[II-AEPCYIA-1] Central venous pressure augmentation against Abdominal compression as a novel marker for cardiovascular load in the Fontan circulation
BACKGROUND AND AIM:Although augmentation of central venous pressure (CVP) by volume loading is highly variable in the patients with Fontan circulation, the mechanism is not clearly understood. Since renin-angiotensin-aldosterone system (RAAS) is highly activated and it closely relate with the serum markers for cardiovascular fibrosis in the Fontan circulation, we hypothesized that reactive augmentation of CVP is affected by circulating blood volume and activation of RAAS.
METHOD:Twenty-nine patients who underwent Fontan procedure more than 10 years ago were enrolled in this study (Age; mean 16.2, 12.7-22.9 years). During cardiac catheterization, ventricular pressure, systemic blood pressure and CVP were simultaneously monitored during abdominal compression procedure for 5 second. Plasma volume was directly measured using dye dilution method. Hemodynamic change during abdominal compression and baseline hemodynamic property, plasma volume, RAAS activity as well as serum markers of cardiovascular fibrosis.
RESULTS:The degree of CVP augmentation against abdominal compression was positively correlated with the baseline CVP (p=0.026). While the CVP augmentation was independent of pulmonary resistance, it was positively correlated with the plasma volume (p=0.0030). Interestingly, the CVP augmentation was also positively correlated with the plasma renin activity (p=0.0060), serum aldosterone level (p=0.011) and type IV collagen 7s (p=0.0074), suggesting close interaction with cardiovascular remodeling in the Fontan circulation. CVP augmentation was independent of EDP or blood pressure augmentations.
CONCLUSIONS:CVP augmentation against abdominal compression was influenced by the RAAS activation and its resultant modification of circulating plasma volume as well as cardiovascular fibrosis, suggesting CVP augmentation as the marker for venous adaptation to the Fontan circulation. The relation between CVP augmentation and outcome of Fontan circulation would be subject for future study.
METHOD:Twenty-nine patients who underwent Fontan procedure more than 10 years ago were enrolled in this study (Age; mean 16.2, 12.7-22.9 years). During cardiac catheterization, ventricular pressure, systemic blood pressure and CVP were simultaneously monitored during abdominal compression procedure for 5 second. Plasma volume was directly measured using dye dilution method. Hemodynamic change during abdominal compression and baseline hemodynamic property, plasma volume, RAAS activity as well as serum markers of cardiovascular fibrosis.
RESULTS:The degree of CVP augmentation against abdominal compression was positively correlated with the baseline CVP (p=0.026). While the CVP augmentation was independent of pulmonary resistance, it was positively correlated with the plasma volume (p=0.0030). Interestingly, the CVP augmentation was also positively correlated with the plasma renin activity (p=0.0060), serum aldosterone level (p=0.011) and type IV collagen 7s (p=0.0074), suggesting close interaction with cardiovascular remodeling in the Fontan circulation. CVP augmentation was independent of EDP or blood pressure augmentations.
CONCLUSIONS:CVP augmentation against abdominal compression was influenced by the RAAS activation and its resultant modification of circulating plasma volume as well as cardiovascular fibrosis, suggesting CVP augmentation as the marker for venous adaptation to the Fontan circulation. The relation between CVP augmentation and outcome of Fontan circulation would be subject for future study.