Exercise‐induced changes in pulmonary artery wedge pressure in adults post‐Fontan versus heart failure with preserved ejection fraction and non‐cardiac dyspnoea

摘要

Abstract Aims Despite their universal predisposition, diagnosing diastolic dysfunction in patients post‐Fontan palliation is challenging. Our aim was to compare exercise haemodynamics between adults post‐Fontan and patients with heart failure with preserved ejection fraction (HFpEF) and non‐cardiac dyspnoea (NCD). Methods and results Twenty‐four adults (age ≥18?years) post‐Fontan palliation with resting and exercise pulmonary artery wedge pressure (PAWP) measured during supine biking were identified. Forty‐eight patients with HFpEF and 48 with NCD diagnosed at catheterization were selected for comparison. Mean age for Fontan patients was 30.3?±?7.5?years; median ventricular ejection fraction was 52.5% (45–55.8), being 12?mmHg in 25%); PAWP was lower in Fontan patients than in HFpEF but higher than NCD. During exercise, PAWP was lower in the Fontan group than HFpEF (22.5?mmHg [19.3–28] vs. 28.2?±?6.3; p?=?0.0006) but higher than NCD (11.2?±?4.2, p?≤?0.0001). However, there were no differences in ΔPAWP/ΔQs between Fontan and HFpEF patients (4.0 [2.1–7.3] vs. 2.7 [1.6–4.4]; p?=?0.10) with the ratio being higher post‐Fontan than in NCD (0.6 [0.2–1.2]; p?