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Usefulness of Peripheral Vascular Function to Predict Functional Health Status in Patients With Fontan Circulation
After the Fontan operation, patients are at a substantial risk of the development of impaired functional health status. Few early markers of suboptimal outcomes have been identified. We sought to assess the association between peripheral vascular function and functional health status in Fontan-palli...
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| Published in: | The American journal of cardiology 2011-08, Vol.108 (3), p.428-434 |
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| creator | Goldstein, Bryan H., MD Golbus, Jessica R Sandelin, Angela M Warnke, Nicole, BS Gooding, Lindsay, BS King, Karen K., CCRC Donohue, Janet E., MPH Gurney, James G., PhD Goldberg, Caren S., MD, MS Rocchini, Albert P., MD Charpie, John R., MD, PhD |
| description | After the Fontan operation, patients are at a substantial risk of the development of impaired functional health status. Few early markers of suboptimal outcomes have been identified. We sought to assess the association between peripheral vascular function and functional health status in Fontan-palliated patients. Asymptomatic Fontan patients (n = 51) and age- and gender-matched healthy controls (n = 22) underwent endothelial pulse amplitude testing using a noninvasive fingertip peripheral arterial tonometry (PAT) device. Raw data were transformed into the PAT ratio, an established marker of vascular function. Cardiopulmonary exercise testing was performed using the Bruce protocol. In the Fontan cohort, 94% of patients were New York Heart Association functional class I and 88% had a B-type natriuretic peptide level of |
| doi_str_mv | 10.1016/j.amjcard.2011.03.064 |
| format | article |
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Few early markers of suboptimal outcomes have been identified. We sought to assess the association between peripheral vascular function and functional health status in Fontan-palliated patients. Asymptomatic Fontan patients (n = 51) and age- and gender-matched healthy controls (n = 22) underwent endothelial pulse amplitude testing using a noninvasive fingertip peripheral arterial tonometry (PAT) device. Raw data were transformed into the PAT ratio, an established marker of vascular function. Cardiopulmonary exercise testing was performed using the Bruce protocol. In the Fontan cohort, 94% of patients were New York Heart Association functional class I and 88% had a B-type natriuretic peptide level of <50 pg/ml. The baseline pulse amplitude, a measure that reflects the arterial tone at rest, was greater in the Fontan patients than in the controls (median 2.74, interquartile range 1.96 to 4.13 vs median 1.86, interquartile range 1.14 to 2.79, p = 0.03). The PAT ratio, a measure of reactive hyperemia, was lower in Fontan patients (median 0.17, interquartile range −0.04 to 0.44, vs median 0.50, interquartile range 0.27 to 0.74, p = 0.002). The key parameters of exercise performance, including peak oxygen consumption (median 28.8 ml/kg/min, interquartile range 25.6 to 33.2 vs median 45.5 ml/kg/min, interquartile range 41.7 to 49.9, p <0.0001) and peak work (median 192 W, interquartile range 150 to 246 vs median 330, interquartile range 209 to 402 W, p <0.0001), were lower in Fontan patients than in the controls. The PAT ratio correlated with the peak oxygen consumption (r = 0.28, p = 0.02) and peak work (r = 0.26, p = 0.03). In conclusion, in an asymptomatic Fontan population, there is evidence of reduced basal peripheral arterial tone and vasodilator response, suggesting dysfunction of the endothelium-derived nitric oxide pathway. Vasodilator function appears to correlate with exercise performance.