title: Exercise oscillatory ventilation in patients with Fontan physiology.
abstract: BACKGROUND
  Exercise oscillatory ventilation (EOV) refers to regular oscillations in minute ventilation (VE) during exercise. Its presence correlates with heart failure severity and worse prognosis in adults with acquired heart failure. We evaluated the prevalence and predictive value of EOV in patients with single ventricle Fontan physiology.
  
  
  RESULTS
  We performed a cross-sectional analysis and prospective survival analysis of patients who had undergone a Fontan procedure and subsequent cardiopulmonary exercise test. Data were reviewed for baseline characteristics and incident mortality, heart transplant, or nonelective cardiovascular hospitalization. EOV was defined as regular oscillations for >60% of exercise duration with amplitude >15% of average VE. Survival analysis was performed using Cox regression. Among 253 subjects, EOV was present in 37.5%. Patients with EOV were younger (18.8±9.0 versus 21.7±10.1 years; P=0.02). EOV was associated with higher New York Heart Association functional class (P=0.02) and VE/VCO2 slope (36.8±6.9 versus 33.7±5.7; P=0.0002), but not with peak VO2 (59.7±14.3 versus 61.0±16.0% predicted; P=0.52) or noninvasive measures of cardiac function. The presence of EOV was associated with slightly lower mean cardiac index but other invasive hemodynamic variables were similar. During a median follow-up of 5.5 years, 22 patients underwent transplant or died (n=19 primary deaths, 3 transplants with 2 subsequent deaths). EOV was associated with increased risk of death or transplant (hazard ratio, 3.9; 95% confidence interval, 1.5-10.0; P=0.002) and also predicted the combined outcome of death, transplant, or nonelective cardiovascular hospitalization after adjusting for New York Heart Association functional class, peak VO2, and other covariates (multivariable hazard ratio, 2.0; 95% confidence interval, 1.2-3.6; P=0.01).
  
  
  CONCLUSIONS
  EOV is common in the Fontan population and strongly predicts lower transplant-free survival.
authors.affiliation: From the Department of Medicine, Brigham and Women's Hospital, Boston, MA (A.S.N., F.W., D.M.S., K.S., M.J.L., A.R.O.); Departments of Cardiology (B.L., L.M., F.W., J.R., R.H.R., A.U.T., K.S., M.J.L., A.R.O.) and Cardiovascular Surgery (A.U.T.), Boston Children's Hospital, MA; and Department of Medicine, Massachusetts General Hospital, Boston (G.D.L.).
authors.forename: Ashwin S
authors.initials: AS
authors.lastname: Nathan
authors.affiliation: From the Department of Medicine, Brigham and Women's Hospital, Boston, MA (A.S.N., F.W., D.M.S., K.S., M.J.L., A.R.O.); Departments of Cardiology (B.L., L.M., F.W., J.R., R.H.R., A.U.T., K.S., M.J.L., A.R.O.) and Cardiovascular Surgery (A.U.T.), Boston Children's Hospital, MA; and Department of Medicine, Massachusetts General Hospital, Boston (G.D.L.).
authors.forename: Brittani
authors.initials: B
authors.lastname: Loukas
authors.affiliation: From the Department of Medicine, Brigham and Women's Hospital, Boston, MA (A.S.N., F.W., D.M.S., K.S., M.J.L., A.R.O.); Departments of Cardiology (B.L., L.M., F.W., J.R., R.H.R., A.U.T., K.S., M.J.L., A.R.O.) and Cardiovascular Surgery (A.U.T.), Boston Children's Hospital, MA; and Department of Medicine, Massachusetts General Hospital, Boston (G.D.L.).
authors.forename: Lilamarie
authors.initials: L
authors.lastname: Moko
authors.affiliation: From the Department of Medicine, Brigham and Women's Hospital, Boston, MA (A.S.N., F.W., D.M.S., K.S., M.J.L., A.R.O.); Departments of Cardiology (B.L., L.M., F.W., J.R., R.H.R., A.U.T., K.S., M.J.L., A.R.O.) and Cardiovascular Surgery (A.U.T.), Boston Children's Hospital, MA; and Department of Medicine, Massachusetts General Hospital, Boston (G.D.L.).
authors.forename: Fred
authors.initials: F
authors.lastname: Wu
authors.affiliation: From the Department of Medicine, Brigham and Women's Hospital, Boston, MA (A.S.N., F.W., D.M.S., K.S., M.J.L., A.R.O.); Departments of Cardiology (B.L., L.M., F.W., J.R., R.H.R., A.U.T., K.S., M.J.L., A.R.O.) and Cardiovascular Surgery (A.U.T.), Boston Children's Hospital, MA; and Department of Medicine, Massachusetts General Hospital, Boston (G.D.L.).
