@Article{chd.2025.073864,
AUTHOR = {Kentaro Kogawa, Daishi Hirano, Yuka Okawa, Emi Kittaka, Shunsuke Baba, Reiji Ito},
TITLE = {Association Between Blood Biomarkers and Hemodynamic Parameters in Adolescents and Adults After the Fontan Procedure: A Retrospective Cohort Study},
JOURNAL = {Structural and Congenital Heart Disease},
VOLUME = {20},
YEAR = {2025},
NUMBER = {6},
PAGES = {659--671},
URL = {http://www.techscience.com/schd/v20n6/66122},
ISSN = {3071-1738},
ABSTRACT = {<b>Background:</b> 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. <b>Objectives:</b> 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. <b>Methods:</b> 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 (ScvO<sub>2</sub>). <b>Results:</b> 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, <i>p</i> &lt; 0.001) and negatively with ScvO<sub>2</sub> (ρ = –0.66, <i>p</i> &lt; 0.001) and the cardiac index (ρ = –0.34, <i>p</i> = 0.03). Patients with elevated RDW (&gt;14.5%) had higher CVP (14.5 vs. 10.5 mmHg, <i>p</i> &lt; 0.001) and lower ScvO<sub>2</sub> (63.8% vs. 76.1%, <i>p</i> &lt; 0.001), compared with those with normal RDW. Multivariable analysis identified RDW as an independent predictor of ScvO<sub>2</sub> (<i>p</i> &lt; 0.001). <b>Conclusions:</b> In adolescents and adults after the Fontan procedure, RDW was significantly associated with elevated CVP and reduced ScvO<sub>2</sub> 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.},
DOI = {10.32604/chd.2025.073864}
}