</description><identifier>ISSN: 0002-9149</identifier><identifier>EISSN: 1879-1913</identifier><identifier>DOI: 10.1016/j.amjcard.2011.03.064</identifier><identifier>PMID: 21600541</identifier><identifier>CODEN: AJCDAG</identifier><language>eng</language><publisher>New York, NY: Elsevier Inc</publisher><subject>Adolescent ; Adult ; Biological and medical sciences ; Biomarkers ; Blood Pressure - physiology ; Cardiology ; Cardiology. Vascular system ; Cardiovascular ; Cardiovascular disease ; Child ; Child, Preschool ; Disability Evaluation ; Echocardiography, Doppler ; Endothelium, Vascular - physiopathology ; Exercise Test ; Female ; Fingers - blood supply ; Fontan Procedure ; Health Status ; Humans ; Hyperemia - physiopathology ; Male ; Manometry ; Medical sciences ; Nitric Oxide - physiology ; Oxygen ; Oxygen - blood ; Patients ; Peripheral Vascular Diseases - diagnosis ; Peripheral Vascular Diseases - physiopathology ; Postoperative Complications - diagnosis ; Postoperative Complications - physiopathology ; Prognosis ; Prospective Studies ; Pulse ; Quality of Life ; Reference Values ; Vascular Resistance - physiology ; Young Adult</subject><ispartof>The American journal of cardiology, 2011-08, Vol.108 (3), p.428-434</ispartof><rights>Elsevier Inc.</rights><rights>2011 Elsevier Inc.</rights><rights>2015 INIST-CNRS</rights><rights>Copyright © 2011 Elsevier Inc. All rights reserved.</rights><rights>Copyright Elsevier Sequoia S.A. Aug 1, 2011</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c476t-386a999cdc8a79aac2bd2dd8e540989d9c8f476a2e568059a17f1738168f9763</citedby><cites>FETCH-LOGICAL-c476t-386a999cdc8a79aac2bd2dd8e540989d9c8f476a2e568059a17f1738168f9763</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>315,786,790,27957,27958</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=24424708$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/21600541$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Goldstein, Bryan H., MD</creatorcontrib><creatorcontrib>Golbus, Jessica R</creatorcontrib><creatorcontrib>Sandelin, Angela M</creatorcontrib><creatorcontrib>Warnke, Nicole, BS</creatorcontrib><creatorcontrib>Gooding, Lindsay, BS</creatorcontrib><creatorcontrib>King, Karen K., CCRC</creatorcontrib><creatorcontrib>Donohue, Janet E., MPH</creatorcontrib><creatorcontrib>Gurney, James G., PhD</creatorcontrib><creatorcontrib>Goldberg, Caren S., MD, MS</creatorcontrib><creatorcontrib>Rocchini, Albert P., MD</creatorcontrib><creatorcontrib>Charpie, John R., MD, PhD</creatorcontrib><title>Usefulness of Peripheral Vascular Function to Predict Functional Health Status in Patients With Fontan Circulation</title><title>The American journal of cardiology</title><addtitle>Am J Cardiol</addtitle><description>After the Fontan operation, patients are at a substantial risk of the development of impaired functional health status. Few early markers of suboptimal outcomes have been identified. We sought to assess the association between peripheral vascular function and functional health status in Fontan-palliated patients. Asymptomatic Fontan patients (n = 51) and age- and gender-matched healthy controls (n = 22) underwent endothelial pulse amplitude testing using a noninvasive fingertip peripheral arterial tonometry (PAT) device. Raw data were transformed into the PAT ratio, an established marker of vascular function. Cardiopulmonary exercise testing was performed using the Bruce protocol. In the Fontan cohort, 94% of patients were New York Heart Association functional class I and 88% had a B-type natriuretic peptide level of <50 pg/ml. The baseline pulse amplitude, a measure that reflects the arterial tone at rest, was greater in the Fontan patients than in the controls (median 