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Venous Pressure Cost for Cardiac Index Increases During Exercise in Patients with Fontan Circulation Versus Those

Hiroyuki Takao1, Koki Sugiyama2, Takuro Kojima1

  • 1Department of Pediatric Cardiology, International Medical Center, Saitama Medical University.

International Heart Journal
|March 30, 2025
PubMed

Insights

Patients with Fontan circulation have a higher cost to increase venous pressure per unit cardiac index during exercise compared to biventricular circulation. This ΔVP/ΔCI may serve as a valuable prognostic marker for Fontan patients.

Area of Science:

  • Cardiology
  • Pediatric Cardiology
  • Hemodynamics

Background:

  • Patients with Fontan circulation (Fontan) exhibit higher venous pressure (VP) and lower cardiac index (CI) than those with biventricular circulation (BiV).
  • The cost to increase VP per unit CI (ΔVP/ΔCI) during exercise is hypothesized to be higher in Fontan than BiV.
  • No prior studies have specifically investigated ΔVP/ΔCI as a primary variable in this context.

Purpose of the Study:

  • To compare the ΔVP/ΔCI during exercise between patients with Fontan circulation and those with biventricular circulation.
  • To determine if ΔVP/ΔCI can serve as a potential circulatory or prognostic marker in Fontan patients.

Main Methods:

  • A pilot study involving 9 patients with Fontan and 10 with postoperative BiV.
  • Hemodynamic assessment during an ergometer-based exercise test.
  • Continuous measurement of CI using impedance cardiography.

Main Results:

  • Patients with Fontan were significantly older than those with BiV.
  • ΔVP/ΔCI values were significantly higher in the Fontan group at 25 W (P = 0.0008) and peak exercise (P = 0.0002).
  • High ΔVP/ΔCI values in Fontan patients correlated with elevated New York Heart Association functional class and hemodynamic concerns.

Conclusions:

  • Fontan circulation demonstrates a higher cost to increase VP per unit CI during exercise.
  • ΔVP/ΔCI may represent a potential circulatory or prognostic marker for Fontan patients.
  • Larger prospective studies are needed to validate these findings.

Keywords:
Cardiac outputCentral venous pressureErgometerPeripheral venous pressureUniventricular

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