Semi-invasive Pressure-flow Plots Obtained Using Exercise Echocardiography Relate to Clinical Status and Exercise Capacity in Patients with a Fontan Circulation.

IF 5.4 2区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

Journal of the American Society of Echocardiography Pub Date : 2025-05-21 DOI:10.1016/j.echo.2025.05.007

Aleksandra Cieplucha, Hannah Van Belle, William R Miranda, Youri Bekhuis, Elise Decorte, Mathijs Michielsen, Pieter De Meester, Els Troost, Irene Cattapan, Thomas Rosseel, Jan Verwerft, Guido Claessen, Véronique A Cornelissen, Kaatje Goetschalckx, Marc Gewillig, Werner Budts, Alexander Van De Bruaene

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引用次数: 0

Abstract

Aims: Exercise echocardiography with peripheral venous pressure measurement (CPETecho-PVP) may provide superior insights into the pathophysiology of Fontan failure compared to standard cardiopulmonary exercise testing. Accordingly, we assessed (1) the clinical and hemodynamic correlates of pressure-flow plots obtained from CPETecho-PVP in Fontan patients and (2) the relationship between pressure-flow plots and exercise capacity.

Methods: Forty-one consecutive Fontan patients underwent CPETecho-PVP. PVP was measured in the distal upper extremity using an 18-20-gauge intravenous line. A multipoint PVP/cardiac output (CO) slope was calculated as a linear approximation using linear regression analysis from individual pressure-flow plots. A PVP/CO >3 mmHg/L/min was considered elevated.

Results: Median age was 28 (range 17-60) years; LV dominance was present in 32 (78%) patients. Compared to patients with a PVP/CO slope ≤3 mmHg/L/min (n=29), those with a PVP/CO slope >3 mmHg/L/min were more likely to have a NYHA functional class III-IV (p=0.005), lung pathology (p=0.004), a history of atrial arrhythmia (p=0.009) or thrombo-embolism (p=0.02). Additionally, a PVP/CO slope >3 mmHg/L/min was associated with higher NT pro-BNP levels (325.0 [176.3-590.0] vs. 150.5 [61.3 - 255.0] ng/L, p=0.034), lower peak oxygen consumption (peak VO₂) 48.7±13.3 vs 65.2±15.3 % predicted, p=0.003), heart rate reserve (65 [42-105] vs. 100 [75-127] % predicted, p=0.010) and peak cardiac index (CI) (3.8±0.8 vs 6.3±1.5 L/min.m², p<0.001). Rest-to-peak change in HR (p<0.001) and CI (p=0.006), %predicted forced vital capacity (p=0.044) and PVP/CO slope (p=0.009) were all related to % predicted peak VO₂.

Conclusions: A steeper PVP/CO plot is associated with worse clinical status, including lower exercise capacity. This supports the notion of implementing the CPETecho-PVP in the standard of care for Fontan patients.

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利用运动超声心动图获得的半有创压力-血流图与Fontan循环患者的临床状态和运动能力有关。

目的：与标准的心肺运动试验相比，运动超声心动图外周静脉压测量（cpeteco - pvp）可以更好地了解Fontan衰竭的病理生理学。因此，我们评估了(1)cpeteco - pvp在Fontan患者中获得的压力-血流图的临床和血流动力学相关性；(2)压力-血流图与运动能力之间的关系。方法：连续41例Fontan患者行cpeteco - pvp治疗。在上肢远端使用18-20号静脉滴注线测量PVP。通过对个体压力-流量图进行线性回归分析，计算多点PVP/心输出量（CO）斜率为线性近似。PVP/CO浓度为3mmhg /L/min。结果：中位年龄28岁（17-60岁）；32例（78%）患者存在左室优势。与PVP/CO斜率≤3mmhg /L/min （n=29）的患者相比，PVP/CO斜率为bbb3mmhg /L/min的患者更有可能出现NYHA功能III-IV级（p=0.005）、肺部病理（p=0.004）、心房心律失常（p=0.009）或血栓栓塞（p=0.02）。此外，PVP/CO斜率bbbb3 mmHg/L/min与NT pro-BNP水平升高（325.0 [176.3-590.0]vs 150.5 [61.3 - 255.0] ng/L, p=0.034）、峰值耗氧量（峰值VO2）降低（48.7±13.3 vs 65.2±15.3%,p=0.003）、心率储备（65 [42-105]vs 100[75-127] %预测，p=0.010）和峰值心脏指数（CI）（3.8±0.8 vs 6.3±1.5 L/min）相关。平方米,p2。结论：PVP/CO曲线陡峭与较差的临床状况相关，包括较低的运动能力。这支持在Fontan患者的护理标准中实施cpetech - pvp的概念。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of the American Society of Echocardiography 医学-心血管系统

CiteScore

9.50

自引率

12.30%

发文量

257

审稿时长

66 days

期刊介绍： The Journal of the American Society of Echocardiography(JASE) brings physicians and sonographers peer-reviewed original investigations and state-of-the-art review articles that cover conventional clinical applications of cardiovascular ultrasound, as well as newer techniques with emerging clinical applications. These include three-dimensional echocardiography, strain and strain rate methods for evaluating cardiac mechanics and interventional applications.