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Background: There are limited data about the prognostic valve of cardiopulmonary exercise test (CPET) in adults with prior Fontan operation.
Methods: Retrospective review of adults with prior Fontan operation who had treadmill CPET at Mayo Clinic, 1994-2013. The study objective was to determine the role of CPET indices in predicting cardiovascular adverse events (CAE) defined as death, cardiac surgery or transcatheter interventions.
Patients with loss of follow-up defined as ≥2 years without clinical follow-up were excluded. The results of serial CPETs were reviewed, and patients with CPETs meeting the following criteria were selected for analysis: maximum effort on serial CPETs, minimum of 3-year interval between CPETs, and absence of CAE between CPETs.
Results: 145 patients met inclusion criteria for the study; mean age at baseline CPET was 24±3 years; mean age at Fontan operation was 11±5 years; and 91 (63%) were males.
Baseline peak oxygen consumption (VO2) was 22.7±5.4 ml/kg/min (63±11% predicted), peak heart rate was 135±31 beats per minute, and oxygen saturation at peak exercise was 86±7%. Serial CPETs were performed in 71/145 patients (49%); mean duration between CPETs was 3.8±0.3 years. The % predicted peak VO2 decreased by 1.7±0.9 percentage points/year.
CAE (deaths n=22; cardiac surgery n=45; transcatheter interventions n=38) occurred in 69/145 patients (48%) within 8±3 years. Decline in % predicted peak VO2 ≥3 percentage point/year was the only predictor of 5-year risk of CAE (HR 2.79, 95% CI 1.37-3.21, P=.01).
Conclusions: Serial CPET is prognostic of CAE in the adult Fontan population, and can be used to risk stratify these patients.
Legend: Kaplan-Meier curves comparing freedom from CAE for patients with decline in %predicted peak VO2 ≥3 percentage point/year (blue) vs those with decline in %predicted peak VO2 <3 percentage point/year (red). The second CPET marks the beginning of time zero (at risk period).
Poster Hall, Hall C
Saturday, March 18, 2017, 9:45 a.m.-10:30 a.m.
Session Title: Fontan in the Modern World
Abstract Category: 9. Congenital Heart Disease: Adult
Presentation Number: 1183-024
- 2017 American College of Cardiology Foundation