Ahmanson/UCLA Adult Congenital Heart Disease Center, Division of Cardiology, Department of Medicine, University of California Los Angeles, Los Angeles, CA, United States of America.
Adult Congenital Heart Disease, Division of Cardiology, Department of Medicine, NYU Grossman School of Medicine, New York, NY, United States of America; Ahmanson/UCLA Adult Congenital Heart Disease Center, Division of Cardiology, Department of Medicine, University of California Los Angeles, Los Angeles, CA, United States of America.
Int J Cardiol. 2021 Mar 1;326:77-80. doi: 10.1016/j.ijcard.2020.11.007. Epub 2020 Nov 13.
Patients with the Fontan circulation lack a subpulmonary ventricular pump and thus the main driver for pulmonary blood flow is a high central venous pressure. Peripheral venous pressure (PVP) measurement has been shown to be a reproducible and fairly accurate surrogate for central venous pressure (CVP), but not specifically for the adult Fontan circulation. This study aims to determine the relationship of PVP to CVP in adult Fontan patients.
All adult patients (≥18 yo) with a Fontan circulation undergoing cardiac catheterization were included. Both CVP and PVP were measured during the catheterization. The relationship between the peripheral venous and central venous pressures was assessed using simple linear regression and the Bland-Altman plot analysis for differences.
Thirty-eight adult Fontan patients (mean age 30.7 ± 8.5, range 18-52 years) undergoing 43 cardiac catheterizations were analyzed. The mean CVP was 17.3 +/- 4.7 mmHg. The mean PVP was 18.4 +/- 5 mmHg. CVP and PVP were highly correlated, with an R value of 0.83 (p < 0.001). The CVP can be estimated with PVP measurements using the formula CVP = (0.86 * PVP) + 1.3. A Bland-Altman plot for PVP and CVP demonstrated that the PVP overestimated CVP by a mean of 1.2 mmHg, with a 95% limit of agreement of -5.2 mmHg to 2.8 mmHg.
In adult Fontan patients, measuring PVP is a reliable, less-invasive, and accurate method of estimating the CVP during cardiac catheterization procedures. These findings may enable outpatient monitoring of Fontan hemodynamics.
Fontan 循环患者缺乏一个亚肺动脉泵，因此肺动脉血流的主要驱动力是高中心静脉压。外周静脉压（PVP）测量已被证明是一种可重复且相当准确的中心静脉压（CVP）替代指标，但不是专门针对成人 Fontan 循环的。本研究旨在确定成人 Fontan 患者的 PVP 与 CVP 之间的关系。
所有接受心导管检查的成年（≥18 岁）Fontan 循环患者均纳入研究。在心导管检查期间同时测量 CVP 和 PVP。使用简单线性回归和 Bland-Altman 差值分析评估外周静脉压和中心静脉压之间的关系。
分析了 38 例接受 43 次心导管检查的成年 Fontan 患者（平均年龄 30.7 ± 8.5 岁，范围 18-52 岁）。平均 CVP 为 17.3 ± 4.7mmHg。平均 PVP 为 18.4 ± 5mmHg。CVP 和 PVP 高度相关，R 值为 0.83（p<0.001）。可以使用公式 CVP =（0.86 * PVP）+1.3 从 PVP 测量值估算 CVP。PVP 和 CVP 的 Bland-Altman 图表明，PVP 平均高估 CVP 1.2mmHg，95%一致性界限为-5.2mmHg 至 2.8mmHg。
在成人 Fontan 患者中，测量 PVP 是一种可靠、微创且准确的方法，可在心导管检查过程中估计 CVP。这些发现可能使 Fontan 血流动力学的门诊监测成为可能。
