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Showing 441–460 of 2058 publications.
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Chami, Jason; Strange, G. A.; Nicholson, Calum; Celermajer, David S.[No abstract available]
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Wali, Jibran A.; Milner, Annabelle J.; Luk, Alison W.S.; Pulpitel, Tamara Jayne; Dodgson, Tim; Facey, Harrison J.W.; Wahl, Devin; Kebede, Melkam A.; Senior, Alistair M.; Sullivan, Mitchell A.; Brandon, Amanda E.; Yau, Belinda; Lockwood, Glen P.; Koay, Yen Chin; Ribeiro, Rosilene V.; Solon-Biet, Samantha M.; Bell-Anderson, Kim S.; OSullivan, John F.; Macia, Laurence M.; Forbes, Josephine Maree; Cooney, Gregory J.; Cogger, Victoria Carroll; Holmes, Andrew J.; Raubenheimer, David R.; Le Couteur, David G.; Simpson, Stephen JamesReduced protein intake, through dilution with carbohydrate, extends lifespan and improves mid-life metabolic health in animal models. However, with transition to industrialised food systems, reduced dietary protein is associated with poor health outcomes in humans. Here we systematically interrogate the impact of carbohydrate quality in diets with varying carbohydrate and protein content. Studying 700 male mice on 33 isocaloric diets, we find that the type of carbohydrate and its digestibility profoundly shape the behavioural and physiological responses to protein dilution, modulate nutrient processing in the liver and alter the gut microbiota. Low (10%)-protein, high (70%)-carbohydrate diets promote the healthiest metabolic outcomes when carbohydrate comprises resistant starch (RS), yet the worst outcomes were with a 50:50 mixture of monosaccharides fructose and glucose. Our findings could explain the disparity between healthy, high-carbohydrate diets and the obesogenic impact of protein dilution by glucosefructose mixtures associated with highly processed diets. 2021, The Author(s), under exclusive licence to Springer Nature Limited.
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Lowres, Nicole; Freedman, Ben Ben[No abstract available]
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Lim, Michelle Su Anne; Celermajer, David S.; Bannon, Paul GerardBackground: Patients with bicuspid aortic valve (BAV) with zero or two raphes have been under-represented in previous studies. Whether these patients have unique clinical courses remains unclear. We describe the indications for and types of surgery in patients with BAV, and describe differences between valve morphotypes. Methods: Adults who had undergone aortic and/or aortic valve surgery for BAV disease at our centres were identified and classified according to the Sievers definitions. Results: 317 patients were included (74.4% male, median age at surgery 62 years). Of these, 187 (59.0%) had aortic valve surgery, 7 (2.2%) aortic surgery, 120 (37.9%) combined valve and aortic surgery and 3 had a Ross procedure. Most patients had aortic stenosis (71.9%), followed by aortic regurgitation (16.7%). 30-day mortality was low (1.6%). The commonest valve morphology was type-1 (one raphe) in 89.6%; type-0 (no raphes) occurred in 7.9% and type-2 (two raphes) in 2.5%. Patients with type-2 valves were substantially younger at time of surgery than type-1 patients (median 36 vs 63 years, p = 0.008). A higher proportion of patients with type-0 valves required aortic surgery than those with type-1 (68.0% vs 37.3%, p = 0.007). There were no differences between groups for the indication for surgery, valvular abnormality or 30-day mortality. Conclusions: The number of BAV raphes was independently and significantly associated with age at surgery and the need for aortic intervention. Patients with type 0 and type 2 valves are a small but important proportion of the BAV population, potentially requiring different clinical surveillance and management. 2021 The Authors
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Tucker, Bradley; Vaidya, Kaivan; Cochran, Blake J.; Patel, SanjayPeriprocedural myocardial injury and myocardial infarction (MI) are not infrequent complications of percutaneous coronary intervention (PCI) and are associated with greater short? and long?term mortality. There is an abundance of preclinical and observational data demonstrating that high levels of pre?, intra? and post?procedural inflammation are associated with a higher incidence of periprocedural myonecrosis as well as future ischaemic events, heart failure hospitalisations and cardiac?related mortality. Beyond inflammation associated with the underlying coronary pathol-ogy, PCI itself elicits an acute inflammatory response. PCI?induced inflammation is driven by a combination of direct endothelial damage, liberation of intra?plaque proinflammatory debris and reperfusion injury. Therefore, anti?inflammatory medications, such as colchicine, may provide a novel means of improving PCI outcomes in both the short? and long?term. This review summarises periprocedural MI epidemiology and pathophysiology, evaluates the prognostic value of pre?, in-tra? and post?procedural inflammation, dissects the mechanisms involved in the acute inflammatory response to PCI and discusses the potential for periprocedural anti?inflammatory treatment. 2021 by the authors. Licensee MDPI, Basel, Switzerland.
