Does High-Intensity Exercise Cause Acute Liver Injury in Patients with Fontan Circulation? A Prospective Pilot Study. Pediatr Cardiol 2024 Oct;45(7):1503-1514
Date
05/23/2023Pubmed ID
37219588DOI
10.1007/s00246-023-03193-yScopus ID
2-s2.0-85160257265 (requires institutional sign-in at Scopus site) 1 CitationAbstract
The Fontan procedure results in chronic hepatic congestion and Fontan-associated liver disease (FALD) characterized by progressive liver fibrosis and cirrhosis. Exercise is recommended in this population, but may accelerate the progression of FALD from abrupt elevations in central venous pressure. The aim of this study was to assess if acute liver injury occurs after high-intensity exercise in patients with Fontan physiology. Ten patients were enrolled. Nine had normal systolic ventricular function and one had an ejection fraction < 40%. During cardiopulmonary exercise testing, patients had near-infrared spectroscopy (NIRS) to measure oxygen saturation of multiple organs, including the liver, and underwent pre- and post-exercise testing with liver elastography, laboratory markers, and cytokines to assess liver injury. The hepatic and renal NIRS showed a statistically significant decrease in oxygenation during exercise, and the hepatic NIRS had the slowest recovery compared to renal, cerebral, and peripheral muscle NIRS. A clinically significant increase in shear wave velocity occurred after exercise testing only in the one patient with systolic dysfunction. There was a statistically significant, albeit trivial, increase in ALT and GGT after exercise. Fibrogenic cytokines traditionally associated with FALD did not increase significantly in our cohort; however, pro-inflammatory cytokines that predispose to fibrogenesis did significantly rise during exercise. Although patients with Fontan circulation demonstrated a significant reduction in hepatic tissue oxygenation based on NIRS saturations during exercise, there was no clinical evidence of acute increase in liver congestion or acute liver injury following high-intensity exercise.
Author List
Gumm A, Ginde S, Hoffman G, Liegl M, Mack C, Simpson P, Vo N, Telega G, Vitola B, Chugh AAuthors
Ankur A. Chugh MD Associate Professor in the Pediatrics department at Medical College of WisconsinSalil Ginde MD, MPH Associate Professor in the Pediatrics department at Medical College of Wisconsin
Alexis J. Gumm MD Assistant Professor in the Pediatrics department at Medical College of Wisconsin
George M. Hoffman MD Chief, Professor in the Anesthesiology department at Medical College of Wisconsin
Cara Lynn Mack MD Chief, Professor in the Pediatrics department at Medical College of Wisconsin
Pippa M. Simpson PhD Adjunct Professor in the Pediatrics department at Medical College of Wisconsin
Bernadette Vitola MD, MPH Associate Professor in the Pediatrics department at Medical College of Wisconsin
MESH terms used to index this publication - Major topics in bold
AdolescentChild
Elasticity Imaging Techniques
Exercise
Exercise Test
Female
Fontan Procedure
Heart Defects, Congenital
Humans
Liver
Liver Diseases
Liver Function Tests
Male
Pilot Projects
Prospective Studies
Spectroscopy, Near-Infrared
Young Adult
