Open Access

ARTICLE

Association Between Blood Biomarkers and Hemodynamic Parameters in Adolescents and Adults After the Fontan Procedure: A Retrospective Cohort Study

Kentaro Kogawa^*, Daishi Hirano, Yuka Okawa, Emi Kittaka, Shunsuke Baba, Reiji Ito
Department of Pediatrics, The Jikei University School of Medicine, Tokyo, 105-8471, Japan
* Corresponding Author: Kentaro Kogawa. Email:
(This article belongs to the Special Issue: Novel Insights into Congenital Heart Disease: Pathophysiology, Biomarkers, and Future Directions)

Congenital Heart Disease https://doi.org/10.32604/chd.2025.073864

Received 27 September 2025; Accepted 23 December 2025; Published online 05 February 2026

Abstract

Background: An increasing number of patients with Fontan circulation are reaching adulthood; however, long-term outcomes remain limited by Fontan failure, which is characterized by elevated central venous pressure (CVP) and reduced cardiac output. Red blood cell distribution width (RDW), a readily available hematological parameter, is a known prognostic marker of heart failure. However, its relationship with invasive hemodynamics in adolescent and adult Fontan patients has not been fully examined. Objectives: To clarify the association between RDW and invasive hemodynamic indices in adolescent and adult Fontan patients and assess the utility of RDW as a noninvasive circulatory marker. Methods: This single-center retrospective study included consecutive Fontan patients aged ≥16 years who underwent routine cardiac catheterization ≥5 years after surgery, between June 2014 and July 2025. Laboratory data and catheter-derived hemodynamics were also analyzed. The primary endpoint was the correlation between RDW and CVP, and the secondary endpoint was the correlation between RDW and central venous oxygen saturation (ScvO₂). Results: Forty patients (median age: 22 years) were analyzed. The median RDW was 13.3%, and the median CVP was 11.0 mmHg. RDW correlated positively with CVP (ρ = 0.57, p < 0.001) and negatively with ScvO₂ (ρ = –0.66, p < 0.001) and the cardiac index (ρ = –0.34, p = 0.03). Patients with elevated RDW (>14.5%) had higher CVP (14.5 vs. 10.5 mmHg, p < 0.001) and lower ScvO₂ (63.8% vs. 76.1%, p < 0.001), compared with those with normal RDW. Multivariable analysis identified RDW as an independent predictor of ScvO₂ (p < 0.001). Conclusions: In adolescents and adults after the Fontan procedure, RDW was significantly associated with elevated CVP and reduced ScvO₂ and independently predicted impaired oxygen delivery. RDW is inexpensive, widely accessible, and may serve as a practical noninvasive biomarker for the early detection of Fontan failure and the optimization of invasive testing and interventions during long-term follow-up.

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Keywords

Biological markers; central venous pressure; erythrocyte indices; fontan procedure; hemodynamics; oxygen saturation

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