Orthostatic stress response in pediatric Fontan patients and the effect of ACE inhibition

Many cardiocirculatory mechanisms are involved in the adaptation to orthostatic stress. While these mechanisms may be impaired in Fontan patients. However, it is yet unclear how Fontan patients, who exhibit a critical fluid balance, respond to orthostatic stress. Angiotensin converting enzyme inhibi...

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Vydané v:PloS one Ročník 17; číslo 9; s. e0273940
Hlavní autori: Harteveld, Lisette M., Blom, Nico A., van Dijk, J. Gert, Reijntjes, Robert H., van Someren, Paul J., Kerkhof, Fabian I., Kuipers, Irene M., Rammeloo, Lukas A. J., de Geus, Eco J. C., ten Harkel, Arend D. J.
Médium: Journal Article
Jazyk:English
Vydavateľské údaje: San Francisco Public Library of Science 01.09.2022
Public Library of Science (PLoS)
Predmet:
ACE inhibitors
Analysis
Angiotensin
Angiotensin-converting enzyme inhibitors
Aorta
Autonomic nervous system
Biology and Life Sciences
Blood flow
Blood pressure
Body fluids
Cerebral blood flow
Complications and side effects
Data analysis
Diagnosis
Enzyme inhibitors
Heart
Heart rate
Heart surgery
Hemodynamic responses
Hemodynamics
Hypotension, Orthostatic
Medicine and health sciences
Nervous system
Orthostatic tolerance
Parameters
Patients
Pediatrics
Peptidyl-dipeptidase A
Physical Sciences
Pulmonary arteries
Respiration
Sinuses
Stiffness
Stress response
Supine position
Velocity
Ventricle
Netherlands
ISSN:1932-6203, 1932-6203
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Shrnutí:Many cardiocirculatory mechanisms are involved in the adaptation to orthostatic stress. While these mechanisms may be impaired in Fontan patients. However, it is yet unclear how Fontan patients, who exhibit a critical fluid balance, respond to orthostatic stress. Angiotensin converting enzyme inhibitors are often prescribed to Fontan patients, but they may negatively influence orthostatic tolerance. Therefore, we evaluated the response to orthostatic stress in pediatric Fontan patients before and after treatment with enalapril. Thirty-five Fontan patients (aged 14 years) with moderate-good systolic ventricular function without pre-existent enalapril treatment were included. Before and after a three-month enalapril treatment period, the hemodynamic response to head-up tilt test was evaluated by various parameters including cardiac index, blood pressure, cerebral blood flow, aortic stiffness and cardiac autonomous nervous activity. Thirty-four healthy subjects (aged 13 years) served as controls. Fontan patients had a decreased cerebral blood flow and increased aortic stiffness in the supine position compared to controls, while all other factors did not differ. Patients and controls showed a comparable response to head-up tilt test for most parameters. Twenty-seven patients completed the enalapril study with a mean dosage of 0.3±0.1mg/kg/day. Most parameters were unaffected by enalapril, only the percent decrease in cardiac index to tilt was higher after treatment, but the cardiac index during tilt was not lower (3.0L/min/m.sup.2 pre-enalapril versus 2.8L/min/m.sup.2 after treatment; P = 0.15). Pediatric Fontan patients adequately respond to orthostasis with maintenance of blood pressure and cerebral blood flow and sufficient autonomic response. Enalapril treatment did not alter the response.
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Competing Interests: The authors have declared that no competing interests exist.
ISSN:1932-6203
1932-6203
DOI:10.1371/journal.pone.0273940