Elevated ventricular filling pressures and long-term survival in adults post-Fontan

William R. Miranda, Donald J. Hagler, Nathaniel W. Taggart, Barry A Borlaug, Heidi M. Connolly, Alexander Egbe

Research output: Contribution to journalArticle

Abstract

Objective: To assess the association between elevated ventricular-end diastolic pressures (VEDP) and pulmonary artery wedge pressure (PAWP) on long-term survival in adult Fontan patients. Background: The impact of ventricular filling pressures on long-term survival in adults post-Fontan palliation is unknown. Methods: We included 148 adult Fontan patients (age ≥ 18 years) without atrioventricular valve prosthesis or pulmonary vein stenosis undergoing arterial and venous catheterization between December 1999 and November 2017. VEDP was defined as ≥12 mmHg and PAWP as >12 mmHg based on optimal cut-offs for prediction of mortality on receiver-operator curves (AUC 0.63 and 0.66, respectively). Results: Mean age was 31.3 ± 9.2 years and 48.6% of patients were females. Most common congenital defects were tricuspid atresia (36.4%) and double-inlet left ventricle (28.3%); 59.5% patients had atriopulmonary Fontan connections. Mean VEDP was 11.5 ± 4.7 mmHg and PAWP 10.6 ± 4.5 mmHg (correlation coefficient.76). During a follow-up of 6.0 ± 4.8 years (median 5.4, IQR 1.4–9.4), there were 45 deaths (30.4%). Overall survival was lower in patients with VEDP ≥ 12 compared to those with VEDP < 12 mmHg (p =.02). Similarly, survival was lower in patients with PAWP>12 compared to patients with PAWP ≤ 12 mmHg (p <.0001). In the multivariate model, PAWP was an independent predictor of death (HR 1.1 per mmHg, 95% CI 1.02–1.15, p =.009) whereas VEDP was not (HR 1.1 per mmHg, 95% CI 1.0–1.13; p =.08). Conclusion: PAWP but not VEDP was independently associated with long-term overall mortality in adult Fontan patients. Perhaps PAWP rather than VEDP should be used in the risk stratification of these patients.

Original languageEnglish (US)
JournalCatheterization and Cardiovascular Interventions
DOIs
StatePublished - Jan 1 2019

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Ventricular Pressure
Pulmonary Wedge Pressure
Blood Pressure
Survival
Tricuspid Atresia
Mortality
Catheterization
Prostheses and Implants
Area Under Curve
Heart Ventricles

Keywords

  • Fontan palliation
  • hemodynamics
  • survival
  • ventricular filling pressures

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine

Cite this

Elevated ventricular filling pressures and long-term survival in adults post-Fontan. / Miranda, William R.; Hagler, Donald J.; Taggart, Nathaniel W.; Borlaug, Barry A; Connolly, Heidi M.; Egbe, Alexander.

In: Catheterization and Cardiovascular Interventions, 01.01.2019.

Research output: Contribution to journalArticle

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abstract = "Objective: To assess the association between elevated ventricular-end diastolic pressures (VEDP) and pulmonary artery wedge pressure (PAWP) on long-term survival in adult Fontan patients. Background: The impact of ventricular filling pressures on long-term survival in adults post-Fontan palliation is unknown. Methods: We included 148 adult Fontan patients (age ≥ 18 years) without atrioventricular valve prosthesis or pulmonary vein stenosis undergoing arterial and venous catheterization between December 1999 and November 2017. VEDP was defined as ≥12 mmHg and PAWP as >12 mmHg based on optimal cut-offs for prediction of mortality on receiver-operator curves (AUC 0.63 and 0.66, respectively). Results: Mean age was 31.3 ± 9.2 years and 48.6{\%} of patients were females. Most common congenital defects were tricuspid atresia (36.4{\%}) and double-inlet left ventricle (28.3{\%}); 59.5{\%} patients had atriopulmonary Fontan connections. Mean VEDP was 11.5 ± 4.7 mmHg and PAWP 10.6 ± 4.5 mmHg (correlation coefficient.76). During a follow-up of 6.0 ± 4.8 years (median 5.4, IQR 1.4–9.4), there were 45 deaths (30.4{\%}). Overall survival was lower in patients with VEDP ≥ 12 compared to those with VEDP < 12 mmHg (p =.02). Similarly, survival was lower in patients with PAWP>12 compared to patients with PAWP ≤ 12 mmHg (p <.0001). In the multivariate model, PAWP was an independent predictor of death (HR 1.1 per mmHg, 95{\%} CI 1.02–1.15, p =.009) whereas VEDP was not (HR 1.1 per mmHg, 95{\%} CI 1.0–1.13; p =.08). Conclusion: PAWP but not VEDP was independently associated with long-term overall mortality in adult Fontan patients. Perhaps PAWP rather than VEDP should be used in the risk stratification of these patients.",
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T1 - Elevated ventricular filling pressures and long-term survival in adults post-Fontan

AU - Miranda, William R.

