Cardiovascular magnetic resonance–derived hemodynamics predict adverse outcomes after Fontan palliation
4 affiliations
- 1Department of Anesthesiology, Children's Hospital Colorado, University of Colorado School of Medicine
- 2Department of Pediatrics, Section of Cardiology, Children's Hospital Colorado, University of Colorado School of Medicine
- 3Department of Pediatrics, West Virginia University Medicine Children's Hospital, West Virginia University
- 4Department of Cardiovascular and Thoracic Surgery, West Virginia University Medicine Children's Hospital, West Virginia University
Abstract
Background: Long-term outcomes following the Fontan procedure remain heterogeneous, and robust imaging-based predictors of adverse events are limited. Patients residing at moderate-altitude may experience additional pulmonary vascular stress; however, the prognostic value of cardiovascular magnetic resonance (CMR)–derived flow parameters in this population are not well defined.
Methods: We performed a retrospective cohort study of Fontan patients followed at a single moderate-altitude center who were ≥5 years post-Fontan and had undergone comprehensive CMR exams. Demographic, anatomic, and surgical data were collected. CMR-derived variables included indexed ventricular volumes and function, systemic arterial dimensions, and flow indices in the ascending and descending aorta, superior vena cava (SVC), inferior vena cava, and branch pulmonary arteries.
The primary composite outcome was death or referral/listing for heart transplantation. Time-to-event analyses from the time of CMR were performed using Kaplan–Meier estimates and Cox proportional hazards regression.
Results: A total of 182 Fontan patients were included (median age at Fontan 3.2 years [interquartile range (IQR) 2.6–3.9]; median time from Fontan to CMR 10.9 years [IQR 7.7–14.2]). Over a median follow-up of 4.7 years following CMR (IQR 3.1–6.6), 14 patients (7.7%) experienced the primary outcome. In univariable Cox regression, a higher SVC flow index was significantly associated with a lower risk of the primary outcome [hazard ratio [HR] 0.70 per 0.1 L/min/m ² increase; 95% confidence interval [CI] 0.50–0.92; p = 0.008].
Conclusions: In this moderate-altitude Fontan cohort, reduced CMR-derived SVC flow index was significantly associated with the primary outcome. This finding suggests that systemic venous flow merits further investigation as a prognostic marker in the Fontan population.
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BibTeX
@article{platnick2026cardiovascular,
title = {{Cardiovascular magnetic resonance–derived hemodynamics predict adverse outcomes after Fontan palliation}},
author = {Carson Platnick and Benjamin Frank and Jennifer Romanowicz and Cesar Gonzalez De Alba and Maria Chase and Amna Umer and Nita R. Chaudhuri and Jonathan Awori and Dhaval Chauhan and Christopher E. Mascio and Jai P. Udassi and Mehdi Hedjazi Moghari},
journal = {Frontiers in Cardiovascular Medicine},
year = {2026},
month = oct,
doi = {10.3389/fcvm.2026.1937933},
url = {https://www.frontiersin.org/articles/10.3389/fcvm.2026.1937933/full},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Cardiovascular magnetic resonance–derived hemodynamics predict adverse outcomes after Fontan palliation
AU - Carson Platnick
AU - Benjamin Frank
AU - Jennifer Romanowicz
AU - Cesar Gonzalez De Alba
AU - Maria Chase
AU - Amna Umer
AU - Nita R. Chaudhuri
AU - Jonathan Awori
AU - Dhaval Chauhan
AU - Christopher E. Mascio
AU - Jai P. Udassi
AU - Mehdi Hedjazi Moghari
PY - 2026
DA - 2026/10/21
JO - Frontiers in Cardiovascular Medicine
DO - 10.3389/fcvm.2026.1937933
UR - https://www.frontiersin.org/articles/10.3389/fcvm.2026.1937933/full
AB - Background: Long-term outcomes following the Fontan procedure remain heterogeneous, and robust imaging-based predictors of adverse events are limited. Patients residing at moderate-altitude may experience additional pulmonary vascular stress; however, the prognostic value of cardiovascular magnetic resonance (CMR)–derived flow parameters in this population are not well defined. Methods: We performed a retrospective cohort study of Fontan patients followed at a single moderate-altitude center who were ≥5 years post-Fontan and had undergone comprehensive CMR exams. Demographic, anatomic, and surgical data were collected. CMR-derived variables included indexed ventricular volumes and function, systemic arterial dimensions, and flow indices in the ascending and descending aorta, superior vena cava (SVC), inferior vena cava, and branch pulmonary arteries. The primary composite outcome was death or referral/listing for heart transplantation. Time-to-event analyses from the time of CMR were performed using Kaplan–Meier estimates and Cox proportional hazards regression. Results: A total of 182 Fontan patients were included (median age at Fontan 3.2 years [interquartile range (IQR) 2.6–3.9]; median time from Fontan to CMR 10.9 years [IQR 7.7–14.2]). Over a median follow-up of 4.7 years following CMR (IQR 3.1–6.6), 14 patients (7.7%) experienced the primary outcome. In univariable Cox regression, a higher SVC flow index was significantly associated with a lower risk of the primary outcome [hazard ratio [HR] 0.70 per 0.1 L/min/m ² increase; 95% confidence interval [CI] 0.50–0.92; p = 0.008]. Conclusions: In this moderate-altitude Fontan cohort, reduced CMR-derived SVC flow index was significantly associated with the primary outcome. This finding suggests that systemic venous flow merits further investigation as a prognostic marker in the Fontan population.
SN - 2297-055X
ER -