2.74, interquartile range 1.96 to 4.13 vs median 1.86, interquartile range 1.14 to 2.79, p = 0.03). The PAT ratio, a measure of reactive hyperemia, was lower in Fontan patients (median 0.17, interquartile range −0.04 to 0.44, vs median 0.50, interquartile range 0.27 to 0.74, p = 0.002). The key parameters of exercise performance, including peak oxygen consumption (median 28.8 ml/kg/min, interquartile range 25.6 to 33.2 vs median 45.5 ml/kg/min, interquartile range 41.7 to 49.9, p <0.0001) and peak work (median 192 W, interquartile range 150 to 246 vs median 330, interquartile range 209 to 402 W, p <0.0001), were lower in Fontan patients than in the controls. The PAT ratio correlated with the peak oxygen consumption (r = 0.28, p = 0.02) and peak work (r = 0.26, p = 0.03). In conclusion, in an asymptomatic Fontan population, there is evidence of reduced basal peripheral arterial tone and vasodilator response, suggesting dysfunction of the endothelium-derived nitric oxide pathway. Vasodilator function appears to correlate with exercise performance.</description><subject>Adolescent</subject><subject>Adult</subject><subject>Biological and medical sciences</subject><subject>Biomarkers</subject><subject>Blood Pressure - physiology</subject><subject>Cardiology</subject><subject>Cardiology. Vascular system</subject><subject>Cardiovascular</subject><subject>Cardiovascular disease</subject><subject>Child</subject><subject>Child, Preschool</subject><subject>Disability Evaluation</subject><subject>Echocardiography, Doppler</subject><subject>Endothelium, Vascular - physiopathology</subject><subject>Exercise Test</subject><subject>Female</subject><subject>Fingers - blood supply</subject><subject>Fontan Procedure</subject><subject>Health Status</subject><subject>Humans</subject><subject>Hyperemia - physiopathology</subject><subject>Male</subject><subject>Manometry</subject><subject>Medical sciences</subject><subject>Nitric Oxide - physiology</subject><subject>Oxygen</subject><subject>Oxygen - blood</subject><subject>Patients</subject><subject>Peripheral Vascular Diseases - diagnosis</subject><subject>Peripheral Vascular Diseases - physiopathology</subject><subject>Postoperative Complications - diagnosis</subject><subject>Postoperative Complications - physiopathology</subject><subject>Prognosis</subject><subject>Prospective Studies</subject><subject>Pulse</subject><subject>Quality of Life</subject><subject>Reference Values</subject><subject>Vascular Resistance - physiology</subject><subject>Young Adult</subject><issn>0002-9149</issn><issn>1879-1913</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2011</creationdate><recordtype>article</recordtype><recordid>eNqFkl1rFDEUhoModlv9CUoQpFcz5sxHPm4UWVwrFFxo1ctwmsnQjLOZNckI_fdm2HWF3ngVcnjeNznnPYS8AlYCA_5uKHE3GAxdWTGAktUl480TsgIpVAEK6qdkxRirCgWNOiPnMQ75CtDy5-SsAs5Y28CKhG_R9vPobYx06unWBre_twFH-h2jmUcMdDN7k9zkaZroNtjOmXSqZe7K4pju6U3CNEfqPN1ictanSH-4XN9MPqGnaxcWt0XzgjzrcYz25fG8ILebT7frq-L66-cv64_XhWkET0UtOSqlTGckCoVoqruu6jpp24YpqTplZJ9BrGzLJWsVguhB1BK47JXg9QW5PNjuw_RrtjHpnYvGjiN6O81RSyEaqLloM_nmETlMc8i9ZUgy1SouIEPtATJhijHYXu-D22F40MD0koge9DERvSSiWa1zIln3-mg-3-1sd1L9jSADb49AHjiOfUBvXPzHNU3VCCYz9-HA2Tyz384GHU2es8mBBGuS7ib336-8f-RgRuddfvSnfbDx1DToWGmmb5b1WbYHsmfdqqr-AzCswO0</recordid><startdate>20110801</startdate><enddate>20110801</enddate><creator>Goldstein, Bryan H., MD</creator><creator>Golbus, Jessica R</creator><creator>Sandelin, Angela M</creator><creator>Warnke, Nicole, BS</creator><creator>Gooding, Lindsay, BS</creator><creator>King, Karen K., CCRC</creator><creator>Donohue, Janet E., MPH</creator><creator>Gurney, James G., PhD</creator><creator>Goldberg, Caren S., MD, MS</creator><creator>Rocchini, Albert P., MD</creator><creator>Charpie, John R., MD, PhD</creator><general>Elsevier Inc</general><general>Elsevier</general><general>Elsevier Limited</general><scope>IQODW</scope><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>7TS</scope><scope>8FD</scope><scope>FR3</scope><scope>K9.