Central Venous Waveform Patterns in the Fontan Circulation Independently Contribute to the Prediction of Composite Survival
It is well appreciated that the Fontan circulation perturbs central venous hemodynamics, with elevated pressure being the clearest change associated with Fontan comorbidities, such as Fontan-associated liver disease (FALD) and protein-losing enteropathy (PLE). Our group has better quantity of these...
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| Veröffentlicht in: | Pediatric cardiology 2024-12, Vol.45 (8), p.1617-1626 |
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| creator | Ferrari, Margaret R. Schäfer, Michal Hunter, Kendall S. Di Maria, Michael V. |
| description | It is well appreciated that the Fontan circulation perturbs central venous hemodynamics, with elevated pressure being the clearest change associated with Fontan comorbidities, such as Fontan-associated liver disease (FALD) and protein-losing enteropathy (PLE). Our group has better quantity of these venous perturbations through single- and multi-location analyses of flow waveforms obtained from magnetic resonance imaging of Fontan patients. Here, we determine if such analyses, which yield principal components (PC) that describe flow features, are associated with Fontan survival. Patients with a Fontan circulation (
N
= 140) that underwent free-breathing and mechanically ventilated cardiac MRI were included in this study. Standard volumetric and functional hemodynamics, as well as flow analysis principal components, were subjected to univariate and bivariate Cox regression analyses to determine composite clinical outcome, including plastic bronchitis, PLE, and referral and receipt of transplant. Unsurprisingly, ventricular function measures of ejection fraction (EF; HR = 0.88,
p
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| doi_str_mv | 10.1007/s00246-023-03268-w |
| format | Article |
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N
= 140) that underwent free-breathing and mechanically ventilated cardiac MRI were included in this study. Standard volumetric and functional hemodynamics, as well as flow analysis principal components, were subjected to univariate and bivariate Cox regression analyses to determine composite clinical outcome, including plastic bronchitis, PLE, and referral and receipt of transplant. Unsurprisingly, ventricular function measures of ejection fraction (EF; HR = 0.88,
p
< 0.0001), indexed end-systolic volume (ESVi; HR 1.02,
p
< 0.0001), and indexed end-diastolic volume (EDVi; HR = 1.02,
p
= 0.0007) were found as specific predictors of clinical events, with specificities uniformly > 0.75. Additionally a feature of IVC flow (PC2) indicating increased flow in systole was found as a highly sensitive predictor (HR = 0.851,
p
= 0.027, sensitivity 0.93). In bivariate prediction, combinations of ventricular function (EF, ESVi, EDVi) with this IVC flow feature yielded best overall prediction of composite outcome. This suggests that central venous waveform analysis relays additional information about Fontan patient survival and that coupling sensitive and specific measures in bivariate analysis is a useful approach for obtaining superior prediction of survival.</description><identifier>ISSN: 0172-0643</identifier><identifier>ISSN: 1432-1971</identifier><identifier>EISSN: 1432-1971</identifier><identifier>DOI: 10.1007/s00246-023-03268-w</identifier><identifier>PMID: 37773462</identifier><language>eng</language><publisher>New York: Springer US</publisher><subject>Adolescent ; Cardiac Surgery ; Cardiology ; Child ; Child, Preschool ; Female ; Fontan Procedure ; Heart Defects, Congenital - physiopathology ; Heart Defects, Congenital - surgery ; Hemodynamics ; Humans ; Magnetic Resonance Imaging ; Magnetic Resonance Imaging, Cine - methods ; Male ; Medicine ; Medicine & Public Health ; Protein-Losing Enteropathies - etiology ; Protein-Losing Enteropathies - physiopathology ; Retrospective Studies ; Review ; Stroke Volume - physiology ; Vascular Surgery</subject><ispartof>Pediatric cardiology, 2024-12, Vol.45 (8), p.1617-1626</ispartof><rights>The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature 2023. Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.</rights><rights>2023. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><cites>FETCH-LOGICAL-c354t-bc8a360d4f1806defc485e6b0cb7b9ba9550f68a1f74b8d40be97f5b609a02023</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1007/s00246-023-03268-w$$EPDF$$P50$$Gspringer$$H</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1007/s00246-023-03268-w$$EHTML$$P50$$Gspringer$$H</linktohtml><link.rule.ids>230,314,780,784,885,27924,27925,41488,42557,51319</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/37773462$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Ferrari, Margaret R.