Prediction of heart failure and death in an adult population of Fontan patients
| العنوان: | Prediction of heart failure and death in an adult population of Fontan patients |
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| المؤلفون: | Johann Bauersachs, Arash Haghikia, Carolin Zwadlo, Carolin Klages, Tobias König, Christian Riehle, Jens Treptau, Jan Thorben Sieweke, Mechthild Westhoff-Bleck, Andreas Schäfer, Muharrem Akin |
| المصدر: | Cardiology in the young. 29(5) |
| سنة النشر: | 2019 |
| مصطلحات موضوعية: | Adult, Heart Defects, Congenital, Male, medicine.medical_specialty, medicine.medical_treatment, Cardiac index, 030204 cardiovascular system & hematology, Fontan Procedure, Fontan procedure, 03 medical and health sciences, Young Adult, 0302 clinical medicine, Afterload, Cardiac magnetic resonance imaging, Internal medicine, Germany, Medicine, Humans, 030212 general & internal medicine, Longitudinal Studies, End-systolic volume, Heart Failure, Ejection fraction, medicine.diagnostic_test, business.industry, Stroke Volume, General Medicine, medicine.disease, Prognosis, Magnetic Resonance Imaging, Heart failure, Pediatrics, Perinatology and Child Health, Multivariate Analysis, Cardiology, Exercise Test, End-diastolic volume, Regression Analysis, Female, Cardiology and Cardiovascular Medicine, business, Biomarkers |
| الوصف: | Background:Late Fontan survivors are at high risk to experience heart failure and death. Therefore, the current study sought to investigate the role of non-invasive diagnostics as prognostic markers for failure of the systemic ventricle following Fontan procedure.Methods:This monocentric, longitudinal observational study included 60 patients with a median age of 24.5 (19–29) years, who were subjected to cardiac magnetic resonance imaging, echocardiography, cardiopulmonary exercise testing, and blood analysis. The primary endpoint of this study was decompensated heart failure with symptoms at rest, peripheral and/or pulmonary edema, and/or death.Results:During a follow-up of 24 months, 5 patients died and 5 patients suffered from decompensated heart failure. Clinical (NYHA class, initial surgery), functional (VO2peak, ejection fraction, cardiac index), circulating biomarkers (N-terminal pro brain natriuretic peptide), and imaging parameters (end diastolic volume index, end systolic volume index, mass-index, contractility, afterload) were significantly related to the primary endpoint. Multi-variate regression analysis identified afterload as assessed by cardiac magnetic resonance imaging as an independent predictor of the primary endpoint (hazard ratio 1.98, 95% confidence interval 1.19–3.29, p = 0.009).Conclusion:We identified distinct parameters of cardiopulmonary exercise testing, cardiac magnetic resonance imaging, and blood testing as markers for future decompensated heart failure and death in patients with Fontan circulation. Importantly, our data also identify increased afterload as an independent predictor for increased morbidity and mortality. This parameter is easy to assess by non-invasive cardiac magnetic resonance imaging. Its modulation may represent a potential therapeutic approach target in these high-risk patients. |
| تدمد: | 1467-1107 1047-9511 |
| URL الوصول: | https://explore.openaire.eu/search/publication?articleId=doi_dedup___::6b5aff521e853f31c2ae97369ac52506 https://pubmed.ncbi.nlm.nih.gov/31036097 |
| Rights: | CLOSED |
| رقم الانضمام: | edsair.doi.dedup.....6b5aff521e853f31c2ae97369ac52506 |
| قاعدة البيانات: | OpenAIRE |
| تدمد: | 14671107 10479511 |
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