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Turrell, Gavin; Nathan, Andrea; Burton, Nicola W.; Brown, Wendy J.; McElwee, Paul R.; Barnett, Adrian G.; Pachana, Nancy A.; Oldenburg, Brian F.; Rachele, Jerome N.; Giskes, Katrina; Giles-Corti, Billie[No abstract available]
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Gibbs, Harry H.; Freedman, Ben Ben; Rosenqvist, Mten; Virdone, Saverio; Almahmeed, Wael A.; Ambrosio, Giuseppe B.; Camm, Alan John; Jacobson, Barry Frank; Jerjes-Sanchez, Carlos D.; Kayani, Gloria; Oto, Ali M.; Panchenko, Elizaveta P.; Ragy, Hany Ibrahim; Kakkar, Ajay K.Background: Asymptomatic atrial fibrillation is often detected incidentally. Prognosis and optimal therapy for asymptomatic compared with symptomatic atrial fibrillation is uncertain. This study compares clinical characteristics, treatment, and 2-year outcomes of asymptomatic and symptomatic atrial fibrillation presentations. Methods: Global Anticoagulant Registry in the Field-Atrial Fibrillation (GARFIELD-AF) is a global, prospective, observational study of newly diagnosed atrial fibrillation with ?1 stroke risk factors (http://www.clinicaltrials.gov, unique identifier: NCT01090362). Patients were characterized by atrial fibrillation-related symptoms at presentation and the CHA<inf>2</inf>DS<inf>2</inf>-VASc score. Two-year follow-up recorded anticoagulation patterns (vitamin K antagonist, direct oral anticoagulants, parenteral therapy) and outcomes (stroke/systemic embolism, all-cause mortality, and bleeding). Results: At presentation, of 52,032 eligible patients, 25.4% were asymptomatic and 74.6% symptomatic. Asymptomatic patients were slightly older (72 vs 70 years), more often male (64.2% vs 52.9%), and more frequently initiated on anticoagulation antiplatelets (69.4% vs 66.0%). No difference in events (adjusted hazard ratios, 95% confidence interval) for nonhemorrhagic stroke/systemic embolism (1.19, 0.97-1.45), all-cause mortality (1.06, 0.94-1.20), or bleeding (1.02, 0.87-1.19) was observed. Anticoagulation was associated with comparable reduction in nonhemorrhagic stroke/systemic embolism (0.59, 0.430.82 vs 0.78, 0.650.93) and all-cause mortality (0.69, 0.59-0.81 vs 0.77, 0.71-0.85) in asymptomatic versus symptomatic, respectively. Conclusions: Major outcomes do not differ between asymptomatic and symptomatic atrial fibrillation presentations and are comparably reduced by anticoagulation. Opportunistic screening-detected asymptomatic atrial fibrillation likely has the same prognosis as asymptomatic atrial fibrillation at presentation and likely responds similarly to anticoagulation thromboprophylaxis. 2021 The Authors
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Ferguson, Caleb; Lowres, Nicole; Freedman, Ben Ben[No abstract available]
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Galougahi, Keyvan Karimi; Shlofmitz, Evan S.; Jeremias, Allen; Petrossian, Gregory; Mintz, Gary S.; Maehara, Akiko; Shlofmitz, Richard Alan; Ali, Ziad A.[No abstract available]
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Queiroz, Raphael Ferreira; Suarna, Cacang; Corcilius, Leo; Sergeant, Genevieve E.; Shengule, Sudhir R.; Payne, Richard J.; Ayer, Anita; Stocker, RolandThe l-tryptophanderived tricyclic hydroperoxide cis-WOOH was recently identified as a novel and biologically important factor for regulating vascular tone and blood pressure under inflammatory conditions and potentially other cellular redox signaling events. cis-WOOH is highly labile and currently not available commercially. In this protocol, we provide procedures for the synthesis, purification, quantification and characterization of cis-WOOH, its epimer trans-WOOH and their respective alcohols (cis-WOH and trans-WOH). Photo-oxidation of l-tryptophan (l-Trp) results in a mixture containing cis-WOOH and trans-WOOH, which are separated and purified by semi-preparative HPLC. cis-WOH and trans-WOH are then produced by sodium borohydride reduction and purified by semi-preparative HPLC. Characterization of cis-WOOH and trans-WOOH and the reduced alcohol variants is achieved using HPLC, fluorescence, NMR and liquid chromatography-tandem mass spectrometry. The protocol provides instructions for storage and quantification, as well as ways to test the stability of these hydroperoxides in commonly used buffers and media. Finally, we describe examples of how to monitor the formation of cis-WOOH in biological samples. The protocol ensures reasonable yield (11%) and purity (>99%) of cis-WOOH and control compounds in 56 d and outlines conditions under which cis-WOOH is stable for several months. 2021, The Author(s), under exclusive licence to Springer Nature Limited.
