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Predictors of Poor Functional Status in Adult Fontan Patients Living at Moderate Altitude

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Abstract

Patients who have undergone Fontan palliation have reduced exercise tolerance measured by maximal oxygen consumption (VO2 max). Declining exercise capacity is associated with increased morbidity and mortality. The impact of hemodynamics and other variables on this population’s functional status is not well understood. This study sought to identify variables that predict low VO2 max in Fontan patients living at moderate altitude (5,000–8,000 feet). We performed a retrospective cohort study of 44 adult Fontan patients living at moderate altitude who had undergone cardiopulmonary exercise testing (CPET) and cardiac catheterization. We evaluated hemodynamic parameters measured during catheterization, imaging results, and laboratory studies for correlation with VO2 max measured during CPET. Our study cohort (median age 30 years, 52% female) had exercise impairment with mean VO2 max of 21.6 mL/kg/min. Higher trans-pulmonary gradient (TPG) (p < 0.001) and mean pulmonary artery (PA) pressure (p = 0.013) were predictors of lower maximal and submaximal VO2. Higher BNP values correlated with lower VO2 max (p = 0.01). Platelet count, GGT, albumin, and pulmonary vasodilator therapy did not correlate with VO2 max. None of the studied variables were associated with higher minute ventilation to peak carbon dioxide production (VE/VCO2 slope) or change in VO2 max over time. In conclusion, higher TPG and mean PA pressure predicted lower exercise tolerance amongst our cohort of adult Fontan patients living at moderate altitude. Future studies are needed to determine if these clinical variables represent viable therapeutic targets that could result in improved exercise tolerance and outcomes in patients with Fontan circulation.

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Funding

Not applicable, as the study was not funded.

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Authors and Affiliations

  1. University of Colorado School of Medicine, Aurora, USA

    CG. Stevens

  2. Department of Pediatrics, Section of Cardiology, University of Colorado School of Medicine, Aurora, USA

    J. Kay, AD. Khanna, E. Yeung, SD. Miyamoto & RM. Jacobsen

  3. Department of Medicine, Division of Cardiology, University of Colorado School of Medicine, Aurora, USA

    J. Kay, AD. Khanna, E. Yeung & RM. Jacobsen

  4. Department of Pediatrics, University of Colorado School of Medicine, Aurora, USA

    K. Pickett & K. Campbell

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  1. CG. Stevens
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Contributions

All authors contributed to the study design. Data collection and analysis were performed by CGS, JK, and RMJ. The first draft of the manuscript was written by CGS, JK, SDM and RMJ, and all authors edited and commented on subsequent drafts. All authors read and approved the final manuscript.

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Correspondence to CG. Stevens.

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The authors declare that they have no conflicts of interest.

Ethics Approval

This research study was conducted retrospectively from data obtained for clinical purposes. The Colorado Multiple Institutions Review Board determined that our study did not need ethical approval. An IRB official waiver of ethical approval was granted from the IRB.

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Stevens, C., Kay, J., Pickett, K. et al. Predictors of Poor Functional Status in Adult Fontan Patients Living at Moderate Altitude. Pediatr Cardiol 42, 1757–1765 (2021). https://doi.org/10.1007/s00246-021-02660-8

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  • DOI: https://doi.org/10.1007/s00246-021-02660-8

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