Abstract
ObjectivesIncreased arterial stiffness is a risk factor of atherosclerosis and cardio-vascular complications. The aim of the study was to determine whether peripheral vascular function might be an early marker of impaired health status in patients with a single ventricle after Fontan procedure.Methods and resultsTwenty five consecutive adults (11 women and 14 men) aged 24.7 ± 6.2 years after the Fontan procedure and 25 sex, age and BMI match healthy volunteers underwent physical examination, blood analysis, transthoracic echocardiography and noninvasive assessment of aortic stiffness. Augmented pressure and Augmentation Index (AIx) were both significantly elevated in Fontan when compared to the controls (6,08 ± 0,7 vs. 2,0 ± 3,7; p = 0.002 and 17,01 ± 3,3 vs. 6,05 ± 11; p < 0.001, respectively). There were no differences in pulse wave velocity (PWV), mean blood pressure (BP), brachial pulse pressure (PP), central: systolic BP, diastolic BP and PP. In Fontan group we find negative correlation between PWV and SatO2 (r = −0.68; p = 0.04) and positive correlation with WBC (0.72; p = 0.72; p = 0.013), INR (0.81; p = 0.008), TNFα (r = 0.45; p = 0.04), and postoperative time (r = 0.77; p = 0.02). AIx correlates positively only with age at surgery (r = 0.45; p = 0.04). Bilirubin level correlates positively with brachial PP (r = 0.71; p = 0.02) and central PP (r = 0.68; p = 0.03).The multivariate model showed that SatO2 (β = −0.44, p = 0.04) was the only independent predictor of PWV (R2 = 0.32, p = 0.03).ConclusionAdult Fontan patients have an increased arterial stiffness assessed by a noninvasive technique. Low arterial oxygen saturation postoperative time, age at surgery, white blood cells, TNFα and bilirubin level are associated with arterial stiffening in these patients. The combination of blood parameters of the hepatic function and noninvasive measurements of arterial stiffness could be helpful in comprehensive care of patients with Fontan circulation.
Highlights
Non-invasive measurement of vascular parameters is increasingly used to assess the risk of cardiovascular disease
Our study demonstrated that arterial oxygen saturation is an important determinant of arterial stiffness in adult Fontan patients
Our study showed that inflammation influenced arterial stiffness in adult Fontan patients
Summary
Non-invasive measurement of vascular parameters is increasingly used to assess the risk of cardiovascular disease. It is considered that the loss of elasticity of the walls of the arteries, especially the aorta is a marker of the early changes that may lead to the development of atherosclerosis and its following complications (eg, hypertension, stroke, myocardial infarction) in healthy individuals [1]. Increase in arterial stiffness was proven to be caused by several factors such as age, hypertension, hypercholesterolemia, diabetes, and Fontan operation is a widely used method of treatment of patients with single ventricle. The main goal of this procedure is the separation of the pulmonary and systemic circulation. The treatment is multistage and it results in the absence of subpulmonary ventricle. The blood flow through the lungs is effected due to the pressure gradient between the systemic veins and the left atrium and has non-pulsatile character [7,8]
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