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DETECTION OF HEART FAILURE WITH PRESERVED EJECTION FRACTION IN SINGLE VENTRICLE PHYSIOLOGY: INSIGHTS FROM THE PEDIATRIC HEART NETWORK FONTAN CROSS-SECTIONAL STUDY PUBLIC USE DATASET
623 JACC March 21, 2017 Volume 69, Issue 11
Congenital Heart Disease DETECTION OF HEART FAILURE WITH PRESERVED EJECTION FRACTION IN SINGLE VENTRICLE PHYSIOLOGY: INSIGHTS FROM THE PEDIATRIC HEART NETWORK FONTAN CROSS-SECTIONAL STUDY PUBLIC USE DATASET Poster Contributions Poster Hall, Hall C Saturday, March 18, 2017, 9:45 a.m.-10:30 a.m. Session Title: Congenital Heart Disease: Innovations in Single Ventricle Heart Disease Abstract Category: 10. Congenital Heart Disease: Pediatric Presentation Number: 1182-013 Authors: Shahryar Chowdhury, Eric Graham, Carolyn Taylor, Geoffrey Forbus, Andrew Savage, Andrew Atz, Medical University of South Carolina, Charleston, SC, USA Introduction: Patients with single ventricle physiology frequently demonstrate decreased exercise tolerance after the Fontan operation. The objective of this study was to investigate the contribution of diastolic function to exercise function in these patients.
Methods: Core-lab echocardiograms and exercise test results were obtained from the publically-available Pediatric Heart Network Fontan Cross-sectional Study database. Exercise function was quantified as % predicted peak VO2. Ejection fraction (EF) was considered abnormal if < 50%. End-diastolic volume (EDV) was indexed to body surface area1.4. Diastolic function was defined as abnormal lateral E:e’/EDV was > 10th percentile. Patients were divided into three groups: 1 = normal EF and normal diastolic function, 2 = normal EF with abnormal diastolic function, and 3 = decreased EF with normal diastolic function. There were an inadequate number of patients with both abnormal EF and diastolic dysfunction to be included in the analysis. Results: 185 patients (61% left, 29% right, 10% mixed ventricular dominance) had EF, lateral E:e’/EDV, and peak VO2 measured. Differences between groups are reported in the Table.
Conclusions: Single ventricle patients with abnormal diastolic function and preserved EF had worse exercise capacity than patients with both normal and abnormal EF. Diastolic dysfunction appears to be an important limitation to exercise function in this population. Echocardiography may be useful in detecting this subset of patients. Group 1 (n = 141) Group 2 (n = 13) Group 3 (n = 31) p-value Age (years) 11.5 (4.5) 13.2 (5.8) 12.5 (5.3) 0.24 Height (cm) 145 (25) 161 (22) 147 (26) 0.07 # 36.2 (18.8) 0.01 Weight (kg) 38.8 (22.8) 55.5 (21.0)* SBP (mm Hg) 99 (18) 106 (14) 100 (15) 0.11 DBP (mm Hg) 56 (13) 56 (15) 56 (17) 0.65 54 (23) 33 (13)*# 62 (20) < 0.01 SV EDV (mL/m2.8) < 0.01 SV EF (%) 62.4 (11.3) 66.0 (11.0) 46.0 (7.3)#^ 2.8 # 0.13 (0.08) 0.34 (0.08)* 0.12 (0.05) < 0.01 Lateral E:e’/EDV (1/mL/m ) 64 (24) 56 (8) 68 (23) 0.41 Ventricular mass (g/m2.8) # 67 (23) 52 (20)* 63 (29) 0.02 % predicted peak VO2 93 (29) 72 (38) 87 (26) 0.09 % predicted peak O2 pulse * = p < 0.05, Group 1 vs. Group 2 ^ = p < 0.05, Group 1 vs. Group 3 # = p < 0.05, Group 2 vs. Group 3 Results reported as median (interquartile range). DBP = diastolic blood pressure; EDV = end-diastolic volume; EF = ejection fraction; SBP = systolic blood pressure SV = single ventricle
Congenital Heart Disease DETECTION OF HEART FAILURE WITH PRESERVED EJECTION FRACTION IN SINGLE VENTRICLE PHYSIOLOGY: INSIGHTS FROM THE PEDIATRIC HEART NETWORK FONTAN CROSS-SECTIONAL STUDY PUBLIC USE DATASET Poster Contributions Poster Hall, Hall C Saturday, March 18, 2017, 9:45 a.m.-10:30 a.m. Session Title: Congenital Heart Disease: Innovations in Single Ventricle Heart Disease Abstract Category: 10. Congenital Heart Disease: Pediatric Presentation Number: 1182-013 Authors: Shahryar Chowdhury, Eric Graham, Carolyn Taylor, Geoffrey Forbus, Andrew Savage, Andrew Atz, Medical University of South Carolina, Charleston, SC, USA Introduction: Patients with single ventricle physiology frequently demonstrate decreased exercise tolerance after the Fontan operation. The objective of this study was to investigate the contribution of diastolic function to exercise function in these patients.
Methods: Core-lab echocardiograms and exercise test results were obtained from the publically-available Pediatric Heart Network Fontan Cross-sectional Study database. Exercise function was quantified as % predicted peak VO2. Ejection fraction (EF) was considered abnormal if < 50%. End-diastolic volume (EDV) was indexed to body surface area1.4. Diastolic function was defined as abnormal lateral E:e’/EDV was > 10th percentile. Patients were divided into three groups: 1 = normal EF and normal diastolic function, 2 = normal EF with abnormal diastolic function, and 3 = decreased EF with normal diastolic function. There were an inadequate number of patients with both abnormal EF and diastolic dysfunction to be included in the analysis. Results: 185 patients (61% left, 29% right, 10% mixed ventricular dominance) had EF, lateral E:e’/EDV, and peak VO2 measured. Differences between groups are reported in the Table.
Conclusions: Single ventricle patients with abnormal diastolic function and preserved EF had worse exercise capacity than patients with both normal and abnormal EF. Diastolic dysfunction appears to be an important limitation to exercise function in this population. Echocardiography may be useful in detecting this subset of patients. Group 1 (n = 141) Group 2 (n = 13) Group 3 (n = 31) p-value Age (years) 11.5 (4.5) 13.2 (5.8) 12.5 (5.3) 0.24 Height (cm) 145 (25) 161 (22) 147 (26) 0.07 # 36.2 (18.8) 0.01 Weight (kg) 38.8 (22.8) 55.5 (21.0)* SBP (mm Hg) 99 (18) 106 (14) 100 (15) 0.11 DBP (mm Hg) 56 (13) 56 (15) 56 (17) 0.65 54 (23) 33 (13)*# 62 (20) < 0.01 SV EDV (mL/m2.8) < 0.01 SV EF (%) 62.4 (11.3) 66.0 (11.0) 46.0 (7.3)#^ 2.8 # 0.13 (0.08) 0.34 (0.08)* 0.12 (0.05) < 0.01 Lateral E:e’/EDV (1/mL/m ) 64 (24) 56 (8) 68 (23) 0.41 Ventricular mass (g/m2.8) # 67 (23) 52 (20)* 63 (29) 0.02 % predicted peak VO2 93 (29) 72 (38) 87 (26) 0.09 % predicted peak O2 pulse * = p < 0.05, Group 1 vs. Group 2 ^ = p < 0.05, Group 1 vs. Group 3 # = p < 0.05, Group 2 vs. Group 3 Results reported as median (interquartile range). DBP = diastolic blood pressure; EDV = end-diastolic volume; EF = ejection fraction; SBP = systolic blood pressure SV = single ventricle