authors.forename: Jonathan
authors.initials: J
authors.lastname: Rhodes
authors.affiliation: From the Department of Medicine, Brigham and Women's Hospital, Boston, MA (A.S.N., F.W., D.M.S., K.S., M.J.L., A.R.O.); Departments of Cardiology (B.L., L.M., F.W., J.R., R.H.R., A.U.T., K.S., M.J.L., A.R.O.) and Cardiovascular Surgery (A.U.T.), Boston Children's Hospital, MA; and Department of Medicine, Massachusetts General Hospital, Boston (G.D.L.).
authors.forename: Rahul H
authors.initials: RH
authors.lastname: Rathod
authors.affiliation: From the Department of Medicine, Brigham and Women's Hospital, Boston, MA (A.S.N., F.W., D.M.S., K.S., M.J.L., A.R.O.); Departments of Cardiology (B.L., L.M., F.W., J.R., R.H.R., A.U.T., K.S., M.J.L., A.R.O.) and Cardiovascular Surgery (A.U.T.), Boston Children's Hospital, MA; and Department of Medicine, Massachusetts General Hospital, Boston (G.D.L.).
authors.forename: David M
authors.initials: DM
authors.lastname: Systrom
authors.affiliation: From the Department of Medicine, Brigham and Women's Hospital, Boston, MA (A.S.N., F.W., D.M.S., K.S., M.J.L., A.R.O.); Departments of Cardiology (B.L., L.M., F.W., J.R., R.H.R., A.U.T., K.S., M.J.L., A.R.O.) and Cardiovascular Surgery (A.U.T.), Boston Children's Hospital, MA; and Department of Medicine, Massachusetts General Hospital, Boston (G.D.L.).
authors.forename: Ana
authors.initials: A
authors.lastname: Ubeda Tikkanen
authors.affiliation: From the Department of Medicine, Brigham and Women's Hospital, Boston, MA (A.S.N., F.W., D.M.S., K.S., M.J.L., A.R.O.); Departments of Cardiology (B.L., L.M., F.W., J.R., R.H.R., A.U.T., K.S., M.J.L., A.R.O.) and Cardiovascular Surgery (A.U.T.), Boston Children's Hospital, MA; and Department of Medicine, Massachusetts General Hospital, Boston (G.D.L.).
authors.forename: Keri
authors.initials: K
authors.lastname: Shafer
authors.affiliation: From the Department of Medicine, Brigham and Women's Hospital, Boston, MA (A.S.N., F.W., D.M.S., K.S., M.J.L., A.R.O.); Departments of Cardiology (B.L., L.M., F.W., J.R., R.H.R., A.U.T., K.S., M.J.L., A.R.O.) and Cardiovascular Surgery (A.U.T.), Boston Children's Hospital, MA; and Department of Medicine, Massachusetts General Hospital, Boston (G.D.L.).
authors.forename: Gregory D
authors.initials: GD
authors.lastname: Lewis
authors.affiliation: From the Department of Medicine, Brigham and Women's Hospital, Boston, MA (A.S.N., F.W., D.M.S., K.S., M.J.L., A.R.O.); Departments of Cardiology (B.L., L.M., F.W., J.R., R.H.R., A.U.T., K.S., M.J.L., A.R.O.) and Cardiovascular Surgery (A.U.T.), Boston Children's Hospital, MA; and Department of Medicine, Massachusetts General Hospital, Boston (G.D.L.).
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Landzberg
authors.affiliation: From the Department of Medicine, Brigham and Women's Hospital, Boston, MA (A.S.N., F.W., D.M.S., K.S., M.J.L., A.R.O.); Departments of Cardiology (B.L., L.M., F.W., J.R., R.H.R., A.U.T., K.S., M.J.L., A.R.O.) and Cardiovascular Surgery (A.U.T.), Boston Children's Hospital, MA; and Department of Medicine, Massachusetts General Hospital, Boston (G.D.L.). alexander.opotowsky@cardio.chboston.org.
authors.forename: Alexander R
authors.initials: AR
authors.lastname: Opotowsky
mesh_terms: D000293:Adolescent; D000328:Adult; D002639:Cheyne-Stokes Respiration / Q000209:etiology / Q000503:physiopathology*; D003430:Cross-Sectional Studies; D005080:Exercise Test; D005260:Female; D018729:Fontan Procedure; D006330:Heart Defects, Congenital / Q000503:physiopathology* / Q000601:surgery; D006333:Heart Failure / Q000453:epidemiology / Q000401:mortality / Q000503:physiopathology*; D016027:Heart Transplantation; D006352:Heart Ventricles / Q000002:abnormalities*; D006801:Humans; D008297:Male; D016019:Survival Analysis; D055815:Young Adult
keywords: Cheyne-Stokes respiration; Fontan procedure; cardiopulmonary exercise test; exercise; heart defects, congenital; ventilation