Journal article

Authors list: Latus, Heiner; Hofmann, Lucas; Gummel, Kerstin; Khalil, Markus; Yerebakan, Can; Waschulzik, Birgit; Schranz, Dietmar; Voges, Inga; Jux, Christian; Reich, Bettina

Publication year: 2022

Pages: 88-97

Journal: European Heart Journal - Cardiovascular Imaging

Volume number: 24

Issue number: 1

ISSN: 2047-2404

eISSN: 2047-2412

Open access status: Hybrid

DOI Link: https://doi.org/10.1093/ehjci/jeac001

Publisher: Oxford University Press

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.

Harvard Citation style: Latus, H., Hofmann, L., Gummel, K., Khalil, M., Yerebakan, C., Waschulzik, B., et al. (2022) Exercise-dependent changes in ventricular-arterial coupling and aortopulmonary collateral flow in Fontan patients: a real-time CMR study, European Heart Journal - Cardiovascular Imaging, 24(1), pp. 88-97. https://doi.org/10.1093/ehjci/jeac001

APA Citation style: Latus, H., Hofmann, L., Gummel, K., Khalil, M., Yerebakan, C., Waschulzik, B., Schranz, D., Voges, I., Jux, C., & Reich, B. (2022). Exercise-dependent changes in ventricular-arterial coupling and aortopulmonary collateral flow in Fontan patients: a real-time CMR study. European Heart Journal - Cardiovascular Imaging. 24(1), 88-97. https://doi.org/10.1093/ehjci/jeac001