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Peripheral venous pressure (PVP) in #Fontan:
There have been 2 recent papers published on PVP in patients with a Fontan circulation. It’s time for a
There have been 2 recent papers published on PVP in patients with a Fontan circulation. It’s time for a
Elevated central venous pressure (CVP) in patients with a Fontan circulation contributes to adverse outcomes.
Having a way to estimate CVP w/o frequent trips to the cath lab would be invaluable to help monitor patients and track the effectiveness of interventions & medications
Having a way to estimate CVP w/o frequent trips to the cath lab would be invaluable to help monitor patients and track the effectiveness of interventions & medications
In 2004, @pastorkirkMD et al. measured PVP and simultaneous CVP in 19 pediatric patients (10 BDG and 9 Fontan). Mean PVP 17.5 ± 5.6 mmHg and mean CVP 16.1 ± 5.4 mmHg. Correlation coefficient PVP to SVC was 0.97 (p < 0.001).
Another study by Masutani et al. evaluated 30 patients post-Fontan (median age 8.6 yrs) and confirmed CVP and PVP were highly correlated (R=0.86, P<.0001).
PVP was always > than CVP (otherwise there would be no forward flow).
Regression equation:
CVP = 1.6 + 0.68 * PVP
PVP was always > than CVP (otherwise there would be no forward flow).
Regression equation:
CVP = 1.6 + 0.68 * PVP
Recently, the ACHD group at UCLA measured PVP and CVP in 38 ADULTS with a Fontan and found that PVP overestimates CVP by a mean of 1.2 mmHg.
CVP = 1.3 + 0.86*PVP.
https://doi.org/10.1016/j.ijcard.2020.11.007
CVP = 1.3 + 0.86*PVP.
https://doi.org/10.1016/j.ijcard.2020.11.007
So, these studies demonstrate good correlation between PVP and CVP.
PVP of 15mmHg estimates CVP 12-14mmHg
PVP of 20mmHg estimates CVP 15-18mmHg
PVP of 25mmHg estimates CVP 19-23mmHg
What about a 2-ventricle circulation?
PVP of 15mmHg estimates CVP 12-14mmHg
PVP of 20mmHg estimates CVP 15-18mmHg
PVP of 25mmHg estimates CVP 19-23mmHg
What about a 2-ventricle circulation?
PVP is only moderately correlated with CVP in 2-ventricle patients likely related to lower CVP and the need for PVP to be elevated to prevent venous collapse.
However, when CVP is higher the difference between PVP and CVP is less. https://doi.org/10.1161/circheartfailure.117.004130
However, when CVP is higher the difference between PVP and CVP is less. https://doi.org/10.1161/circheartfailure.117.004130
What about during exercise?
Navaratnam et al. evaluated exercise PVP (10 Fontan and 9 controls). PVP increased abruptly at exercise onset in patients and controls but continued to increase throughout exercise in Fontan.
Peak exercise PVP 25 ± 6 in Fontan and 9 ± 3 in controls
Navaratnam et al. evaluated exercise PVP (10 Fontan and 9 controls). PVP increased abruptly at exercise onset in patients and controls but continued to increase throughout exercise in Fontan.
Peak exercise PVP 25 ± 6 in Fontan and 9 ± 3 in controls
At @CincyKidsHeart we have been doing cardiopulmonary exercise tests (CPET) with PVP monitoring and recently published our findings in @Heart_BMJ.
http://dx.doi.org/10.1136/heartjnl-2020-317179
http://dx.doi.org/10.1136/heartjnl-2020-317179
46 patients (age 26.9±9.5yrs) underwent CPET with PVP.
PVP was measured at rest, with unloaded exercise (0 watts), and at each min of exercise
PVP was 13.6±3.5 mmHg at rest
PVP increased to 23.0±5.5 mmHg at peak exercise
PVP was measured at rest, with unloaded exercise (0 watts), and at each min of exercisePVP was 13.6±3.5 mmHg at rest PVP increased to 23.0±5.5 mmHg at peak exercise
We found that higher PVP at unloaded and peak exercise was strongly associated with adverse Fontan outcomes https://twitter.com/ralogon/status/1325662924589948928?s=20
How can Fontan PVP be used in the future?
-PVP monitoring in clinic -
PVP may prompt investigations (MRI/CT/Cath) or meds (diuretics)
-Exercise PVP may predict those at highest risk of adverse outcomes
-PVP to monitor response to med changes
-PVP as part of clinical trials
-PVP monitoring in clinic -
PVP may prompt investigations (MRI/CT/Cath) or meds (diuretics)-Exercise PVP may predict those at highest risk of adverse outcomes
-PVP to monitor response to med changes
-PVP as part of clinical trials
Thanks for reading.
Any other thoughts or comments?
(no better way to end a thread than with a picture of my puppy)
#CincyACHDdog
Any other thoughts or comments?
(no better way to end a thread than with a picture of my puppy)
#CincyACHDdog