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Chami, Jason; Nicholson, Calum; Strange, G. A.; Cordina, Rachael Louise; Celermajer, David S.Background: We aim to establish a new and informative bi-national Registry for Congenital Heart Disease (CHD) patients in Australia and New Zealand, to document the burden of disease and clinical outcomes for patients with CHDs across the lifespan. When planning for the implementation of this Registry, we sought to evaluate the strengths and weaknesses of existing national and large regional CHD databases. Methods: We characterised 15 large multi-institutional databases of pediatric and/or adult patients with CHD, documenting the richness of their datasets, the ease of linkage to other databases, the coverage of the target cohort and the strategies utilised for quality control. Results: The best databases contained demographic, clinical, physical, laboratory and patient-reported data, and were linked at least to the national/regional death registry. They also employed automatic data verification and regular manual audits. Coverage ranged from around 25% of all eligible CHD cases for larger databases to near 100% for some smaller registries of patients with specific CHD lesions, such as the Australia and New Zealand Fontan Registry. Conclusions: Existing national and regional CHD databases have strengths and weaknesses; few combine complete coverage with high quality and regularly audited data, across the broad range of CHDs. 2021 Elsevier B.V.
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Schumann, Tina; Kig, Jg; von Loeffelholz, Christian; Vatner, Daniel F.; Zhang, Dongyang Yan; Perry, Rachel J.; Bernier, Michel; Chami, Jason; Henke, Christine; Kurzbach, Anica; El-Agroudy, Nermeen N.; Willmes, Diana Maria; Pesta, Dominik Hans; de Cabo, Rafael C.; OSullivan, John F.; Simon, Eric; Shulman, Gerald I.; Hamilton, Bradford S.; Birkenfeld, Andreas L.[No abstract available]
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Yuasa, Hajime Julie; Stocker, RolandIndoleamine 2,3-dioxygenases (IDOs) catalyze the oxidative cleavage of L-tryptophan (Trp) to N-formylkynurenine. Two IDOs, IDO1 and IDO2, are present in vertebrates. IDO1 is a high-affinity Trp-degrading enzyme involved in several physiological processes. By comparison, IDO2 generally has been reported to have low affinity (high K<inf>m</inf>-value) for Trp, and the enzyme's invivo function remains unclear. Using IDOs from different species, we show that compared with ferrous-oxy (Fe2+O<inf>2</inf>) IDO1, Fe2+O<inf>2</inf> IDO2 is substantially more stable and engages in multiple turnovers of the reaction in the absence of a reductant. Without reductant, Fe2+O<inf>2</inf> IDO2 showed K<inf>m</inf>-values in the range of 80356?M, that is, values substantially lower than reported previously and close to the physiological concentrations of Trp. Methylene blue and ascorbate (Asc), used commonly as the reducing system for IDO activity determination, significantly affected the enzymatic activity of IDO2: In combination, the two reductants increased the apparent K<inf>m</inf>- and k<inf>cat</inf>-values 8- to 117-fold and 2-fold, respectively. Asc alone both activated and inhibited IDO2 by acting as a source of electrons and as a weak competitive inhibitor, respectively. In addition, ferric (Fe3+) IDO1 and IDO2 exhibited weak dioxygenase activity, similar to tryptophan 2,3-dioxygenase. Our results shed new light in the enzymatic activity of IDO2, and they support the view that this isoform of IDO also participates in the metabolism of Trp invivo. 2021 Federation of European Biochemical Societies
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Nedoboy, Polina E.; Cohen, E. Myfanwy; Farnham, M. M. J.The sympathoadrenal counterregulatory response to hypoglycemia is critical for individuals with type 1 diabetes due to impaired ability to produce glucagon. Ketogenic diets (KD) are an increasingly popular diabetes management tool; however, the effects of KD on the sympathoadrenal response are largely unknown. Here, we determined the effects of KD-induced ketosis on the sympathoadrenal response to a single insulin-induced hypoglycemic challenge. We investigated how a 3 week KD feeding regimen affected the main components of the sympathoadrenal counterregulatory response: adrenal sympathetic nerve activity (ASNA), adrenal gland activity, plasma epinephrine, and brainstem glucose-responsive C1 neuronal activation in anesthetized, nondiabetic male Sprague-Dawley rats. Rats on KD had similar blood glucose (BG) levels and elevated ketone body ?-hydroxybutyrate (BHB) levels compared to the control Chow diet group. All KD rats responded to hypoglycemia with a robust increase in ASNA, which was initiated at significantly lower BG levels compared to Chow-fed rats. The delay in hypoglycemia-induced ASNA increase was concurrent with rapid disappearance of BHB from cerebral and peripheral circulation. Adrenal gland activity paralleled epinephrine and ASNA response. Overall, KD-induced ketosis was associated with initiation of the sympathoadrenal response at lower blood glucose levels; however, the magnitude of the response was not diminished. 2021 by the authors. Licensee MDPI, Basel, Switzerland.
