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。

IF 6 2区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

Journal of the American Society of Echocardiography Pub Date : 2025-09-01 DOI:10.1016/j.echo.2025.05.007

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

{"title":"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。","authors":"Aleksandra Cieplucha MD, PhD , Hannah Van Belle MD , William R. Miranda MD , Youri Bekhuis MD , Elise Decorte MSc , Mathijs Michielsen MSc , Pieter De Meester MD, PhD , Els Troost MD , Irene Cattapan MD , Thomas Rosseel MD , Jan Verwerft MD, PhD , Guido Claessen MD, PhD , Véronique A. Cornelissen PhD , Kaatje Goetschalckx MD , Marc Gewillig MD, PhD , Werner Budts MD, PhD , Alexander Van De Bruaene MD, PhD","doi":"10.1016/j.echo.2025.05.007","DOIUrl":null,"url":null,"abstract":"<div><h3>Aims</h3><div>Exercise echocardiography<span><span> with peripheral venous pressure measurement (CPETecho-PVP) may provide superior insights into the </span>pathophysiology<span> 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.</span></span></div></div><div><h3>Methods</h3><div>Forty-one consecutive Fontan patients underwent CPETecho-PVP. Peripheral venous pressure was measured in the distal upper extremity using an 18- to 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 mm Hg/L/min was considered elevated.</div></div><div><h3>Results</h3><div><span>Median age was 28 (range, 17-60) years; left ventricle dominance was present in 32 (78%) patients. Compared to patients with a PVP/CO slope ≤3 mm Hg/L/min (</span><em>n</em><span> = 29), those with a PVP/CO slope >3 mm Hg/L/min were more likely to have New York Heart Association functional class III to IV (</span><em>P</em> = .005), lung pathology (<em>P</em><span> = .004), history of atrial arrhythmia (</span><em>P</em><span> = .009), or thromboembolism (</span><em>P</em><span> = .02). Additionally, a PVP/CO slope >3 mm Hg/L/min was associated with higher N-terminal prohormone<span> of natriuretic peptide levels (325.0 [176.3-590.0] vs 150.5 [61.3-255.0] ng/L; </span></span><em>P</em> = .034), lower peak oxygen consumption (peak VO<sub>2</sub>) 48.7% ± 13.3% vs 65.2% ± 15.3% predicted; <em>P</em><span> = .003), lower heart rate reserve (65% [42%-105%] vs 100% [75%-127%] predicted; </span><em>P</em> = .010), and lower peak cardiac index (3.8 ± 0.8 vs 6.3 ± 1.5 L/min.m<sup>2</sup>; <em>P</em> < .001). Rest-to-peak change in heart rate (<em>P</em> < .001) and cardiac index (<em>P</em><span> = .006), percentage predicted forced vital capacity (</span><em>P</em> = .044), and PVP/CO slope (<em>P</em> = .009) were all related to percentage predicted peak VO<sub>2</sub>.</div></div><div><h3>Conclusions</h3><div>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.</div></div>","PeriodicalId":50011,"journal":{"name":"Journal of the American Society of Echocardiography","volume":"38 9","pages":"Pages 843-854"},"PeriodicalIF":6.0000,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Semi-Invasive Pressure-Flow Plots Obtained Using Exercise Echocardiography Relate to Clinical Status and Exercise Capacity in Patients With a Fontan Circulation\",\"authors\":\"Aleksandra Cieplucha MD, PhD , Hannah Van Belle MD , William R. Miranda MD , Youri Bekhuis MD , Elise Decorte MSc , Mathijs Michielsen MSc , Pieter De Meester MD, PhD , Els Troost MD , Irene Cattapan MD , Thomas Rosseel MD , Jan Verwerft MD, PhD , Guido Claessen MD, PhD , Véronique A. Cornelissen PhD , Kaatje Goetschalckx MD , Marc Gewillig MD, PhD , Werner Budts MD, PhD , Alexander Van De Bruaene MD, PhD\",\"doi\":\"10.1016/j.echo.2025.05.007\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div><h3>Aims</h3><div>Exercise echocardiography<span><span> with peripheral venous pressure measurement (CPETecho-PVP) may provide superior insights into the </span>pathophysiology<span> 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.</span></span></div></div><div><h3>Methods</h3><div>Forty-one consecutive Fontan patients underwent CPETecho-PVP. Peripheral venous pressure was measured in the distal upper extremity using an 18- to 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 mm Hg/L/min was considered elevated.</div></div><div><h3>Results</h3><div><span>Median age was 28 (range, 17-60) years; left ventricle dominance was present in 32 (78%) patients. Compared to patients with a PVP/CO slope ≤3 mm Hg/L/min (</span><em>n</em><span> = 29), those with a PVP/CO slope >3 mm Hg/L/min were more likely to have New York Heart Association functional class III to IV (</span><em>P</em> = .005), lung pathology (<em>P</em><span> = .004), history of atrial arrhythmia (</span><em>P</em><span> = .009), or thromboembolism (</span><em>P</em><span> = .02). Additionally, a PVP/CO slope >3 mm Hg/L/min was associated with higher N-terminal prohormone<span> of natriuretic peptide levels (325.0 [176.3-590.0] vs 150.5 [61.3-255.0] ng/L; </span></span><em>P</em> = .034), lower peak oxygen consumption (peak VO<sub>2</sub>) 48.7% ± 13.3% vs 65.2% ± 15.3% predicted; <em>P</em><span> = .003), lower heart rate reserve (65% [42%-105%] vs 100% [75%-127%] predicted; </span><em>P</em> = .010), and lower peak cardiac index (3.8 ± 0.8 vs 6.3 ± 1.5 L/min.m<sup>2</sup>; <em>P</em> < .001). Rest-to-peak change in heart rate (<em>P</em> < .001) and cardiac index (<em>P</em><span> = .006), percentage predicted forced vital capacity (</span><em>P</em> = .044), and PVP/CO slope (<em>P</em> = .009) were all related to percentage predicted peak VO<sub>2</sub>.</div></div><div><h3>Conclusions</h3><div>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.</div></div>\",\"PeriodicalId\":50011,\"journal\":{\"name\":\"Journal of the American Society of Echocardiography\",\"volume\":\"38 9\",\"pages\":\"Pages 843-854\"},\"PeriodicalIF\":6.0000,\"publicationDate\":\"2025-09-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Journal of the American Society of Echocardiography\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://www.sciencedirect.com/science/article/pii/S0894731725002676\",\"RegionNum\":2,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q1\",\"JCRName\":\"CARDIAC & CARDIOVASCULAR SYSTEMS\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of the American Society of Echocardiography","FirstCategoryId":"3","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S0894731725002676","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"CARDIAC & CARDIOVASCULAR SYSTEMS","Score":null,"Total":0}

