Maldistribution of pulmonary blood flow in patients after the Fontan operation is associated with worse exercise capacity
Maldistribution of pulmonary blood flow in patients after the Fontan operation is associated with worse exercise capacity
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DOI：
10.1186/s12968-018-0505-4
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发表时间：
2018-12-17
影响因子：
6.4
通讯作者：
Rathod, Rahul H.
中科院分区：
文献类型：
--
作者：
Alsaied, Tarek;Sleeper, Lynn A.;Rathod, Rahul H.
背景肺动脉血流分布不均（MPBF）是单心室姑息手术（Fontan手术）的潜在并发症。心血管磁共振（CMR）是评价该人群MPBF的最佳方法。本研究的目的是确定MPBF的患病率和协会，并确定MPBF对运动能力的影响后Fontan operation.MethodsThis回顾性单中心研究包括所有患者Fontan手术后谁有最大心肺运动试验（CPET）和CMR与流量测量的分支肺动脉。MPBF定义为分支肺动脉血流差异>20%。运动能力测量为峰值运动时预测耗氧量的百分比（%预测VO 2）。线性和逻辑回归模型被用来确定运动能力的单变量和多变量预测因子以及MPBF，结果共纳入1999年至2017年期间发生CMR的147例患者（CMR时的中位年龄为21.8岁[四分位距（IQR）16.5-30.6]），CMR和CPET之间的中位时间为2.8个月[IQR 0-13.8]。53例患者（36%）有MPBF（95% CI 29-45%）。平均%预测VO 2为6316%。与无MPBF的患者相比，MPBF患者的平均%预测VO 2较低（60 +/- 14% vs 65 +/-16%，p=0.04）。在多变量分析中，较低的%预测VO 2与Fontan后较长的时间、较高的心室质量容积比和MPBF独立相关。在多变量分析中，只有升主动脉或主动脉根部压迫肺分支动脉与MPBF相关（OR 6.5，95%CI 5.6-7.4，p
BackgroundMaldistribution of pulmonary artery blood flow (MPBF) is a potential complication in patients who have undergone single ventricle palliation culminating in the Fontan procedure. Cardiovascular magnetic resonance (CMR) is the best modality that can evaluate MPBF in this population. The purpose of this study is to identify the prevalence and associations of MPBF and to determine the impact of MPBF on exercise capacity after the Fontan operation.MethodsThis retrospective single-center study included all patients after Fontan operation who had maximal cardiopulmonary exercise test (CPET) and CMR with flow measurements of the branch pulmonary arteries. MPBF was defined as >20% difference in branch pulmonary artery flow. Exercise capacity was measured as percent of predicted oxygen consumption at peak exercise (% predicted VO2). Linear and logistic regression models were used to determine univariate and multivariable predictors of exercise capacity and correlates of MPBF, respectively.ResultsA total of 147 patients who had CMR between 1999 and 2017 were included (median age at CMR 21.8years [interquartile range (IQR) 16.5-30.6]) and the median time between CMR and CPET was 2.8months [IQR 0-13.8]. Fifty-three patients (36%) had MPBF (95% CI 29-45%). The mean % predicted VO2 was 6316%. Patients with MPBF had lower mean % predicted VO2 compared to patients without MPBF (60 +/- 14% versus 65 +/- 16%, p=0.04). On multivariable analysis, a lower % predicted VO2 was independently associated with longer time since Fontan, higher ventricular mass-to-volume ratio, and MPBF. On multivariable analysis, only compression of the branch pulmonary arteries by the ascending aorta or aortic root was associated with MPBF (OR 6.5, 95% CI 5.6-7.4, p