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Zhang, Wei; Chen, Yi; Miao, Chaoying; Huang, Qifang; Sheng, Changsheng; Shao, Shuai; Wang, Dian; Xu, Shaokun; Lei, Lei; Zhang, Di; Chen, Yilin; Hu, Leixiao; Xia, Jiahui; Ye, Xiaofei; Cheng, Yibang; Wang, Ying; Guo, Qianhui; Li, Yan; Lowres, Nicole; Freedman, Ben Ben; Wang, JiguangBackground: Screening for atrial fibrillation before onset of symptoms and the subsequent initiation of oral anticoagulants could prevent stroke and death. The most cost-effective strategy to screen for atrial fibrillation in a population at high risk aged 65 years and older is unknown. Therefore, we aimed to investigate whether more frequent electrocardiography (ECG) recordings would significantly improve the detection of atrial fibrillation compared with annual ECG screenings. Methods: We did a randomised controlled trial that compared different screening frequencies of 30 s single-lead ECG (AliveCor Heart Monitor) in the detection of atrial fibrillation in Chinese residents (?65 years) in five community health centres in Shanghai, China. Only participants without history of atrial fibrillation and without atrial fibrillation rhythm at baseline were eligible for inclusion in the trial. Random assignment was done with the use of a random number table and stratified for study site. Participants were randomly assigned in a 1:1 ratio to annual or quarterly screening groups. The quarterly screening group was further randomly assigned in a 3:1 ratio to subgroups of quarterly screening and quarterly screening plus (which involved ECG screening once per week for the first month of follow-up, then quarterly for the remainder of follow-up). The primary outcome was the detection rate of atrial fibrillation. The intention-to-treat analysis was done for all randomly assigned patients who had at least one ECG recording during follow-up. This trial was registered at ClinicalTrials.gov, NCT02990741, and terminated on Oct 31, 2020. Findings: Between April 17, 2017, and June 26, 2018, 8240 participants were randomly assigned to annual screening (n=4120), quarterly screening (n=3090), and quarterly screening plus (n=1030), with a mean number of ECG recordings of 16 (SD 05) for annual screening, 35 (15) for quarterly screening, and 52 (29) for quarterly screening plus during a median of 21 years follow-up (13 284 person-years). 73 incident cases of atrial fibrillation occurred: 26 in the annual screening group (41 per 1000 person-years) and 47 in the quarterly screening group (67 per 1000 person-years. Quarterly screening was associated with a significant increase in the detection rate of atrial fibrillation, compared with annual screening (hazard ratio [HR] 171; 95% CI 106276; p=0029). 40 incident cases were detected in quarterly screening (72 per 1000 person-years; HR compared to annual screening, 183; 95% CI 112300; p=0017) and seven in the quarterly screening plus group (48 per 1000 person-years; HR compared with annual screening, 124; 054286; p=061). No significant difference was noted between quarterly screening and the quarterly screening plus group (HR of quarterly screening plus compared with quarterly screening, 068; 030152; p=035). Interpretation: Quarterly 30 s single-lead ECG screening was associated with a significantly higher detection rate of incident atrial fibrillation compared with annual screening, but additional once per week screenings in the first month did not yield an added predictive value. Quarterly screening might be considered in a general population at a high risk of atrial fibrillation, such as those aged 65 years and older. Funding: Bayer Healthcare Company. 2021 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY-NC-ND 4.0 license