引用次数: 0

摘要

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。

查看原文本刊更多论文

Semi-Invasive Pressure-Flow Plots Obtained Using Exercise Echocardiography Relate to Clinical Status and Exercise Capacity in Patients With a Fontan Circulation

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. Peripheral venous pressure was measured in the distal upper extremity using an 18- to 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 mm Hg/L/min was considered elevated.

Results

Median age was 28 (range, 17-60) years; left ventricle dominance was present in 32 (78%) patients. Compared to patients with a PVP/CO slope ≤3 mm Hg/L/min (n = 29), those with a PVP/CO slope >3 mm Hg/L/min were more likely to have New York Heart Association functional class III to IV (P = .005), lung pathology (P = .004), history of atrial arrhythmia (P = .009), or thromboembolism (P = .02). Additionally, a PVP/CO slope >3 mm Hg/L/min was associated with higher N-terminal prohormone of natriuretic peptide levels (325.0 [176.3-590.0] vs 150.5 [61.3-255.0] ng/L; P = .034), lower peak oxygen consumption (peak VO₂) 48.7% ± 13.3% vs 65.2% ± 15.3% predicted; P = .003), lower heart rate reserve (65% [42%-105%] vs 100% [75%-127%] predicted; P = .010), and lower peak cardiac index (3.8 ± 0.8 vs 6.3 ± 1.5 L/min.m²; P < .001). Rest-to-peak change in heart rate (P < .001) and cardiac index (P = .006), percentage predicted forced vital capacity (P = .044), and PVP/CO slope (P = .009) were all related to percentage 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.

求助全文

通过发布文献求助，成功后即可免费获取论文全文。去求助

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.