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Dynamic exercise changes in venous pressure and liver stiffness in Fontan patients: effects of Treprostinil

Part of: Surgery

Published online by Cambridge University Press:  28 January 2021

Mathias Possner Open the ORCID record for Mathias Possner [Opens in a new window] ,
Anisa Chaudhry ,
Jonathan R. Dillman ,
Elaine M. Urbina ,
Zhiqian Gao ,
Connie McCoy ,
Michelle Faust ,
Harry B. Rossiter ,
Adam W. Powell Open the ORCID record for Adam W. Powell [Opens in a new window]  and
Wayne Mays
...Show all authors
Mathias Possner
Affiliation:
Heart Institute, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA University of Cincinnati College of Medicine, Department of Pediatrics, Cincinnati, OH, USA
Anisa Chaudhry
Affiliation:
Heart Institute, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA University of Cincinnati College of Medicine, Department of Pediatrics, Cincinnati, OH, USA
Jonathan R. Dillman
Affiliation:
University of Cincinnati College of Medicine, Department of Pediatrics, Cincinnati, OH, USA Department of Radiology, Cincinnati Children’s Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH, USA
Elaine M. Urbina
Affiliation:
Heart Institute, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA University of Cincinnati College of Medicine, Department of Pediatrics, Cincinnati, OH, USA
Zhiqian Gao
Affiliation:
Heart Institute, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
Connie McCoy
Affiliation:
Heart Institute, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
Michelle Faust
Affiliation:
Heart Institute, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
Harry B. Rossiter
Affiliation:
Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, CA, USA Faculty of Biological Sciences, University of Leeds, Leeds, UK
Adam W. Powell
Affiliation:
Heart Institute, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA University of Cincinnati College of Medicine, Department of Pediatrics, Cincinnati, OH, USA
Wayne Mays
Affiliation:
Heart Institute, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
Gruschen Veldtman*
Affiliation:
Heart Institute, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA University of Cincinnati College of Medicine, Department of Pediatrics, Cincinnati, OH, USA Adult Congenital Heart Disease, Heart Centre, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
*
Author for correspondence: Dr G. Veldtman, FRCP, MBChB, King Faisal Specialist Hospital and Research Centre, Adult Congenital Heart Disease Service, MBC16, PO BOX 3354, Riyadh11211, Saudi Arabia. Tel: 001 513 250 9487. E-mail: gruschen@me.com
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Abstract

Background:

Systemic venous hypertension and low cardiac output are believed to be important mediators of liver injury after the Fontan procedure. Pulmonary vasodilators have the potential to improve such haemodynamics. The aim of this study was to assess the acute effects of exercise on liver stiffness and venous pressures and to assess the impact of inhaled Treprostinil on this response.

Methods:

In this prospective, double-blind, placebo-controlled, crossover trial, 14 patients with a Fontan circulation were randomised to inhalation of placebo and Treprostinil. Incremental and constant work rate exercise tests were performed to assess the effect of Treprostinil on exercise tolerance. Venous pressures were measured throughout and liver stiffness at rest and immediately after peak exercise.

Results:

Mean age was 27.8 ± 7.9 years and 66% were females. Exercise acutely increased liver stiffness by 30% (mean shear wave speed: 2.38 ± 0.71 versus 2.89 ± 0.51 ms, p = 0.02). Peripheral venous pressures increased acutely during both incremental (12.1 ± 2.4 versus 22.6 ± 8.0 mmHg, p < 0.001) and constant work rate exercise (12.5 ± 2.5 versus 23.4 ± 5.2 mmHg, p < 0.001). Overall, Treprostinil failed to attenuate exercise-induced increases in liver stiffness. Compared with placebo, Treprostinil did not significantly impact venous pressure responses, VO2peak, nor exercise endurance times.

Conclusions:

Peripheral venous pressure increased acutely during exercise by an average of 88% above baseline and was not altered by administration of inhaled Treprostinil. Liver stiffness measured immediately post-exercise increased acutely by an average of 30%, with no attenuation following Treprostinil inhalation.

Keywords

FontanTreprostinilpulmonary vasodilationexercise capacityliver stiffnessultrasound shear wave elastography
Type
Original Article
Information
Cardiology in the Young , Volume 31 , Issue 8 , August 2021 , pp. 1283 - 1289
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Copyright
© The Author(s), 2021. Published by Cambridge University Press

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Footnotes

*

Mathias Possner and Anisa Chaudhry are both first authors on this review with a shared first co-authorship.

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