Exercise‐induced changes in pulmonary artery wedge pressure in adults post‐Fontan versus heart failure with preserved ejection fraction and non‐cardiac dyspnoea. (23rd October 2022)

• Record Type: Journal Article
• Authors: Miranda, William R.; Borlaug, Barry A.; Jain, C. Charles; Anderson, Jason H.; Hagler, Donald J.; Connolly, Heidi M.; Egbe, Alexander C.
• Is Part Of: European journal of heart failure. Volume 25:Number 1(2023)
• Page Start: 17
• Page End: 25
• Publication Date: 2022-10-23
• Subjects: Fontan -- Exercise -- Cardiac catheterization -- Haemodynamics; Heart failure -- Periodicals; Heart Failure -- Periodicals; Insuffisance cardiaque -- Périodiques; Heart failure; Periodicals; 616.129005
• DOI: 10.1002/ejhf.2706
• Languages: English
• ISSNs: 1388-9842

Abstract

Abstract: Aims: Despite their universal predisposition, diagnosing diastolic dysfunction in patients post‐Fontan palliation is challenging. Our aim was to compare exercise haemodynamics between adults post‐Fontan and patients with heart failure with preserved ejection fraction (HFpEF) and non‐cardiac dyspnoea (NCD). Methods and results: Twenty‐four adults (age ≥18 years) post‐Fontan palliation with resting and exercise pulmonary artery wedge pressure (PAWP) measured during supine biking were identified. Forty‐eight patients with HFpEF and 48 with NCD diagnosed at catheterization were selected for comparison. Mean age for Fontan patients was 30.3 ± 7.5 years; median ventricular ejection fraction was 52.5% (45–55.8), being <50% in 37.5%. Resting PAWP among Fontan patients was 10.2 ± 3.5 mmHg (>12 mmHg in 25%); PAWP was lower in Fontan patients than in HFpEF but higher than NCD. During exercise, PAWP was lower in the Fontan group than HFpEF (22.5 mmHg [19.3–28] vs. 28.2 ± 6.3; p = 0.0006) but higher than NCD (11.2 ± 4.2, p ≤ 0.0001). However, there were no differences in ΔPAWP/ΔQs between Fontan and HFpEF patients (4.0 [2.1–7.3] vs. 2.7 [1.6–4.4]; p = 0.10) with the ratio being higher post‐Fontan than in NCD (0.6 [0.2–1.2]; p < 0.0001). ΔPAWP/ΔQs remained similar between HFpEF and Fontan patients even when those with ejection fraction <50% were excluded (2.7 [1.6–4.4] vs. 2.7 [1.0–5.8]; p = 0.97). Conclusion: There were no differences in ΔPAWP/ΔQs ratios between post‐Fontan and HFpEF patients, supporting markedly abnormal single ventricle compliance despite lower resting and exercise PAWP. Therefore, exercise invasive haemodynamics may represent a novel tool for the diagnosis of diastolic dysfunction in Fontan patients. Abstract : Serial changes in pulmonary artery wedge pressure (PAWP) and PAWP to Qs slopes in adult Fontan patients, heart failure with preserved ejection fraction (HFpEF) and non‐cardiac dyspnoea (NCD) ( p ‐values in red correspond to differences between Fontan and HFpEF patients while those in gray correspond to differences between Fontan and NCD for each phase).