{
  "abstract": "Introduction CPET is delivered to evaluate functional capacity, support risk stratification and aid clinical decision-making in CHD. In complex or univentricular physiology with Fontan circulation, pulmonary blood flow depends on systemic venous pressure, respiratory mechanics, and skeletal muscle activity rather than a subpulmonary ventricle. Peripheral venous pressure (PvP) has been shown to correlate to central venous pressure (CvP) (Masutani et al., Am J Cardiol 2016; 117:1667-71) in Fontan circulation. Elevated CvP is linked to adverse outcomes (Colman et al., Heart 2021;107:983–988) whilst exercise haemodynamics unmask circulatory impairments. Direct measurement of central venous or right atrial pressure during exercise requires invasive costly catheterisation and is not feasible in the standard physiological laboratory. Monitoring of PvP offers a potentially practical, non invasive surrogate that could be readily implemented, without affecting quality of CPET.Aims To evaluate the feasibility of integrating PvP monitoring into a CPET service and to describe the venous pressure response during exercise in adults with congenital heart disease, including those with Fontan circulation.Methods PvP monitoring was incorporated into supervised CPET, using a bedside patient monitor connected to a saline-filled disposable pressure transducer attached to a peripheral intravenous cannula in an upper-limb vein. The system was zeroed to atmospheric pressure at the phlebostatic axis prior to testing. PvP was recorded throughout testing. Changes in PvP were analysed alongside conventional CPET parameters to determine their value to physiological interpretation, alongside published standards for CPET.Results Eleven patients underwent CPET with PvP monitoring, including eight with Fontan physiology. PvP increased from rest (13.0 ± 6.6 mmHg), throughout exercise, and further at peak (24.5 ± 9.2 mmHg) ( figure 1). No adverse complications were recorded. End-of-test criteria (RER > 1.10 and HR > 90% of predicted) were achieved in all patients.Discussion Implementation of PvP monitoring within a CPET service was straightforward, affordable, and well tolerated. Incorporating PvP assessment enhances interpretation of exercise limitation while reducing the need for invasive catheterisation. This approach highlights how physiology services can provide non invasive haemodynamic assessment without compromising CPET standards. Further research should validate PvP responses against invasive measures and explore the prognostic value across cohorts.Abstract P51 Figure 1Change in PvP from rest to peak exercise in Fontan (dashed lines) and non-Fontan (solid lines) patients",
  "authors": [
    {
      "affiliations": [
        "Liverpool Heart and Chest Hospital, Liverpool, United Kingdom"
      ],
      "name": "Scott Hawkes"
    },
    {
      "affiliations": [
        "Liverpool Heart and Chest Hospital, Liverpool, United Kingdom"
      ],
      "name": "Wayne Donnelly"
    },
    {
      "affiliations": [
        "Liverpool Heart and Chest Hospital, Liverpool, United Kingdom"
      ],
      "name": "Yasser Yousif"
    },
    {
      "affiliations": [
        "Liverpool Heart and Chest Hospital, Liverpool, United Kingdom"
      ],
      "name": "Elen Hughes"
    },
    {
      "affiliations": [
        "Liverpool Heart and Chest Hospital, Liverpool, United Kingdom"
      ],
      "name": "David Mayhew"
    },
    {
      "affiliations": [
        "Liverpool Heart and Chest Hospital, Liverpool, United Kingdom"
      ],
      "name": "Reza Ashrafi"
    }
  ],
  "title": "P51 Peripheral venous pressure monitoring to enhance CPET assessment in adult congenital heart disease",
  "uid": "9e2ebfdb-e073-57f9-b1f3-4c4fb1e03f35"
}