</scope><scope>M7Z</scope><scope>NAPCQ</scope><scope>P64</scope><scope>7X8</scope></search><sort><creationdate>20110801</creationdate><title>Usefulness of Peripheral Vascular Function to Predict Functional Health Status in Patients With Fontan Circulation</title><author>Goldstein, Bryan H., MD ; Golbus, Jessica R ; Sandelin, Angela M ; Warnke, Nicole, BS ; Gooding, Lindsay, BS ; King, Karen K., CCRC ; Donohue, Janet E., MPH ; Gurney, James G., PhD ; Goldberg, Caren S., MD, MS ; Rocchini, Albert P., MD ; Charpie, John R., MD, PhD</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c476t-386a999cdc8a79aac2bd2dd8e540989d9c8f476a2e568059a17f1738168f9763</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2011</creationdate><topic>Adolescent</topic><topic>Adult</topic><topic>Biological and medical sciences</topic><topic>Biomarkers</topic><topic>Blood Pressure - physiology</topic><topic>Cardiology</topic><topic>Cardiology. Vascular system</topic><topic>Cardiovascular</topic><topic>Cardiovascular disease</topic><topic>Child</topic><topic>Child, Preschool</topic><topic>Disability Evaluation</topic><topic>Echocardiography, Doppler</topic><topic>Endothelium, Vascular - physiopathology</topic><topic>Exercise Test</topic><topic>Female</topic><topic>Fingers - blood supply</topic><topic>Fontan Procedure</topic><topic>Health Status</topic><topic>Humans</topic><topic>Hyperemia - physiopathology</topic><topic>Male</topic><topic>Manometry</topic><topic>Medical sciences</topic><topic>Nitric Oxide - physiology</topic><topic>Oxygen</topic><topic>Oxygen - blood</topic><topic>Patients</topic><topic>Peripheral Vascular Diseases - diagnosis</topic><topic>Peripheral Vascular Diseases - physiopathology</topic><topic>Postoperative Complications - diagnosis</topic><topic>Postoperative Complications - physiopathology</topic><topic>Prognosis</topic><topic>Prospective Studies</topic><topic>Pulse</topic><topic>Quality of Life</topic><topic>Reference Values</topic><topic>Vascular Resistance - physiology</topic><topic>Young Adult</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Goldstein, Bryan H., MD</creatorcontrib><creatorcontrib>Golbus, Jessica R</creatorcontrib><creatorcontrib>Sandelin, Angela M</creatorcontrib><creatorcontrib>Warnke, Nicole, BS</creatorcontrib><creatorcontrib>Gooding, Lindsay, BS</creatorcontrib><creatorcontrib>King, Karen K., CCRC</creatorcontrib><creatorcontrib>Donohue, Janet E., MPH</creatorcontrib><creatorcontrib>Gurney, James G., PhD</creatorcontrib><creatorcontrib>Goldberg, Caren S., MD, MS</creatorcontrib><creatorcontrib>Rocchini, Albert P., MD</creatorcontrib><creatorcontrib>Charpie, John R., MD, PhD</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Physical Education Index</collection><collection>Technology Research Database</collection><collection>Engineering Research Database</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Biochemistry Abstracts 1</collection><collection>Nursing & Allied Health Premium</collection><collection>Biotechnology and BioEngineering Abstracts</collection><collection>MEDLINE - Academic</collection><jtitle>The American journal of cardiology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Goldstein, Bryan H., MD</au><au>Golbus, Jessica R</au><au>Sandelin, Angela M</au><au>Warnke, Nicole, BS</au><au>Gooding, Lindsay, BS</au><au>King, Karen K., CCRC</au><au>Donohue, Janet E., MPH</au><au>Gurney, James G., PhD</au><au>Goldberg, Caren S., MD, MS</au><au>Rocchini, Albert P., MD</au><au>Charpie, John R., MD, PhD</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Usefulness