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Exercise Capacity, NT-proBNP, Exercise Hemodynamics in Post-Fontan
Quick Takes
- In adults post-Fontan, resting and exercise Fontan pressure (FP) and pulmonary artery wedge pressure (PAWP) were inversely related to exercise capacity on noninvasive cardiopulmonary exercise testing.
- Exercise FP and PAWP were directly related to NT-proBNP.
- Exercise FP and PAWP were independently associated with clinical outcomes and might be more sensitive than resting values to predict clinical outcomes.
Study Questions:
What is the correlation between resting and exercise Fontan pressure (FP) and pulmonary artery wedge pressure (PAWP) with peak oxygen consumption (VO2) on cardiopulmonary exercise testing (CPET), N-terminal pro–B-type natriuretic peptide (NT-proBNP), and clinical outcomes?
Methods:
A retrospective review was performed at a single center. Post-Fontan patients undergoing supine exercise venous catheterization between 2018 and 2022 were enrolled.
Results:
The median age of the 50 patients enrolled was 31.5 years. Patients with peak VO2 <50% predicted had higher exercise FP (30.0 ± 6.8 vs. 19 mm Hg, p < 0.001) and PAWP (25.9 ± 6.3 vs. 15.1 ± 7.0 mm Hg, p < 0.001) as compared with those with more preserved exercise capacity. Exercise FP and PAWP were higher in those with NT-proBNP levels ≥300 pg/mL. During a follow-up of 0.9 years, exercise FP and PAWP remained independently associated with a compositive of death, cardiac transplantation, or hospitalization due to heart failure/refractory arrhythmias after adjusting for confounders.
Conclusions:
The authors conclude that in adults post-Fontan, resting and exercise FP and PAWP were inversely related to exercise capacity on noninvasive CPET, and exercise hemodynamics were directly related to NT-proBNP levels.
Perspective:
Patients with Fontan circulation are known to have decreased exercise capacity. While NT-proBNP levels are commonly performed in patients with Fontan circulation, there is limited supportive evidence for their use. This study demonstrated an inverse relationship between exercise filling pressures and exercise capacity on noninvasive CPET, and a direct relationship with NT-proBNP levels. Additionally, exercise FP and PAWP were independently associated with clinical outcomes and may be more sensitive than resting values to predict clinical outcomes. Exercise catheterization is not routinely performed at many centers and can be considered to provide additional prognostic data. The study also demonstrates the value of NT-proBNP in predicting exercise hemodynamics. The primary limitation of the study is retrospective design and the possibility of bias based on the patient population referred for invasive hemodynamics.
Clinical Topics: Arrhythmias and Clinical EP, Cardiac Surgery, Congenital Heart Disease and Pediatric Cardiology, Diabetes and Cardiometabolic Disease, Heart Failure and Cardiomyopathies, Invasive Cardiovascular Angiography and Intervention, Prevention, Implantable Devices, SCD/Ventricular Arrhythmias, Atrial Fibrillation/Supraventricular Arrhythmias, Cardiac Surgery and Arrhythmias, Cardiac Surgery and CHD and Pediatrics, Cardiac Surgery and Heart Failure, Congenital Heart Disease, CHD and Pediatrics and Arrhythmias, CHD and Pediatrics and Interventions, CHD and Pediatrics and Prevention, CHD and Pediatrics and Quality Improvement, Acute Heart Failure, Heart Failure and Cardiac Biomarkers, Heart Transplant, Interventions and Structural Heart Disease, Exercise
Keywords: Arrhythmias, Cardiac, Catheterization, Diagnostic Techniques and Procedures, Exercise, Exercise Test, Fontan Procedure, Heart Defects, Congenital, Heart Failure, Heart Transplantation, Hemodynamics, Natriuretic Peptide, Brain, Outcome Assessment, Health Care, Oxygen Consumption, Pulmonary Wedge Pressure
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