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Predictors of sildenafil effects on exercise capacity in adolescents and adults with Fontan circulation

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Abstract

Objective

A single dose of sildenafil improves exercise capacity in Fontan patients. However, a recent study failed to show a long-term effect of sildenafil. This study evaluated whether there are factors that might predict sildenafil effects.

Methods

We studied 36 patients (16–42 years, 14 female) with univentricular heart after various modifications of the Fontan surgery (13 APC, 16 AVC, 7 TCPC). They performed two cardiopulmonary exercise tests, with at least 120 min rest and a single dose of 50 mg sildenafil in between.

Results

After sildenafil administration, patients improved their peak oxygen uptake from 64.5 to 67.3 % predicted (p = 0.0003) without change in ventilatory efficiency (\({\dot{\text{V}}}_{\text{E}} /{\dot{\text{V}}\text{CO}}_{2}\) slope), oxygen saturation (SpO2) at rest or at peak exercise, respiratory exchange ratio. In addition, resting systolic blood pressure was slightly reduced after sildenafil administration. There was a moderate negative correlation of this improvement to baseline peak oxygen uptake (r = −0.395; p = 0.017). The change in peak oxygen uptake could not be correlated to time of surgery, type of surgery, NT-pro-BNP, or to other clinical data. Nevertheless, all four patients with NT-pro-BNP levels higher than 1,000 pg/ml had the most prominent improvements in exercise capacity.

Conclusions

Fontan patients have an improved exercise capacity after a single dose of sildenafil. Patients with worse baseline peak oxygen uptake profit more.

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Acknowledgments

This work was supported by an unrestricted financial grant from Pfizer Pharma GmbH.

Conflict of interest

A. H. was advisory board member at Actelion; received speakers reimbursements from Encysive, Pfizer, Actelion, Medtronic, Schiller, GlaxoSmithKline, OMT, and AOP Orphan; and received travel grants for scientific meetings from Actelion, Pfizer, GlaxoSmithKline, Lilly, and OMT. J. M. received scientific prices from Pfizer and Lilly. R. W. and J. H. declare that they have no conflict of interests.

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Authors and Affiliations

  1. Department of Pediatric Cardiology and Congenital Heart Disease, Deutsches Herzzentrum München, Technische Universität München, Lazarettstr. 36, 80636, Munich, Germany

    Alfred Hager, Ruth Weber, Jan Müller & John Hess

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  1. Alfred Hager
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  2. Ruth Weber
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  3. Jan Müller
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  4. John Hess
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Correspondence to Alfred Hager.

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Hager, A., Weber, R., Müller, J. et al. Predictors of sildenafil effects on exercise capacity in adolescents and adults with Fontan circulation. Clin Res Cardiol 103, 641–646 (2014). https://doi.org/10.1007/s00392-014-0694-2

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  • DOI: https://doi.org/10.1007/s00392-014-0694-2

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