of Peripheral Vascular Function to Predict Functional Health Status in Patients With Fontan Circulation</atitle><jtitle>The American journal of cardiology</jtitle><addtitle>Am J Cardiol</addtitle><date>2011-08-01</date><risdate>2011</risdate><volume>108</volume><issue>3</issue><spage>428</spage><epage>434</epage><pages>428-434</pages><issn>0002-9149</issn><eissn>1879-1913</eissn><coden>AJCDAG</coden><notes>ObjectType-Article-1</notes><notes>SourceType-Scholarly Journals-1</notes><notes>ObjectType-Feature-2</notes><notes>content type line 23</notes><abstract>After the Fontan operation, patients are at a substantial risk of the development of impaired functional health status. Few early markers of suboptimal outcomes have been identified. We sought to assess the association between peripheral vascular function and functional health status in Fontan-palliated patients. Asymptomatic Fontan patients (n = 51) and age- and gender-matched healthy controls (n = 22) underwent endothelial pulse amplitude testing using a noninvasive fingertip peripheral arterial tonometry (PAT) device. Raw data were transformed into the PAT ratio, an established marker of vascular function. Cardiopulmonary exercise testing was performed using the Bruce protocol. In the Fontan cohort, 94% of patients were New York Heart Association functional class I and 88% had a B-type natriuretic peptide level of <50 pg/ml. The baseline pulse amplitude, a measure that reflects the arterial tone at rest, was greater in the Fontan patients than in the controls (median 2.74, interquartile range 1.96 to 4.13 vs median 1.86, interquartile range 1.14 to 2.79, p = 0.03). The PAT ratio, a measure of reactive hyperemia, was lower in Fontan patients (median 0.17, interquartile range −0.04 to 0.44, vs median 0.50, interquartile range 0.27 to 0.74, p = 0.002). The key parameters of exercise performance, including peak oxygen consumption (median 28.8 ml/kg/min, interquartile range 25.6 to 33.2 vs median 45.5 ml/kg/min, interquartile range 41.7 to 49.9, p <0.0001) and peak work (median 192 W, interquartile range 150 to 246 vs median 330, interquartile range 209 to 402 W, p <0.0001), were lower in Fontan patients than in the controls. The PAT ratio correlated with the peak oxygen consumption (r = 0.28, p = 0.02) and peak work (r = 0.26, p = 0.03). In conclusion, in an asymptomatic Fontan population, there is evidence of reduced basal peripheral arterial tone and vasodilator response, suggesting dysfunction of the endothelium-derived nitric oxide pathway. Vasodilator function appears to correlate with exercise performance.</abstract><cop>New York, NY</cop><pub>Elsevier Inc</pub><pmid>21600541</pmid><doi>10.1016/j.amjcard.2011.03.064</doi><tpages>7</tpages></addata></record> |
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| subjects | Adolescent Adult Biological and medical sciences Biomarkers Blood Pressure - physiology Cardiology Cardiology. Vascular system Cardiovascular Cardiovascular disease Child Child, Preschool Disability Evaluation Echocardiography, Doppler Endothelium, Vascular - physiopathology Exercise Test Female Fingers - blood supply Fontan Procedure Health Status Humans Hyperemia - physiopathology Male Manometry Medical sciences Nitric Oxide - physiology Oxygen Oxygen - blood Patients Peripheral Vascular Diseases - diagnosis Peripheral Vascular Diseases - physiopathology Postoperative Complications - diagnosis Postoperative Complications - physiopathology Prognosis Prospective Studies Pulse Quality of Life Reference Values Vascular Resistance - physiology Young Adult |
| title | Usefulness of Peripheral Vascular Function to Predict Functional Health Status in Patients With Fontan Circulation |
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