{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,28]],"date-time":"2026-08-28T22:05:37Z","timestamp":1787954737230,"version":"build-2784847793"},"reference-count":31,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"1","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["JAHA"],"published-print":{"date-parts":[[2023,1,3]]},"abstract":"<jats:sec sec-type=\"background\" xml:lang=\"en\">\n            <jats:title>Background<\/jats:title>\n            <jats:p xml:lang=\"en\">In Fontan circulation, diastolic dysfunction portends a worse clinical outcome but may be concealed during routine assessment. Invasive evaluation with rapid volume expansion (RVE) can identify patients with occult diastolic dysfunction (ODD). We sought to evaluate the association between ODD and adverse clinical outcomes at medium\u2010term follow\u2010up.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec xml:lang=\"en\">\n            <jats:title>Methods and Results<\/jats:title>\n            <jats:p xml:lang=\"en\">\n              We conducted a single\u2010center observational study of patients with Fontan circulation who underwent clinical catheterization with RVE from 2012 to 2017. ODD was defined as post\u2010RVE end\u2010diastolic pressure \u226515\u2009mm\u2009Hg. A composite adverse clinical outcome included mortality, cardiac transplant, ventricular assist device, plastic bronchitis, protein\u2010losing enteropathy, arrhythmia, stroke\/thrombus, or cardiac\u2010related hospital admission. Proportional hazards regression was used to compare the ODD\u2010positive and ODD\u2010negative groups for risk of the composite adverse clinical outcome. Eighty\u2010nine patients with Fontan circulation (47% female patients) were included at a median age of 14\u2009years. ODD was identified in 31%. Fontan duration was longer in the ODD group (\n              <jats:italic>P<\/jats:italic>\n              =0.001). The composite adverse clinical outcome occurred more frequently in the ODD group (52 versus 26%,\n              <jats:italic>P<\/jats:italic>\n              =0.03) during a median follow\u2010up duration of 2.9\u2009years after catheterization. ODD (hazard ratio [HR], 2.68 [95% CI, 1.28\u20135.66];\n              <jats:italic>P<\/jats:italic>\n              =0.02) and Fontan duration (HR, 1.07 [95% CI, 1.02\u20131.12];\n              <jats:italic>P<\/jats:italic>\n              =0.003) were associated with the composite adverse clinical outcome. When stratified by Fontan duration, ODD remained significantly associated with the hazard of adverse clinical outcomes in patients with a Fontan duration \u226510\u2009years (HR, 2.57 [95% CI, 1.03\u20136.57];\n              <jats:italic>P<\/jats:italic>\n              =0.04).\n            <\/jats:p>\n          <\/jats:sec>\n          <jats:sec xml:lang=\"en\">\n            <jats:title>Conclusions<\/jats:title>\n            <jats:p xml:lang=\"en\">Cardiac catheterization with rapid volume expansion reveals a significant incidence of ODD, which relates to Fontan duration. ODD is associated with an increased hazard of adverse clinical outcomes during medium\u2010term follow\u2010up, especially in patients with longer Fontan duration. ODD may portend a worse prognosis in Fontan circulation.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1161\/jaha.122.026508","type":"journal-article","created":{"date-parts":[[2022,12,24]],"date-time":"2022-12-24T10:31:34Z","timestamp":1671877894000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":24,"title":["Occult Diastolic Dysfunction and Adverse Clinical Outcomes in Adolescents and Young Adults With Fontan Circulation"],"prefix":"10.1161","volume":"12","author":[{"given":"Daniel","family":"Peck","sequence":"first","affiliation":[{"name":"The Heart Institute, Cincinnati Children\u2019s Hospital Medical Center Department of Pediatrics University of Cincinnati College of Medicine Cincinnati OH"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4122-9410","authenticated-orcid":false,"given":"Konstantin","family":"Averin","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Department of Pediatrics University of Alberta Edmonton AB"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2611-8835","authenticated-orcid":false,"given":"Philip","family":"Khoury","sequence":"additional","affiliation":[{"name":"The Heart Institute, Cincinnati Children\u2019s Hospital Medical Center Department of Pediatrics University of Cincinnati College of Medicine Cincinnati OH"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Grant","family":"Veldhuis","sequence":"additional","affiliation":[{"name":"The Heart Institute, Cincinnati Children\u2019s Hospital Medical Center Department of Pediatrics University of Cincinnati College of Medicine Cincinnati OH"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3777-4822","authenticated-orcid":false,"given":"Tarek","family":"Alsaied","sequence":"additional","affiliation":[{"name":"The Heart Institute, Cincinnati Children\u2019s Hospital Medical Center Department of Pediatrics University of Cincinnati College of Medicine Cincinnati OH"},{"name":"Heart Institute, UPMC Children\u2019s Hospital of Pittsburgh Department of Pediatrics University of Pittsburgh School of Medicine Pittsburgh PA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6401-9980","authenticated-orcid":false,"given":"Adam