Diastolic Dysfunction With Preserved Ejection Fraction After the Fontan Procedure.
Diastolic Dysfunction With Preserved Ejection Fraction After the Fontan Procedure.
复制标题
Fontan手术后射血分数保留的舒张功能障碍。
DOI：
10.1161/jaha.121.024095
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发表时间：
2022-01-18
影响因子：
5.4
通讯作者：
Atz, Andrew M.
中科院分区：
文献类型：
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作者：
Chowdhury, Shahryar M.;Graham, Eric M.;Taylor, Carolyn L.;Savage, Andrew;McHugh, Kimberly E.;Gaydos, Stephanie;Nutting, Arni C.;Zile, Michael R.;Atz, Andrew M.
单心室Fontan患者的心力衰竭表型是具有挑战性的，特别是在射血分数(EF)正常的患者。本研究的目的是识别Fontan舒张期功能异常的患者，这些患者是心力衰竭的高危人群，并保留射血分数(HFpEF)，并对他们的心脏力学、运动功能和功能健康状况进行特征分析。数据来自儿科心脏网络Fontan横断面研究数据库。如果EF为50%，则认为EF异常。如果舒张压：容商(侧E：E‘/舒张末容量)为>；第90个百分位数(≥为0.26mL-1)，则将舒张压：容积商定义为异常。将患者分为：对照组=EF正常且舒张期功能正常；收缩功能不全(SD)=EF异常伴舒张期功能正常；舒张期功能不全(DD)=EF正常伴舒张压异常：容商。运动功能以预测峰值VO2的百分比来量化。身体功能综合评分(FSS)由儿童健康问卷报告。共纳入239名患者，177名(74%)对照组，36名(15%)SD患者和26名(11%)DD患者。中位年龄为12.2(5.4)岁。动脉弹性是衡量动脉僵硬的一个指标，DD组(3.6±1.1)mm·Hgg/m l高于对照组(2.5±0.8)m m·Hg/m l，P<；0.01。DD患者的预计峰值VO2低于对照组(52%[20]比67%[23]，P<；0.01)。DD组(45±13)分、SD组(44±13)分较对照组(50±7)分低，P<0.01。舒张期功能异常而EF正常的Fontan患者运动耐量降低，功能健康状况降低，动脉僵硬增加。确定HFpEF的高危患者是可行的，在评估Fontan患者时应该考虑到这一点。
Heart failure phenotyping in single‐ventricle Fontan patients is challenging, particularly in patients with normal ejection fraction (EF). The objective of this study was to identify Fontan patients with abnormal diastolic function, who are high risk for heart failure with preserved ejection fraction (HFpEF), and characterize their cardiac mechanics, exercise function, and functional health status. Data were obtained from the Pediatric Heart Network Fontan Cross‐sectional Study database. EF was considered abnormal if <50%. Diastolic function was defined as abnormal if the diastolic pressure:volume quotient (lateral E:e’/end‐diastolic volume) was >90th percentile (≥0.26 mL‐1). Patients were divided into: controls=normal EF and diastolic function; systolic dysfunction (SD) = abnormal EF with normal diastolic function; diastolic dysfunction (DD) = normal EF with abnormal diastolic pressure:volume quotient. Exercise function was quantified as percent predicted peak VO2. Physical Functioning Summary Score (FSS) was reported from the Child Health Questionnaire. A total of 239 patients were included, 177 (74%) control, 36 (15%) SD, and 26 (11%) DD. Median age was 12.2 (5.4) years. Arterial elastance, a measure of arterial stiffness, was higher in DD (3.6±1.1 mm Hg/mL) compared with controls (2.5±0.8 mm Hg/mL), P<0.01. DD patients had lower predicted peak VO2 compared with controls (52% [20] versus 67% [23], P<0.01). Physical FSS was lower in DD (45±13) and SD (44±13) compared with controls (50±7), P<0.01. Fontan patients with abnormal diastolic function and normal EF have decreased exercise tolerance, decreased functional health status, and elevated arterial stiffness. Identification of patients at high risk for HFpEF is feasible and should be considered when evaluating Fontan patients.