Hemodynamic Profiling Using a Cardiac Index–Systemic Vascular Resistance Plot in Patients with Fontan Circulation  

作　　者：Yuki Kawasaki Takeshi Sasaki Daisuke Kobayashi 

机构地区：[1]Division of Pediatric Cardiology,Osaka City General Hospital Pediatric Medical Center,Osaka,5340021,Japan [2]Division of Cardiology,St.Louis Children’s Hospital,Department of Pediatrics,Washington University in St.Louis,St.Louis,MO 63130,USA

出　　处：《Congenital Heart Disease》2023年第4期431-445,共15页先天性心脏病（英文）

摘　　要：Background: Elevated Fontan pressure (FP) alone cannot fully predict clinical outcomes. We hypothesized thathemodynamic profiling using a cardiac index (CI)-systemic vascular resistance (SVR) plot could characterize clinicalfeatures and predict the prognosis of post-Fontan patients. Methods: We included post-Fontan patients whounderwent cardiac catheterization at age < 10 years. Patients were classified into four categories: A, CI ≥ 3, SVRindex (SVRI) ≥ 20;B, CI < 3, SVRI ≥ 20;C, CI ≥ 3, SVRI < 20;and D, CI < 3, SVRI < 20. The primary outcome wasfreedom from the combined endpoint: new onset of protein-losing enteropathy or plastic bronchitis, heart transplant,and death. Clinical and hemodynamic variables and freedom from the endpoint were compared betweenthe hemodynamic categories and outcome predictors were evaluated. Results: Eighty-three patients wereincluded. Median follow-up was 5.3 years. Category A/B/C/D consisted of 4/15/53/11 patients, respectively. Allthe patients in category A were New York Heart Association I/II and had a significantly lower pulmonary vascularresistance index (PVRI). Patients in category C had lower pulmonary/systemic blood flow. Patients in category Dhad a higher PVRI and had the poorest freedom from the endpoint (44% at 5 years). Elevated FP and category Dwere outcome predictors. Conclusions: CI-SVR plots was a novel adjunctive method for Fontan hemodynamicprofiling.

关 键 词：Cardiac index systemic vascular resistance perfusion pressure hemodynamic category fontan circulation PROGNOSIS 

分 类 号：R541[医药卫生—心血管疾病]