Exercise Oscillatory Ventilation in Patients With Fontan Physiology. (March 2015)

• Record Type: Journal Article
• Authors: Nathan, Ashwin S.; Loukas, Brittani; Moko, Lilamarie; Wu, Fred; Rhodes, Jonathan; Rathod, Rahul H.; Systrom, David M.; Ubeda Tikkanen, Ana; Shafer, Keri; Lewis, Gregory D.; Landzberg, Michael J.; Opotowsky, Alexander R.
• Is Part Of: Circulation. Volume 8:Number 2(2015)
• Publication Date: 2015-03
• Subjects: Heart failure -- Periodicals; 616.129005
• DOI: 10.1161/CIRCHEARTFAILURE.114.001749
• Languages: English
• ISSNs: 1941-3289

Abstract

<abstract> <title> <x xml:space="preserve">Abstract</x> </title> <sec> <title>Background—</title> <p>Exercise oscillatory ventilation (EOV) refers to regular oscillations in minute ventilation (V<sub>E</sub>) during exercise. Its presence correlates with heart failure severity and worse prognosis in adults with acquired heart failure. We evaluated the prevalence and predictive value of EOV in patients with single ventricle Fontan physiology.</p> </sec> <sec> <title>Methods and Results—</title> <p>We performed a cross-sectional analysis and prospective survival analysis of patients who had undergone a Fontan procedure and subsequent cardiopulmonary exercise test. Data were reviewed for baseline characteristics and incident mortality, heart transplant, or nonelective cardiovascular hospitalization. EOV was defined as regular oscillations for >60% of exercise duration with amplitude >15% of average V<sub>E</sub>. Survival analysis was performed using Cox regression. Among 253 subjects, EOV was present in 37.5%. Patients with EOV were younger (18.8±9.0 versus 21.7±10.1 years; <italic>P</italic>=0.02). EOV was associated with higher New York Heart Association functional class (<italic>P</italic>=0.02) and V<sub>E</sub>/VCO<sub>2</sub> slope (36.8±6.9 versus 33.7±5.7; <italic>P</italic>=0.0002), but not with peak VO<sub>2</sub> (59.7±14.3 versus 61.0±16.0% predicted; <italic>P</italic>=0.52) or noninvasive measures of cardiac function. The presence of EOV was associated with slightly lower mean cardiac index but other invasive hemodynamic variables were similar. During a median follow-up of 5.5 years, 22 patients underwent transplant or died (n=19 primary deaths, 3 transplants with 2 subsequent deaths). EOV was associated with increased risk of death or transplant (hazard ratio, 3.9; 95% confidence interval, 1.5–10.0; <italic>P</italic>=0.002) and also predicted the combined outcome of death, transplant, or nonelective cardiovascular hospitalization after adjusting for New York Heart Association functional class, peak VO<sub>2</sub>, and other covariates (multivariable hazard ratio, 2.0; 95% confidence interval, 1.2–3.6; <italic>P</italic>=0.01).</p> </sec> <sec> <title>Conclusions—</title> <p>EOV is common in the Fontan population and strongly predicts lower transplant-free survival.</p> </sec> </abstract>