M.","family":"Lubert","sequence":"additional","affiliation":[{"name":"The Heart Institute, Cincinnati Children\u2019s Hospital Medical Center Department of Pediatrics University of Cincinnati College of Medicine Cincinnati OH"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9687-9782","authenticated-orcid":false,"given":"Russel","family":"Hirsch","sequence":"additional","affiliation":[{"name":"The Heart Institute, Cincinnati Children\u2019s Hospital Medical Center Department of Pediatrics University of Cincinnati College of Medicine Cincinnati OH"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2835-3847","authenticated-orcid":false,"given":"Wendy M.","family":"Whiteside","sequence":"additional","affiliation":[{"name":"Congenital Heart Center University of Michigan Medicine Ann Arbor MI"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gruschen","family":"Veldtman","sequence":"additional","affiliation":[{"name":"Heart Center, King Faisal Specialist Hospital and Research Center Riyadh Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8508-9523","authenticated-orcid":false,"given":"Bryan H.","family":"Goldstein","sequence":"additional","affiliation":[{"name":"The Heart Institute, Cincinnati Children\u2019s Hospital Medical Center Department of Pediatrics University of Cincinnati College of Medicine Cincinnati OH"},{"name":"Heart Institute, UPMC Children\u2019s Hospital of Pittsburgh Department of Pediatrics University of Pittsburgh School of Medicine Pittsburgh PA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"key":"e_1_3_1_2_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jtcvs.2017.01.056"},{"key":"e_1_3_1_3_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2017.03.582"},{"key":"e_1_3_1_4_2","doi-asserted-by":"publisher","DOI":"10.1136\/heart.83.4.420"},{"key":"e_1_3_1_5_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjcard.2009.12.020"},{"key":"e_1_3_1_6_2","doi-asserted-by":"publisher","DOI":"10.1001\/jamacardio.2019.5459"},{"key":"e_1_3_1_7_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.echo.2016.07.016"},{"key":"e_1_3_1_8_2","doi-asserted-by":"publisher","DOI":"10.1136\/heartjnl-2015-309042"},{"key":"e_1_3_1_9_2","doi-asserted-by":"publisher","DOI":"10.1136\/heartjnl-2014-306378"},{"key":"e_1_3_1_10_2","doi-asserted-by":"publisher","DOI":"10.1017\/S1047951100000627"},{"key":"e_1_3_1_11_2","doi-asserted-by":"publisher","DOI":"10.1136\/hrt.66.5.375"},{"key":"e_1_3_1_12_2","doi-asserted-by":"publisher","DOI":"10.1016\/0002-9149(92)90808-C"},{"key":"e_1_3_1_13_2","doi-asserted-by":"publisher","DOI":"10.1161\/JAHA.116.003887"},{"key":"e_1_3_1_14_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijcard.2015.05.181"},{"key":"e_1_3_1_15_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2008.01.074"},{"key":"e_1_3_1_16_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa052256"},{"key":"e_1_3_1_17_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa051530"},{"key":"e_1_3_1_18_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2009.05.011"},{"key":"e_1_3_1_19_2","doi-asserted-by":"publisher","DOI":"10.1161\/01.CIR.101.17.2118"},{"key":"e_1_3_1_20_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.105.553370"},{"key":"e_1_3_1_21_2","doi-asserted-by":"publisher","DOI":"10.1136\/heartjnl-2017-311652"},{"key":"e_1_3_1_22_2","doi-asserted-by":"publisher","DOI":"10.1161\/JAHA.116.004809"},{"key":"e_1_3_1_23_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00246-013-0831-0"},{"key":"e_1_3_1_24_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.athoracsur.2007.11.009"},{"key":"e_1_3_1_25_2","doi-asserted-by":"publisher","DOI":"10.1161\/JAHA.121.024095"},{"key":"e_1_3_1_26_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jtcvs.2021.06.064"},{"key":"e_1_3_1_27_2","doi-asserted-by":"publisher","DOI":"10.1161\/JAHA.116.004258"},{"key":"e_1_3_1_28_2","doi-asserted-by":"publisher","DOI":"10.1136\/openhrt-2020-001434"},{"key":"e_1_3_1_29_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.hfc.2013.09.010"},{"key":"e_1_3_1_30_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ahj.2018.03.015"},{"key":"e_1_3_1_31_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.119.044352"},{"key":"e_1_3_1_32_2","doi-asserted-by":"publisher","DOI":"10.1017\/S1047951121005175"}],"container-title":["Journal of the American Heart Association"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ahajournals.org\/doi\/full\/10.1161\/JAHA.122.026508","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,5,13]],"date-time":"2024-05-13T12:59:36Z","timestamp":1715605176000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ahajournals.org\/doi\/10.1161\/JAHA.122.026508"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,1,3]]},"references-count":31,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2023,1,3]]}},"alternative-id":["10.1161\/JAHA.122.026508"],"URL":"https:\/\/doi.org\/10.1161\/jaha.122.026508","relation":{},"ISSN":["2047-9980"],"issn-type":[{"value":"2047-9980","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,1,3]]},"assertion":[{"value":"2022-05-24","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2022-10-31","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2022-12-24","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e026508"}}