C Charles Jain, Alexander C Egbe, Thomas G Allison, Alexander van de Bruaene, Barry A Borlaug, Heidi M Connolly, Luke J Burchill, William R Miranda
{"title":"方坦术后成人的功能能力评估:心肺运动测试--有创运动血流动力学相关性研究。","authors":"C Charles Jain, Alexander C Egbe, Thomas G Allison, Alexander van de Bruaene, Barry A Borlaug, Heidi M Connolly, Luke J Burchill, William R Miranda","doi":"10.1016/j.amjcard.2024.09.005","DOIUrl":null,"url":null,"abstract":"<p><p>Although cardiopulmonary exercise testing (CPET) parameters have known prognostic value in adults after Fontan palliation, there are limited data correlating treadmill CPET with invasive exercise hemodynamics. Furthermore, the invasive hemodynamic underpinnings of exercise limitations have not been thoroughly investigated. This is retrospective analysis of 55 adults (≥18 years) after Fontan palliation who underwent treadmill CPET before invasive exercise hemodynamic testing by way of supine cycle protocol between November 2018 and April 2023. The median age was 32.2 (24.1 to 37.2) years. The peak heart rate (HR) was 139.7 ± 28.1 beats per minute and the peak oxygen consumption (VO<sub>2</sub>) was 19.1 ± 5.7 ml/kg/min (47.4 ± 13.5% predicted). VO<sub>2</sub>/HR was directly related to exercise stroke volume index (r = 0.50, p = 0.0002), whereas no association was seen with exercise arterio-mixed venous O<sub>2</sub> content difference (r = 0.14, p = 0.32). Peak HR was inversely related to exercise pulmonary artery (PA) pressures (r = -0 61, p <0.0001) and PA wedge pressures (PAWP) (r = -0.61, p <0.0001). Moreover, %predicted VO<sub>2</sub> was inversely related to exercise PA pressures (r = -0.50, p <0.0001) and PAWP (r = -0.55, p <0.0001). Peak VO<sub>2</sub> ≤19.1 ml/kg/min had a sensitivity of 81% and a specificity of 76% (area under the curve = 0.82) for predicting a ΔPAWP/ΔQs ratio >2 mm Hg/L/min and/or a ΔPA:ΔQp >3 mm Hg/L/min, whereas a predicted peak VO<sub>2</sub> ≤48% had a sensitivity of 74% and a specificity of 81% (area under the curve = 0.79) for the same parameters. In summary, lower peak HR and peak VO<sub>2</sub> were associated with higher exercise PAWP and PA pressure. Peak VO<sub>2</sub> ≤48% predicted provided the optimal cutoff for predicting increased indexed exercise PAWP or PA pressures; therefore, low peak VO<sub>2</sub> should alert clinicians of abnormal underlying hemodynamics.</p>","PeriodicalId":7705,"journal":{"name":"American Journal of Cardiology","volume":null,"pages":null},"PeriodicalIF":2.3000,"publicationDate":"2024-09-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Functional Capacity Assessment in Adults After Fontan Palliation: A Cardiopulmonary Exercise Test-Invasive Exercise Hemodynamics Correlation Study.\",\"authors\":\"C Charles Jain, Alexander C Egbe, Thomas G Allison, Alexander van de Bruaene, Barry A Borlaug, Heidi M Connolly, Luke J Burchill, William R Miranda\",\"doi\":\"10.1016/j.amjcard.2024.09.005\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><p>Although cardiopulmonary exercise testing (CPET) parameters have known prognostic value in adults after Fontan palliation, there are limited data correlating treadmill CPET with invasive exercise hemodynamics. Furthermore, the invasive hemodynamic underpinnings of exercise limitations have not been thoroughly investigated. This is retrospective analysis of 55 adults (≥18 years) after Fontan palliation who underwent treadmill CPET before invasive exercise hemodynamic testing by way of supine cycle protocol between November 2018 and April 2023. The median age was 32.2 (24.1 to 37.2) years. The peak heart rate (HR) was 139.7 ± 28.1 beats per minute and the peak oxygen consumption (VO<sub>2</sub>) was 19.1 ± 5.7 ml/kg/min (47.4 ± 13.5% predicted). VO<sub>2</sub>/HR was directly related to exercise stroke volume index (r = 0.50, p = 0.0002), whereas no association was seen with exercise arterio-mixed venous O<sub>2</sub> content difference (r = 0.14, p = 0.32). Peak HR was inversely related to exercise pulmonary artery (PA) pressures (r = -0 61, p <0.0001) and PA wedge pressures (PAWP) (r = -0.61, p <0.0001). Moreover, %predicted VO<sub>2</sub> was inversely related to exercise PA pressures (r = -0.50, p <0.0001) and PAWP (r = -0.55, p <0.0001). Peak VO<sub>2</sub> ≤19.1 ml/kg/min had a sensitivity of 81% and a specificity of 76% (area under the curve = 0.82) for predicting a ΔPAWP/ΔQs ratio >2 mm Hg/L/min and/or a ΔPA:ΔQp >3 mm Hg/L/min, whereas a predicted peak VO<sub>2</sub> ≤48% had a sensitivity of 74% and a specificity of 81% (area under the curve = 0.79) for the same parameters. In summary, lower peak HR and peak VO<sub>2</sub> were associated with higher exercise PAWP and PA pressure. Peak VO<sub>2</sub> ≤48% predicted provided the optimal cutoff for predicting increased indexed exercise PAWP or PA pressures; therefore, low peak VO<sub>2</sub> should alert clinicians of abnormal underlying hemodynamics.</p>\",\"PeriodicalId\":7705,\"journal\":{\"name\":\"American Journal of Cardiology\",\"volume\":null,\"pages\":null},\"PeriodicalIF\":2.3000,\"publicationDate\":\"2024-09-06\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"American Journal of Cardiology\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1016/j.amjcard.2024.09.005\",\"RegionNum\":3,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q2\",\"JCRName\":\"CARDIAC & CARDIOVASCULAR SYSTEMS\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"American Journal of Cardiology","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1016/j.amjcard.2024.09.005","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"CARDIAC & CARDIOVASCULAR SYSTEMS","Score":null,"Total":0}
Functional Capacity Assessment in Adults After Fontan Palliation: A Cardiopulmonary Exercise Test-Invasive Exercise Hemodynamics Correlation Study.
Although cardiopulmonary exercise testing (CPET) parameters have known prognostic value in adults after Fontan palliation, there are limited data correlating treadmill CPET with invasive exercise hemodynamics. Furthermore, the invasive hemodynamic underpinnings of exercise limitations have not been thoroughly investigated. This is retrospective analysis of 55 adults (≥18 years) after Fontan palliation who underwent treadmill CPET before invasive exercise hemodynamic testing by way of supine cycle protocol between November 2018 and April 2023. The median age was 32.2 (24.1 to 37.2) years. The peak heart rate (HR) was 139.7 ± 28.1 beats per minute and the peak oxygen consumption (VO2) was 19.1 ± 5.7 ml/kg/min (47.4 ± 13.5% predicted). VO2/HR was directly related to exercise stroke volume index (r = 0.50, p = 0.0002), whereas no association was seen with exercise arterio-mixed venous O2 content difference (r = 0.14, p = 0.32). Peak HR was inversely related to exercise pulmonary artery (PA) pressures (r = -0 61, p <0.0001) and PA wedge pressures (PAWP) (r = -0.61, p <0.0001). Moreover, %predicted VO2 was inversely related to exercise PA pressures (r = -0.50, p <0.0001) and PAWP (r = -0.55, p <0.0001). Peak VO2 ≤19.1 ml/kg/min had a sensitivity of 81% and a specificity of 76% (area under the curve = 0.82) for predicting a ΔPAWP/ΔQs ratio >2 mm Hg/L/min and/or a ΔPA:ΔQp >3 mm Hg/L/min, whereas a predicted peak VO2 ≤48% had a sensitivity of 74% and a specificity of 81% (area under the curve = 0.79) for the same parameters. In summary, lower peak HR and peak VO2 were associated with higher exercise PAWP and PA pressure. Peak VO2 ≤48% predicted provided the optimal cutoff for predicting increased indexed exercise PAWP or PA pressures; therefore, low peak VO2 should alert clinicians of abnormal underlying hemodynamics.
期刊介绍:
Published 24 times a year, The American Journal of Cardiology® is an independent journal designed for cardiovascular disease specialists and internists with a subspecialty in cardiology throughout the world. AJC is an independent, scientific, peer-reviewed journal of original articles that focus on the practical, clinical approach to the diagnosis and treatment of cardiovascular disease. AJC has one of the fastest acceptance to publication times in Cardiology. Features report on systemic hypertension, methodology, drugs, pacing, arrhythmia, preventive cardiology, congestive heart failure, valvular heart disease, congenital heart disease, and cardiomyopathy. Also included are editorials, readers'' comments, and symposia.