What determines the quality of life of adult patients after Fontan procedure?

Smaś-Suska, Monika; Dłużniewska, Natalia; Weryński, Piotr; Pająk, Jacek; Płazak, Wojciech; Olszowska, Maria; Podolec, Piotr; Tomkiewicz‐Pająk, Lidia

doi:10.5603/cj.a2017.0078

Cited by 13 publications

(5 citation statements)

References 38 publications

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“…13,14 Almost all studies of physical capacity and performance in young Fontan patients have shown a reduced maximal heart rate, and many have suggested this to be a limiting factor for physical performance and tolerance. [15][16][17] Repeated heart surgery early in life has been suggested to injure the heart's autonomous nervous system and impair sinoatrial response to exercise. 18 A recent report with measurements of stroke volume during exercise in a small number of adult Fontan patients suggests that the main limiting factor for cardiac output and maximal exercise capacity is impaired diastolic filling and stroke volume by the ventricle rather than heart rate.…”

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confidence: 99%

Appropriate heart rate during exercise in Fontan patients

2020

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Objective:To evaluate heart rate against workload and oxygen consumption during exercise in Fontan patients.Method:Fontan patients (n = 27) and healthy controls (n = 25) underwent cardiopulmonary exercise testing with linear increase of load. Heart rate and oxygen uptake were measured during tests. Heart rate recovery was recorded for 10 minutes.Results:Heart rate at midpoint (140 ± 14 versus 153 ± 11, p < 0.001) and at maximal effort (171 ± 14 versus 191 ± 10 beats per minute, p < 0.001) of test was lower for patients than controls. Heart rate recovery was similar between groups. Heart rate in relation to workload was higher for patients than controls both at midpoint and maximal effort. Heart rate in relation to oxygen uptake was similar between groups throughout test. Oxygen pulse, an indirect surrogate measure of stroke volume, was reduced at maximal effort in patients compared to controls (6.6 ± 1.1 versus 7.5 ± 1.4 ml·beat−1·m−2, p < 0.05) and increased significantly less from midpoint to maximal effort for patients than controls (p < 0.05).Conclusions:Heart rate is increased in relation to workload in Fontan patients compared with controls. At higher loads, Fontan patients seem to have reduced heart rate and smaller increase in oxygen pulse, which may be explained by inability to further increase stroke volume and cardiac output. Reduced ability to increase or maintain stroke volume at higher heart rates may be an important limiting factor for maximal cardiac output, oxygen uptake, and physical performance.

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confidence: 99%

Appropriate heart rate during exercise in Fontan patients

2020

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“…SND is a common, late complication post-Fontan surgery [ 18 , 23 ]. Patients with Fontan circulation reportedly experience a reduced quality of life, compared to healthy controls [ 24 ], with arrhythmia and chronotropic incompetence shown to be predictive of the level of health-related quality of life impairment in these patients [ 25 , 26 ].…”

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confidence: 99%

Sinus node dysfunction in patients with Fontan circulation: could heart rate variability be a predictor for pacemaker implantation?

et al. 2019

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Sinus node dysfunction (SND) causes significant morbidity in patients after Fontan surgery. Heart rate variability (HRV) reflects the autonomic regulation of the heart, and changes in HRV have been associated with SND in adults. We aimed to study whether changes in HRV could be detected in 24-h electrocardiographic (ECG) recordings in Fontan patients with SND. We compared HRV results from two patient groups; patients with Fontan circulation who later required a pacemaker due to severe SND ( n = 12) and patients with Fontan circulation and SND, without indication for pacemaker treatment ( n = 11), with two control groups; patients with Fontan circulation without SND ( n = 90) and healthy controls ( n = 66). The Poincaré plot index SD2 (representing changes in heart rate over 24-h) and the very low-frequency (VLF) HRV component were significantly higher in both SND groups, both compared with healthy controls and patients with Fontan circulation without SND. In SND patients with pacemakers, SD2 and VLF were slightly reduced compared to SND patients without pacemaker ( p = 0.06). In conclusion, in Fontan patients with SND the HRV is significantly higher compared to healthy controls and Fontan patients without SND. However, in patients with severe SND requiring pacemaker, SD2 and VLF tended to be lower than in patients with SND without pacemaker, which could indicate a reduced diurnal HRV in addition to the severe bradycardia. This is a small study, but our results indicate that HRV analysis might be a useful method in the follow-up of Fontan patients regarding development of SND. Electronic supplementary material The online version of this article (10.1007/s00246-019-02092-5) contains supplementary material, which is available to authorized users.

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“…Functional health assessment, using the SF-36, was completed in all 39 patients and 40 controls. Scores were analysed according to published guidelines described previously [ 10 ]. A score between 0 and 100 was calculated for each domain.…”

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confidence: 99%

Quality of life in adults with repaired tetralogy of Fallot

Dłużniewska¹,

Podolec²,

Olszowska³

et al. 2018

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IntroductionObservations of patients after repair of tetralogy of Fallot (ToF) indicate good correction results and long-term survival. Few papers have been published in which the quality of life (QoL) of this population has been assessed.AimTo evaluate QoL in adults with repaired ToF. Material and methodsWe included 39 patients with repaired ToF and 40 age- and sex-matched healthy volunteers. Information recorded included echocardiography, cardiac magnetic resonance, cardiopulmonary exercise test, and self-reported health-related QoL questionnaire (SF-36). ResultsThe perceived physical and mental domains of health were signi cantly poorer in ToF patients than in controls. A positive correlation between VO2 peak and physical domains was observed: (VO2 peak vs. physical domains (r = 0.6, p ≤ 0.001), general health (r = 0.36, p = 0.03), and physical complex status (r = 0.51, p = 0.001). VO2 peak % correlated with physical functioning (r = 0.43, p = 0.007), general health (r = 0.39, p = 0.015) and physical complex status (r = 0.49, p = 0.002). Right ventricle ejection fraction, determined with cardiac magnetic resonance, positively correlated with role physical (r = 0.38, p = 0.04). In echocardiography, pressure half time was posi- tively correlated with physical functioning (r = 0.48, p = 0.004) and role physical (r = 0.4, p = 0.02). ConclusionsThe QoL in adults after repair of ToF and healthy control subjects was compared directly. The self-perceived physical and mental domains of health were significantly poorer in ToF patients than in controls. Strong associations were found between objective exercise capacity and physical aspects of quality of life. Complex assessment and quality of life instruments should be used together to obtain an accurate view of health status of patients with repaired ToF.

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What determines the quality of life of adult patients after Fontan procedure?

Abstract: (Cardiol J 2018; 25, 1: 72-80)

Cited by 13 publications

References 38 publications

Appropriate heart rate during exercise in Fontan patients

Appropriate heart rate during exercise in Fontan patients

Sinus node dysfunction in patients with Fontan circulation: could heart rate variability be a predictor for pacemaker implantation?

Quality of life in adults with repaired tetralogy of Fallot

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