ABSTRACT
BACKGROUND: Iron deficiency (ID) has been reported in patients with congenital heart disease. There is, however, a scarcity of data on its prevalence in patients with a Fontan circulation. The aim of this study is to investigate the prevalence of ID in Fontan patients and to investigate the association between ID and exercise capacity in this population. METHODS AND RESULTS: Blood count and haematological parameters were determined in plasma of 61 Fontan patients (51% female, mean age 29±9 years). ID was defined as transferrin saturation (TSAT) ≤19.8%. The prevalence of ID was 36% (22/61 patients). Especially among women, the diagnosis of ID was highly prevalent (52%) despite normal haemoglobin levels (153.7±18.4 g/L). Mean ferritin levels were 98±80 µg/L and mean TSAT levels were 22%±12%. Cardiopulmonary exercise testing was performed in 46 patients (75%). Patients with ID had a lower peak oxygen uptake (VÌO2peak) (1397±477 vs 1692±530 mL/min; p=0.039), although this relationship was confounded by sex. The presence of ID increased the likelihood of not achieving a respiratory exchange ratio (RER) ≥1.1 by 5-fold (p=0.035). CONCLUSION: ID is highly prevalent among patients with a Fontan circulation. VÌO2peak is lower in patients with ID. Fontan patients with ID are less likely to achieve an RER≥1.1 during cardiopulmonary exercise testing.
Subject(s)
Exercise Test , Exercise Tolerance , Fontan Procedure , Heart Defects, Congenital , Humans , Female , Male , Fontan Procedure/adverse effects , Heart Defects, Congenital/surgery , Heart Defects, Congenital/blood , Heart Defects, Congenital/physiopathology , Heart Defects, Congenital/epidemiology , Exercise Tolerance/physiology , Adult , Prevalence , Young Adult , Biomarkers/blood , Anemia, Iron-Deficiency/blood , Anemia, Iron-Deficiency/epidemiology , Anemia, Iron-Deficiency/diagnosis , Anemia, Iron-Deficiency/physiopathology , Oxygen Consumption/physiology , Iron/blood , Iron Deficiencies , Adolescent , Ferritins/bloodABSTRACT
BACKGROUND AND PURPOSE: The use of patient-specific positioning guides (PSPGs) in total knee arthroplasty (TKA) has been advocated as a means of improving patient outcomes, but the reception of PSPGs has been mixed. The aim of our study was to compare patient-reported outcomes (KOOS, NRS-11, EQ-5D-3L, EQ-VAS) after TKA using PSPG with conventional instrumentation (CI) to determine whether there is a discernible clinical benefit to using PSPGs. PATIENTS AND METHODS: This multicenter randomized controlled trial (RCT) followed 77 patients who were randomly assigned to 1 of 2 cohorts between September 2011 and January 2014-one receiving TKA with PSPGs (from Materialise NV) and one receiving TKA with CI-with each cohort followed up until 5 years after the operation. The Vanguard Cruciate Retaining Total Knee System and Refobacin Bone Cement R were used in all operations. KOOS was evaluated using confidence intervals, with differences of less than 10 KOOS units between the cohorts interpreted as indicating the absence of a clinically meaningful difference. RESULTS: No significant differences were found in any of the measured clinical outcomes-KOOS, NRS-11, EQ-5D-3L, EQ-VAS, range of motion, or radiolucent lines scoring-between the cohort operated on using PSPG and the cohort operated on using CI after 5 years of follow-up. CONCLUSION: There was no statistically significant effect of PSPGs on patient-reported outcomes or range of motion in TKA.