</creatorcontrib><creatorcontrib>Schäfer, Michal</creatorcontrib><creatorcontrib>Hunter, Kendall S.</creatorcontrib><creatorcontrib>Di Maria, Michael V.</creatorcontrib><title>Central Venous Waveform Patterns in the Fontan Circulation Independently Contribute to the Prediction of Composite Survival</title><title>Pediatric cardiology</title><addtitle>Pediatr Cardiol</addtitle><addtitle>Pediatr Cardiol</addtitle><description>It is well appreciated that the Fontan circulation perturbs central venous hemodynamics, with elevated pressure being the clearest change associated with Fontan comorbidities, such as Fontan-associated liver disease (FALD) and protein-losing enteropathy (PLE). Our group has better quantity of these venous perturbations through single- and multi-location analyses of flow waveforms obtained from magnetic resonance imaging of Fontan patients. Here, we determine if such analyses, which yield principal components (PC) that describe flow features, are associated with Fontan survival. Patients with a Fontan circulation (
N
= 140) that underwent free-breathing and mechanically ventilated cardiac MRI were included in this study. Standard volumetric and functional hemodynamics, as well as flow analysis principal components, were subjected to univariate and bivariate Cox regression analyses to determine composite clinical outcome, including plastic bronchitis, PLE, and referral and receipt of transplant. Unsurprisingly, ventricular function measures of ejection fraction (EF; HR = 0.88,
p
< 0.0001), indexed end-systolic volume (ESVi; HR 1.02,
p
< 0.0001), and indexed end-diastolic volume (EDVi; HR = 1.02,
p
= 0.0007) were found as specific predictors of clinical events, with specificities uniformly > 0.75. Additionally a feature of IVC flow (PC2) indicating increased flow in systole was found as a highly sensitive predictor (HR = 0.851,
p
= 0.027, sensitivity 0.93). In bivariate prediction, combinations of ventricular function (EF, ESVi, EDVi) with this IVC flow feature yielded best overall prediction of composite outcome. This suggests that central venous waveform analysis relays additional information about Fontan patient survival and that coupling sensitive and specific measures in bivariate analysis is a useful approach for obtaining superior prediction of survival.</description><subject>Adolescent</subject><subject>Cardiac Surgery</subject><subject>Cardiology</subject><subject>Child</subject><subject>Child, Preschool</subject><subject>Female</subject><subject>Fontan Procedure</subject><subject>Heart Defects, Congenital - physiopathology</subject><subject>Heart Defects, Congenital - surgery</subject><subject>Hemodynamics</subject><subject>Humans</subject><subject>Magnetic Resonance Imaging</subject><subject>Magnetic Resonance Imaging, Cine - methods</subject><subject>Male</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Protein-Losing Enteropathies - etiology</subject><subject>Protein-Losing Enteropathies - physiopathology</subject><subject>Retrospective Studies</subject><subject>Review</subject><subject>Stroke Volume - physiology</subject><subject>Vascular Surgery</subject><issn>0172-0643</issn><issn>1432-1971</issn><issn>1432-1971</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2024</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9kUFv1DAQhS1ERZfCH-CAfOQSGCeOnZwQiihUqtRKLXC07GTSukrsxXa2qvrncTelohcu9uF98zx-j5B3DD4yAPkpApRcFFBWBVSlaIrbF2TDeFUWrJXsJdkAk2UBgleH5HWMNwDQQFO_IoeVlLLiotyQ-w5dCnqiP9H5JdJfeoejDzM91ylhcJFaR9M10mPvkna0s6FfJp2sd_TEDbjFfLg03dEuA8GaJSFNfj9yHnCw_R71Y9bnrY82yxdL2Nmdnt6Qg1FPEd8-3kfkx_HXy-57cXr27aT7clr0Vc1TYfpGVwIGPrIGxIBjz5sahYHeSNMa3dY1jKLRbJTcNAMHg60cayOg1VDmdI7I59V3u5gZh379sdoGO-twp7y26rni7LW68jvFmOCC8QeHD48Owf9eMCY129jjNGmHOTVVNhLalreMZbRc0T74GAOOT-8wUA-1qbU2lRdT-9rUbR56_--GTyN_e8pAtQIxS-4Kg7rxS3A5tf_Z_gHszKeK</recordid><startdate>20241201</startdate><enddate>20241201</enddate><creator>Ferrari, Margaret R.</creator><creator>Schäfer, Michal</creator><creator>Hunter, Kendall S.</creator><creator>Di Maria, Michael V.</creator><general>Springer US</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><scope>5PM</scope></search><sort><creationdate>20241201</creationdate><title>Central Venous Waveform Patterns in the Fontan Circulation Independently Contribute to the Prediction of Composite Survival</title><author>Ferrari, Margaret R. ; Schäfer, Michal ; Hunter, Kendall S. ; Di Maria, Michael V.