Abstract 14633: Cardiopulmonary Exercise Testing as a Predictor of Liver Disease in Fontan Patients: Two Tertiary Center Experience
Introduction: Liver disease (LD) is a known long-term complication in single ventricle patients who undergo Fontan procedures. Cardiopulmonary exercise test (CPET) variables are known to be associated with increased risk of hospitalization in Fontan patients but their association with liver disease is unknown.
Methods/Results: We retrospectively reviewed medical records from 2 tertiary academic institutions (Central Manchester University Hospitals, UK and University of California San Francisco, USA) and identified 114 adult Fontan patients (>18 years). LD was defined as grade IV fibrosis or cirrhosis on either ultrasound or computed tomographic imaging. Mean age was 30.9 ± 7.4 years, age at Fontan 7.9 ± 7.9 years, 56% were females, 63% underwent total cavopulmonary connection, 66% had New York Heart Association (NYHA) I, 42% had arrhythmias, 22% had systemic right ventricle and 35% had ventricular dysfunction. Of 81 patients with liver imaging data, 33 (41%) had LD. There were no differences in the demographic or Fontan related variables between those with and without LD. Of 58 patients with CPET data, mean peak maximal oxygen uptake (VO2) was 18.6 ± 5.7 ml/kg/min, percent predicted peak VO2 was 53.9 ± 15.5%, peak O2 pulse was 9.3 ± 2.9 ml/beat and percent predicted peak O2 pulse was 82.6 ± 21.5%. For each standard deviation (SD) decrease in % predicted peak VO2 (16%) and % predicted peak O2 pulse (22%), there was 2.3 fold increase in the odds for LD after adjusting for age, NYHA class, institution and type of Fontan (Table 1a). Similarly, each SD decrease in % predicted peak VO2 and % predicted O2 pulse was associated with an estimated 5.9 years and 4.9 years early onset of LD respectively (Table 1b).
Conclusions: CPET measures for aerobic capacity and stroke volume (percent predicted peak VO2 and peak O2 pulse) help predict LD in Fontan patients. Patients with poor exercise tolerance on CPET should be considered for screening for liver disease in addition to standard investigations.
Author Disclosures: A. Agarwal: None. C. Cunnington: None. A. Sabanayagam: None. L. Zier: None. C.E. McCulloch: None. I.S. Harris: None. E. Foster: None. D. Atkinson: None. A. Bryan: None. P. Jenkins: None. J. Dua: None. M.J. Parker: None. D. Karunaratne: None. J. Moore: None. J. Meadows: None. B. Clarke: None. A. Hoschtitzky: None. V.S. Mahadevan: None.
- © 2016 by American Heart Association, Inc.