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CMR Derived Measurements Of Ventricular Function Determine The Predictive Power Of Vo2 Max For Fontan Failure
Nicolas D. Drysdale, MD1, Jack Zakrzewski, MD
1, Carson Platnick
1, Michal Schafer, MD, PhD
2, Rob J. van der Geest, PhD
3, Joseph Kay, MD
4, Brian Fonseca, MD
4, Lorna Browne, MD
4, Michael DiMaria, MD
5, Mehdi Moghari, PhD
4, James Jaggers, MD
4, Max B. Mitchell, MD
4, Matthew L. Stone, MD, PhD
4.
1University of Colorado, Aurora, CO, USA,
2University of Utah, Salt Lake City, UT, USA,
3Leiden University, Leiden, Netherlands,
4Childrens Hospital Colorado, Aurora, CO, USA,
5Motts Childrens Hospital, Ann Arbor, MI, USA.
Objective(s): There is an association between exercise capacity and Fontan failure. Data suggests that VO2 max is likely related to ventricular function. We examined the relationship between ventricular strain, as measured by CMR, with VO2 max and Fontan failure in patients with single ventricle disease.
Methods: Retrospective cohort study for patients who had a post-Fontan CMR and cardiopulmonary stress test (CPET) less than one year apart from 2005 to 2021 (n= 41) at a large tertiary children’s hospital. Strain was calculated using Circle CVI42. We obtained peak VO2 and peak VO2 index from CPET. CMR and CPET measurements were compared between RV and LV dominant Fontan. Linear regression was performed between GCS and GLS and peak VO2 index. Adjusted and unadjusted logistic regression was carried out between Fontan failure defined as death or transplant and VO2 max index. All statistical analyses were performed using RStudio.
Results: Peak GCS, EDVi, ESVi, and EF were significantly lower in RV dominant circulation compared to LV dominant circulation. GCS independently predicts odds of Fontan failure (p=0.02). There was only a significant relationship (p=0.005) between odds of Fontan failure and VO2 max index when adjusted for CMR derived measurements of ventricular function. For every unit increase in VO2 max index there is a 0.847 fold reduction in the odds of death or transplant (95%CI: 0.76 to 0.94).
Conclusions: There is a significant relationship between VO2 max index and odds of Fontan failure only when adjusting for CMR measured EDVi, EF, CI, and dominant ventricle.
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