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Hywood, Jack D.; Sadeghipour, Sara; Clayton, Zoe E.; Yuan, Jun; Stubbs, Colleen; Wong, Jack W.T.; Cooke, John P.; Patel, SanjayInduced endothelial cells (iECs) generated from neonatal fibroblasts via transdifferentiation have been shown to have pro-angiogenic properties and are a potential therapy for peripheral arterial disease (PAD). It is unknown if iECs can be generated from fibroblasts collected from PAD patients and whether these cells are pro-angiogenic. In this study fibroblasts were collected from four PAD patients undergoing carotid endarterectomies. These cells, and neonatal fibroblasts, were transdifferentiated into iECs using modified mRNA. Endothelial phenotype and pro-angiogenic cytokine secretion were investigated. NOD-SCID mice underwent surgery to induce hindlimb ischaemia in a murine model of PAD. Mice received intramuscular injections with either control vehicle, or 1 106 neonatal-derived or 1 106 patient-derived iECs. Recovery in perfusion to the affected limb was measured using laser Doppler scanning. Perfusion recovery was enhanced in mice treated with neonatal-derived iECs and in two of the three patient-derived iEC lines investigated in vivo. Patient-derived iECs can be successfully generated from PAD patients and for specific patients display comparable pro-angiogenic properties to neonatal-derived iECs. : 2021 Hywood et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
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Ngo, Linh Thi Hai; Do, Thinh Duc; Van, Bavu; Hoang, Kientrung; Le, Dzung Tien; Nguyen, Huu Cong; Nguyen, Tran Thuy; Freedman, Ben Ben; Lowres, NicoleObjectives: To examine the incidence of atrial fibrillation (AF) newly developed after cardiovascular surgery in Vietnam, its associated risk factors, and postoperative complications. We also sought to evaluate the feasibility of a novel screening strategy for post-operative AF (POAF) using the combination of two portable devices. Methods: Single-centre, prospective cohort study at the Cardiovascular Centre, E Hospital, Hanoi, Vietnam. All patients aged?18 years, undergoing cardiovascular surgery and in sinus rhythm preoperatively were eligible. The primary outcome was occurrence of new-onset POAF detected by hand-held single-lead electrocardiography (ECG) or a sphygmomanometer with AF-detection algorithm. Multivariate logistic regression was used to identify risk factors of developing post-operative AF. Feasibility was evaluated by compliance to the protocol and semi-structured interviews. Results: 112 patients were enrolled between 2018-2019: mean age 52.912.2 years; 50.9% female; 92.0% (n=103) valve surgery; 9.8% (n=11) coronary surgery. New-onset POAF developed in 49 patients (43.8%) with median time to onset 1.27days (IQR 0.96-2.00 days). Age?65 years was the only significant risk factor for the development of POAF(OR 3.78, 95% CI 1.16-12.34).The median thromboembolism risk scores (CHA<inf>2</inf>DS<inf>2</inf>-VASc score) were comparable among patients with and without POAF (1.0 vs. 1.0, p=0.104). The occurrence of POAF was associated with higher rates of postoperative complications (24.5% vs. 3.2%, p<0.001). Both doctors and nurses found this screening strategy feasible to be implemented long-term with the main difficulties being the instructions on both devices were in English, and an increase in workload. Conclusions: In this single-centre study, new-onset POAF occurred in 43.8% of patients who underwent cardiovascular surgery. This novel POAF screening strategy was feasible in a low resource setting, and its implementation could be improved by providing continuous training and translation to local language. 2021 CardioFront LLC. All rights reserved.
