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Predictive utility of cardiac index-systemic vascular resistance plot and perfusion pressure in late post-Fontan
Yuki Kawasaki1, Takeshi Sasaki1, Daisuke Kobayashi1
1Division of Cardiology, Children's Hospital of Michigan, Carman and Ann Adams Department of Pediatrics, Wayne State University School of Medicine, St Louis, MO, USA.
Insights
In late Fontan patients, low perfusion pressure (< 53 mmHg) and specific hemodynamic categories predict heart transplantation or death, even with normal Fontan pressure. This aids in understanding post-Fontan status and prognosis.
Area of Science:
- Cardiology
- Pediatric Cardiology
- Congenital Heart Disease
Background:
- Fontan-associated complications can occur even with normal Fontan pressures.
- Identifying predictors of adverse outcomes in late Fontan patients is crucial.
Purpose of the Study:
- To identify hemodynamic predictors of heart transplantation or death in late post-Fontan patients, beyond Fontan pressure.
- To evaluate the predictive value of the cardiac index-systemic vascular resistance index plot and perfusion pressure.
Main Methods:
- Retrospective study of 79 post-Fontan patients (age ≥10 years) undergoing cardiac catheterization (1993-2018).
- Patients categorized into four hemodynamic groups (A-D) based on cardiac index and systemic vascular resistance index.
- Analysis of perfusion pressure and hemodynamic categories as predictors of heart transplantation/death.
Main Results:
- The primary endpoint (heart transplantation/death) occurred in 13% of patients.
- Hemodynamic Category C (low cardiac index, low systemic vascular resistance index) was associated with significantly shorter freedom from the endpoint.
- Multivariable analysis identified perfusion pressure < 53 mmHg and Category C as independent predictors of heart transplantation/death, alongside Fontan pressure.
Conclusions:
- Hemodynamic profiling using the cardiac index-systemic vascular resistance index plot is valuable for assessing late post-Fontan patients.
- Perfusion pressure and specific hemodynamic categories are important predictors of clinical outcomes in this population.
Introduction:
Cases of Fontan failure with normal Fontan pressure have been reported. This study aimed to identify catheterisation-derived haemodynamic predictors of heart transplantation/death, other than Fontan pressure, in late post-Fontan patients.
Methods:
This retrospective study evaluated post-Fontan patients who underwent cardiac catheterisation at age ≥10 years between 1993 and 2018. The predictive effect of cardiac index-systemic vascular resistance index plot and perfusion pressure on freedom from the primary outcome (heart transplantation/death) was evaluated. Patients were categorised into haemodynamic categories A (cardiac index ≥ 3, systemic vascular resistance index ≥ 13), B (cardiac index < 3, systemic vascular resistance index ≥ 13), C (cardiac index ≥ 3, systemic vascular resistance index < 13), and D (cardiac index < 3, systemic vascular resistance index < 13).
Results:
In total, 79 patients (median age: 15.7 [range: 10.1-50.2] years) were included; of them, the primary endpoint occurred in 10 (13%; median follow-up: 1.9 [range: 0.1-18.8] years). Category C patients had significantly shorter freedom from the endpoint than categories A and B patients. Univariate analysis identified significant haemodynamic predictors, including Fontan pressure, pulmonary/systemic vascular resistance index, pulmonary/systemic flow, systemic arterial oxygen saturation, systemic venous oxygen saturation, systemic vascular resistance index, perfusion pressure, perfusion pressure < 53 mmHg, and category C. In multivariable analysis, perfusion pressure < 53 mmHg and category C emerged as predictors of heart transplantation/death alongside Fontan pressure.
Conclusion:
Haemodynamic profiling of late post-Fontan patients using the cardiac index-systemic vascular resistance index plot can aid to comprehend the post-Fontan status and predict clinical prognosis.
