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Titel:

Exercise-dependent changes in ventricular-arterial coupling and aortopulmonary collateral flow in Fontan patients: a real-time CMR study.

Dokumenttyp:
Article; Journal Article
Autor(en):
Latus, Heiner; Hofmann, Lucas; Gummel, Kerstin; Khalil, Markus; Yerebakan, Can; Waschulzik, Birgit; Schranz, Dietmar; Voges, Inga; Jux, Christian; Reich, Bettina
Abstract:
AIMS: Inefficient ventricular-arterial (V-A) coupling has been described in Fontan patients and may result in adverse haemodynamics. A varying amount of aortopulmonary collateral (APC) flow is also frequently present that increases volume load of the single ventricle. The aim of the study was to assess changes in V-A coupling and APC flow during exercise CMR. METHODS AND RESULTS: Eighteen Fontan patients (age 24 ± 3 years) and 14 controls (age 23 ± 4 years) underwent exercise CMR using a cycle ergometer. Ventricular volumetry and flow measurements in the ascending aorta (AAO), inferior (IVC), and superior (SVC) vena cava were assessed using real-time sequences during stepwise increases in work load. Measures of systemic arterial elastance Ea, ventricular elastance Ees, and V-A coupling (Ea/Ees) were assessed. APC flow was quantified as AAO - (SVC + IVC). Ea remained unchanged during all levels of exercise in both groups (P = 0.39 and P = 0.11). Ees increased in both groups (P = 0.001 and P < 0.001) with exercise but was lower in the Fontan group (P = 0.04). V-A coupling was impaired in Fontan patients at baseline (P = 0.04). Despite improvement during exercise (P = 0.002) V-A coupling remained impaired compared with controls (P = 0.001). Absolute APC flow in Fontan patients did not change during exercise even at maximum work load (P = 0.98). CONCLUSIONS: Inefficient V-A coupling was already present at rest in Fontan patients and aggravated during exercise due to a limited increase in ventricular contractility which demonstrates the importance of a limited functional reserve of the single ventricle. APC flow remained unchanged suggesting no further increase in volume load during exercise.
Zeitschriftentitel:
Eur Heart J Cardiovasc Imaging
Jahr:
2022
Band / Volume:
24
Heft / Issue:
1
Seitenangaben Beitrag:
88-97
Volltext / DOI:
doi:10.1093/ehjci/jeac001
PubMed:
http://view.ncbi.nlm.nih.gov/pubmed/35045176
Print-ISSN:
2047-2404
TUM Einrichtung:
Institut für KI und Informatik in der Medizin (Prof. Rückert); Klinik für Kinderkardiologie und angeborene Herzfehler (DHM) (Prof. Ewert); Lehrstuhl für Medizinische Informatik (Prof. Boeker)
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