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Offen, Sophie M.; Cham, Jamie; Tan, Charis; Chard, Richard B.; Cordina, Rachael Louise; Celermajer, David S.Background: Tricuspid valve (TV) pathology can occur in a diverse range of patients with adult congenital heart disease (ACHD). Data is lacking to guide indications and timing for surgical TV intervention and few series have documented the outcomes of TV surgery in this heterogenous cohort. Methods: We reviewed the records of 36 patients with congenital heart disease and biventricular circulations who had undergone TV surgery. Fourteen were men (38%) and mean age at the time of TV surgery was 36 13years. 19 had Ebstein's anomaly (53%) and 17 had alternative diagnoses (47%), including TV disease associated with pulmonary stenosis (20%), Tetralogy of Fallot (11%), atrioventricular septal defects (11%) or TV dysplasia (5%). Results: The most common indication for surgery was severe tricuspid regurgitation (TR) and right-sided heart failure. The TV was repaired in 22 (61%) and replaced in 14 (39%). There was no peri-operative or 30-day mortality, and only one patient died during medium-term follow-up. At last follow up (9.88years from operation), 25 (71%) patients were functional New York Heart Association (NYHA) Class I. Four patients required re-operation at a mean age of 48 11years and 9.27years after their initial TV surgery. In patients who underwent a single TV surgery, 83% had trivial or mild TR at 8.1 7.5years from date of surgery, and no patients had more than mild obstruction to TV inflow. Conclusion: Irrespective of the underlying pathology for TV disease in patients with ACHD, surgical TV intervention is associated with very low early mortality and good medium to long-term outcomes, when patients are cared for at a specialised ACHD centre. 2021 The Authors
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Moore, Benjamin M.; Tran, Derek L.; McGuire, Mark A.; Celermajer, David S.; Cordina, Rachael LouiseBackground: The atrioventricular (AV) delay may be altered in ventricularly paced patients with either dual-chamber pacemakers or cardiac resynchronization therapy (CRT), to optimize diastolic filling and cardiac output, but such modifications are virtually unstudied in the setting of complex congenital heart disease (CHD). We sought to assess the optimal AV delay in a pilot study of ventricularly paced adults with CHD. Methods: AV delay optimization was performed by the iterative method utilising pulsed wave Doppler of systemic AV valve inflow, in the patient's presenting rhythm (atrial-sensed or paced). Diastolic filling time (DFT), inflow and outflow velocity time integrals (VTI) were compared at optimal and nominal AV delay settings. Results: Nine patients were studied with the following CHD diagnoses: congenitally corrected transposition of the great arteries (TGA) in 4, D-TGA post Senning in 2, tetralogy of Fallot in 2 and Fontan circulation in 1. The median optimal AV delay was 100 20 ms, shorter than the median nominal AV delay of 150 20 ms. The median difference between optimal and nominal AV delay setting was 50 40 ms, with the optimal AV delay shorter than the nominal in all but one patient. At optimal AV delay, the DFT was longer, and inflow and outflow VTIs were larger, compared to nominal. Conclusions: AV delay optimization in ventricularly paced adult CHD patients resulted in an optimal AV delay that differed to the nominal setting in all patients, and typically was shorter. 2021
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Tran, Derek L.; Rodrigues, Cameron; Du Plessis, Karin; Zannino, Diana; Davis, Glen Macartney; Celermajer, David S.; d'Udekem, Yves A.; Cordina, Rachael LouiseBackground: In people with a Fontan circulation, serial cardiopulmonary exercise testing (CPET) to evaluate change in peak exercise capacity has been increasingly recognised as a useful prognostic tool; a decline is associated with adverse clinical outcomes. The aim of this study is to describe the natural history of exercise capacity in the Australian and New Zealand (ANZ) Fontan cohort and to identify factors associated with a decline. Methods: The ANZ Fontan registry was retrospectively reviewed for adolescent and adult patients (?16 years) with serial CPET results performed on a cycle ergometer ?6 months apart. Patients were excluded if they underwent a surgical procedure or fenestration closure in-between tests or if the tests were considered as submaximal effort. Exercise capacity trajectory was defined as the change in percentage of predicted peak oxygen uptake (% pred VO<inf>2peak</inf>) points per year. Results: Thirty-seven (37) patients (59.5% male, mean age 247 years) were eligible. Average duration between CPET was 5.33.9 years. At baseline, % pred VO<inf>2peak</inf> was 61.314.5%. Thirteen (13) (35%) had a systemic right ventricle, and 14 (38%) had an atriopulmonary type Fontan circulation. Average change in % pred VO<inf>2peak</inf> overall was +1.36.4 percentage points per year. Sixteen (16) had a negative exercise capacity trajectory, and the average decline in that group was ?2.73.4 percentage points per year. There was no association between exercise capacity trajectory and clinical characteristics. Of the 18 patients with physical activity levels recorded, 12 (67%) were physically active and % pred VO<inf>2peak</inf> in that group increased by 2.74.0 percentage points per year compared with the physically inactive group who fell by 0.50.8 percentage points per year. Conclusions: In this ANZ series of Fontan patients, over half of our cohort had stable, or an increase, in peak exercise capacity. Regular participation in physical activity was common in patients with a positive exercise capacity trajectory. Clinical characteristics were not associated with exercise capacity trajectory. 2021 Australian and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society of Australia and New Zealand (CSANZ)
