Walser Matthias, Arnold Leonie, Mandilaras Guido, Funk Christoph, Dalla-Pozza Robert, Pattathu Joseph, Haas Nikolaus A, Jakob André
Department of Paediatric Cardiology and Paediatric Intensive Care, Ludwig-Maximilians-University of Munich, Marchioninistr. 15, 81377, Munich, Germany.
Pediatr Cardiol. 2025 Aug;46(6):1581-1591. doi: 10.1007/s00246-024-03572-z. Epub 2024 Jul 15.
Increased aortic stiffness predisposes cardiac afterload and influences cardiac function. Congenital heart diseases involving aortic arch malformation and extended cardiovascular surgery, i.e. univentricular heart diseases, can lead to increased aortic stiffness. This study aimed to investigate whether Fontan patients (FO) have increased aortic stiffness within distinct aortic segments, and whether these parameters relate to Fontan-specific haemodynamics. In a prospective case-control study, 20 FO and 49 heart-transplanted control subjects with biventricular circulation underwent invasive cardiac catheterisation. We invasively measured pulse wave velocity (PWV) in the ascending aorta and along the entire aorta. Haemodynamic parameters, including end-diastolic pressure, pulmonary artery pressure, the cardiac index and systemic vascular resistance index were also assessed. FO exhibited significantly higher ascending aorta PWV (aPWV) than controls (FO: 7.2 ± 2.4 m/s|Controls: 4.9 ± 0.7 m/s, p < 0.001) and compared to the inner group central aorta PWV (cPWV; FO: 5.5 ± 1.2 m/s|Controls: 5.3 ± 1.0 m/s). Multivariate analysis confirmed this aPWV elevation in FO even after adjusting for age and BMI. aPWV and cPWV were almost identical within the control group. Correlation analyses revealed associations between cPWV and blood pressure in controls, while correlations were less apparent in FO. We detected no significant association between the aPWV and other haemodynamic parameters in any of our groups. FO exhibit increased aPWV, indicating specific vascular stiffness in the ascending aorta, while their overall aortic stiffness remains comparable to controls. Further research is needed to understand the implications of these findings on Fontan circulation and long-term cardiovascular health.
Fontan patients show increased aortic arch pulse wave velocity, suggesting specific vascular stiffness.
Our study offers rare insights into pulse wave velocity in Fontan patients, highlighting increased arterial stiffness in the aortic arch. Vascular stiffness was particularly increased in the area of surgical reconstruction. This indicates the need for further research on vascular stiffness in Fontan circulation to understand its impact on cardiovascular health.
German clinical trial registration, DRKS00015066.
主动脉僵硬度增加会使心脏后负荷增加并影响心脏功能。涉及主动脉弓畸形的先天性心脏病以及广泛的心血管手术，即单心室心脏病，可导致主动脉僵硬度增加。本研究旨在调查Fontan患者（FO）在不同主动脉节段的主动脉僵硬度是否增加，以及这些参数是否与Fontan特定的血流动力学相关。在一项前瞻性病例对照研究中，20例FO患者和49例接受双心室循环心脏移植的对照受试者接受了有创心脏导管检查。我们有创测量了升主动脉和整个主动脉的脉搏波速度（PWV）。还评估了血流动力学参数，包括舒张末期压力、肺动脉压力、心脏指数和全身血管阻力指数。FO患者的升主动脉PWV（aPWV）显著高于对照组（FO：7.2±2.4m/s|对照组：4.9±0.7m/s，p<0.001），与内组中心主动脉PWV（cPWV；FO：5.5±1.2m/s|对照组：5.3±1.0m/s）相比也是如此。多因素分析证实，即使在调整年龄和体重指数后，FO患者的aPWV仍升高。对照组内aPWV和cPWV几乎相同。相关性分析显示对照组中cPWV与血压之间存在关联，而在FO患者中相关性不太明显。在我们的任何一组中，均未检测到aPWV与其他血流动力学参数之间存在显著关联。FO患者表现出aPWV增加，表明升主动脉存在特定的血管僵硬度，而其整体主动脉僵硬度与对照组相当。需要进一步研究以了解这些发现对Fontan循环和长期心血管健康的影响。
Fontan患者的主动脉弓脉搏波速度增加，提示特定的血管僵硬度。
我们的研究为Fontan患者的脉搏波速度提供了罕见的见解，突出了主动脉弓动脉僵硬度增加。血管僵硬度在手术重建区域尤其增加。这表明需要对Fontan循环中的血管僵硬度进行进一步研究，以了解其对心血管健康的影响。
德国临床试验注册，DRKS00015066。
