
- Exercise Physiology
Background:
- Fontan procedure leads to chronic liver issues (FALD), including fibrosis and cirrhosis.
- Exercise is recommended but may worsen FALD due to increased central venous pressure.
- The impact of high-intensity exercise on acute liver injury in Fontan physiology is not well understood.
Purpose of the Study:
- To evaluate if acute liver injury occurs after high-intensity exercise in patients with Fontan physiology.
- To assess changes in liver oxygenation and injury markers during and after exercise.
Main Methods:
- Ten patients with Fontan physiology underwent cardiopulmonary exercise testing.
- Near-infrared spectroscopy (NIRS) monitored organ oxygen saturation, including the liver.
- Liver elastography, lab markers, and cytokines were measured pre- and post-exercise.
Main Results:
- Hepatic and renal NIRS showed decreased oxygenation during exercise, with slowest recovery in the liver.
- One patient with systolic dysfunction had increased liver stiffness post-exercise.
- Minor increases in ALT/GGT and significant rises in pro-inflammatory cytokines were observed, but no significant fibrogenic cytokine increase.
Conclusions:
- Fontan patients experience reduced liver oxygenation during high-intensity exercise.
- No clear evidence of acute liver congestion or injury was found immediately after exercise.
- Pro-inflammatory cytokines increased, suggesting potential long-term fibrogenic risk warrants further investigation.
Keywords:
Acute liver injuryExercise toleranceFontan-Associated Liver Disease (FALD)Liver ultrasound elastographyNear-infrared spectroscopy (NIRS)More Related Videos
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