第60回日本小児循環器学会総会・学術集会

講演情報

JCK-AP

Fontan

JCK-AP session 4 (II-JCKAP4)
Fontan

2024年7月12日(金) 14:05 〜 15:20 第8会場・JCK-AP Forum (5F 502+503)

Chair:Ryo Inuzuka(Department of Pediatrics, University of Tokyo)
Chair:Tae Gook Jun(Department of Thoracic and Cardiovascular Surgery, Sungkyunkwan University School of Medicine, Samsung Seoul Hospital)

[II-JCKAP4-1] Optimal Heart Rate May Improve Systolic and Diastolic Function in Patients with Fontan Circulation

Keiichi Hirono1, Teruhiko Imamura2, Kaori Tsuboi1, Shinya Takarada1, Mako Okabe1, Hideyuki Nakaoka1, Keijiro Ibuki1, Sayaka Ozawa1 (1.Department of Pediatrics, Faculty of Medicine, University of Toyama, Toyama, 2.Second department of Internal Medicine, Faculty of Medicine, University of Toyama, Toyama)

Background: The optimal heart rate, at which the E-wave and A-wave stand adjacent without any overlaps in the Doppler transmitral flow echocardiography, is associated with maximum cardiac output and favorable clinical outcomes in adult patients with systolic heart failure. However, the clinical implication of the echocardiographic overlap length in patients with Fontan circulation remains unknown. We investigated the relationship between heart rate (HR) and hemodynamics in Fontan surgery patients with and without beta-blockers.
Methods: A total of 26 patients (median age 1.8 years, 13 males) were enrolled. We investigated the relationship between HR and hemodynamics in Fontan surgery patients with and without beta-blockers in this study.
Results: At baseline, the plasma N-terminal pro-B-type natriuretic peptide was 2439 ± 3483 pg/mL, the fraction area change was 33.5 ± 11.4%, the cardiac index was 3.55 ± 0.90 L/min/m2, and the overlap length was 45.2 ± 59.0 msec. Overlap length was importantly decreased after the one-year follow-up (7.60 ± 78.57 msec, p = 0.0069). Positive correlations were noted between the overlap length and A-wave and E/A ra-tio (p = 0.0021 and p = 0.0046, respectively). Ventricular end-diastolic pressure was significantly correlated with the overlap length in non-beta-blocker patients (p = 0.0483).
Conclusion: Overlap length may reflect the status of ventricular dysfunction. Hemodynamic preservation at lower HR could be critical for cardiac reverse remodeling.