AU - Hagler, Donald J.

AU - Taggart, Nathaniel W.

AU - Borlaug, Barry A

AU - Connolly, Heidi M.

AU - Egbe, Alexander

PY - 2019/1/1

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N2 - Objective: To assess the association between elevated ventricular-end diastolic pressures (VEDP) and pulmonary artery wedge pressure (PAWP) on long-term survival in adult Fontan patients. Background: The impact of ventricular filling pressures on long-term survival in adults post-Fontan palliation is unknown. Methods: We included 148 adult Fontan patients (age ≥ 18 years) without atrioventricular valve prosthesis or pulmonary vein stenosis undergoing arterial and venous catheterization between December 1999 and November 2017. VEDP was defined as ≥12 mmHg and PAWP as >12 mmHg based on optimal cut-offs for prediction of mortality on receiver-operator curves (AUC 0.63 and 0.66, respectively). Results: Mean age was 31.3 ± 9.2 years and 48.6% of patients were females. Most common congenital defects were tricuspid atresia (36.4%) and double-inlet left ventricle (28.3%); 59.5% patients had atriopulmonary Fontan connections. Mean VEDP was 11.5 ± 4.7 mmHg and PAWP 10.6 ± 4.5 mmHg (correlation coefficient.76). During a follow-up of 6.0 ± 4.8 years (median 5.4, IQR 1.4–9.4), there were 45 deaths (30.4%). Overall survival was lower in patients with VEDP ≥ 12 compared to those with VEDP < 12 mmHg (p =.02). Similarly, survival was lower in patients with PAWP>12 compared to patients with PAWP ≤ 12 mmHg (p <.0001). In the multivariate model, PAWP was an independent predictor of death (HR 1.1 per mmHg, 95% CI 1.02–1.15, p =.009) whereas VEDP was not (HR 1.1 per mmHg, 95% CI 1.0–1.13; p =.08). Conclusion: PAWP but not VEDP was independently associated with long-term overall mortality in adult Fontan patients. Perhaps PAWP rather than VEDP should be used in the risk stratification of these patients.

AB - Objective: To assess the association between elevated ventricular-end diastolic pressures (VEDP) and pulmonary artery wedge pressure (PAWP) on long-term survival in adult Fontan patients. Background: The impact of ventricular filling pressures on long-term survival in adults post-Fontan palliation is unknown. Methods: We included 148 adult Fontan patients (age ≥ 18 years) without atrioventricular valve prosthesis or pulmonary vein stenosis undergoing arterial and venous catheterization between December 1999 and November 2017. VEDP was defined as ≥12 mmHg and PAWP as >12 mmHg based on optimal cut-offs for prediction of mortality on receiver-operator curves (AUC 0.63 and 0.66, respectively). Results: Mean age was 31.3 ± 9.2 years and 48.6% of patients were females. Most common congenital defects were tricuspid atresia (36.4%) and double-inlet left ventricle (28.3%); 59.5% patients had atriopulmonary Fontan connections. Mean VEDP was 11.5 ± 4.7 mmHg and PAWP 10.6 ± 4.5 mmHg (correlation coefficient.76). During a follow-up of 6.0 ± 4.8 years (median 5.4, IQR 1.4–9.4), there were 45 deaths (30.4%). Overall survival was lower in patients with VEDP ≥ 12 compared to those with VEDP < 12 mmHg (p =.02). Similarly, survival was lower in patients with PAWP>12 compared to patients with PAWP ≤ 12 mmHg (p <.0001). In the multivariate model, PAWP was an independent predictor of death (HR 1.1 per mmHg, 95% CI 1.02–1.15, p =.009) whereas VEDP was not (HR 1.1 per mmHg, 95% CI 1.0–1.13; p =.08). Conclusion: PAWP but not VEDP was independently associated with long-term overall mortality in adult Fontan patients. Perhaps PAWP rather than VEDP should be used in the risk stratification of these patients.

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KW - hemodynamics

KW - survival

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