Noninvasive Advanced Cardiovascular Magnetic Resonance-Derived Fontan Hemodynamics Are Associated With Reduced Kidney...

Area of Science:

• Cardiology
• Nephrology
• Biomedical Engineering

Background:

• Kidney disease is a critical predictor of mortality in Fontan circulation patients.
• Clinical and hemodynamic factors contributing to kidney disease in this population are not well-established.

Purpose of the Study:

• To investigate the prevalence and correlates of kidney dysfunction in adolescents and young adults with Fontan circulation.
• To explore the association between advanced cardiovascular magnetic resonance (CMR)-derived hemodynamic metrics and kidney function.

Main Methods:

• 53 ambulatory patients with Fontan circulation underwent advanced CMR, including 4D flow imaging and computational fluid dynamics.
• Evaluated estimated glomerular filtration rate (eGFR) and albumin-to-creatinine ratio (ACR).
• Correlated hemodynamic parameters with eGFR and ACR.

Main Results:

• 20.8% of patients had eGFR <90 mL/min/1.73m² and 39.6% had ACR >3 mg/mmol.
• Average eGFR decline rate was -1.83 mL/min/1.73m²/year.
• Lower eGFR was associated with older age, larger body surface area, longer time since Fontan, and lower systemic ventricular ejection fraction.
• Hemodynamic factors like lower conduit area, higher velocity mismatch, and increased total cavopulmonary connection resistance correlated with lower eGFR.

Conclusions:

• Kidney dysfunction and albuminuria are prevalent in clinically stable young Fontan patients.
• CMR-derived hemodynamic metrics are linked to eGFR, offering potential therapeutic targets.
• Factors driving albuminuria require further investigation.