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c354t-bc8a360d4f1806defc485e6b0cb7b9ba9550f68a1f74b8d40be97f5b609a02023</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2024</creationdate><topic>Adolescent</topic><topic>Cardiac Surgery</topic><topic>Cardiology</topic><topic>Child</topic><topic>Child, Preschool</topic><topic>Female</topic><topic>Fontan Procedure</topic><topic>Heart Defects, Congenital - physiopathology</topic><topic>Heart Defects, Congenital - surgery</topic><topic>Hemodynamics</topic><topic>Humans</topic><topic>Magnetic Resonance Imaging</topic><topic>Magnetic Resonance Imaging, Cine - methods</topic><topic>Male</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Protein-Losing Enteropathies - etiology</topic><topic>Protein-Losing Enteropathies - physiopathology</topic><topic>Retrospective Studies</topic><topic>Review</topic><topic>Stroke Volume - physiology</topic><topic>Vascular Surgery</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Ferrari, Margaret R.</creatorcontrib><creatorcontrib>Schäfer, Michal</creatorcontrib><creatorcontrib>Hunter, Kendall S.</creatorcontrib><creatorcontrib>Di Maria, Michael V.</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Pediatric cardiology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Ferrari, Margaret R.</au><au>Schäfer, Michal</au><au>Hunter, Kendall S.</au><au>Di Maria, Michael V.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Central Venous Waveform Patterns in the Fontan Circulation Independently Contribute to the Prediction of Composite Survival</atitle><jtitle>Pediatric cardiology</jtitle><stitle>Pediatr Cardiol</stitle><addtitle>Pediatr Cardiol</addtitle><date>2024-12-01</date><risdate>2024</risdate><volume>45</volume><issue>8</issue><spage>1617</spage><epage>1626</epage><pages>1617-1626</pages><issn>0172-0643</issn><issn>1432-1971</issn><eissn>1432-1971</eissn><abstract>It is well appreciated that the Fontan circulation perturbs central venous hemodynamics, with elevated pressure being the clearest change associated with Fontan comorbidities, such as Fontan-associated liver disease (FALD) and protein-losing enteropathy (PLE). Our group has better quantity of these venous perturbations through single- and multi-location analyses of flow waveforms obtained from magnetic resonance imaging of Fontan patients. Here, we determine if such analyses, which yield principal components (PC) that describe flow features, are associated with Fontan survival. Patients with a Fontan circulation (
N
= 140) that underwent free-breathing and mechanically ventilated cardiac MRI were included in this study. Standard volumetric and functional hemodynamics, as well as flow analysis principal components, were subjected to univariate and bivariate Cox regression analyses to determine composite clinical outcome, including plastic bronchitis, PLE, and referral and receipt of transplant. Unsurprisingly, ventricular function measures of ejection fraction (EF; HR = 0.88,
p
< 0.0001), indexed end-systolic volume (ESVi; HR 1.02,
p
< 0.0001), and indexed end-diastolic volume (EDVi; HR = 1.02,
p
= 0.0007) were found as specific predictors of clinical events, with specificities uniformly > 0.75. Additionally a feature of IVC flow (PC2) indicating increased flow in systole was found as a highly sensitive predictor (HR = 0.851,
p
= 0.027, sensitivity 0.93). In bivariate prediction, combinations of ventricular function (EF, ESVi, EDVi) with this IVC flow feature yielded best overall prediction of composite outcome. This suggests that central venous waveform analysis relays additional information about Fontan patient survival and that coupling sensitive and specific measures in bivariate analysis is a useful approach for obtaining superior prediction of survival.</abstract><cop>New York</cop><pub>Springer US</pub><pmid>37773462</pmid><doi>10.1007/s00246-023-03268-w</doi><tpages>10</tpages></addata></record> |
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| subjects | Adolescent Cardiac Surgery Cardiology Child Child, Preschool Female Fontan Procedure Heart Defects, Congenital - physiopathology Heart Defects, Congenital - surgery Hemodynamics Humans Magnetic Resonance Imaging Magnetic Resonance Imaging, Cine - methods Male Medicine Medicine & Public Health Protein-Losing Enteropathies - etiology Protein-Losing Enteropathies - physiopathology Retrospective Studies Review Stroke Volume - physiology Vascular Surgery |
| title | Central Venous Waveform Patterns in the Fontan Circulation Independently Contribute to the Prediction of Composite Survival |
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