Echocardiographic assessment of single‐ventricle diastolic function and its correlation to short‐term outcomes after the Fontan operation

Davis, Erin K.; Ginde, Salil; Stelter, Jessica; Frommelt, Peter C.

doi:10.1111/chd.12814

Cited by 8 publications

(2 citation statements)

References 16 publications

(21 reference statements)

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“…If E-and Awave fusion occurred, only the E-wave was assessed (16). Tissue Doppler imaging (TDI) (e', a', s') was performed at the free wall of the systemic ventricle (17) corresponding to the lateral wall in healthy controls. In double inlet left ventricles, the lateral wall was chosen.…”

Section: Echocardiographic Image Acquisition and Analysismentioning

confidence: 99%

Systemic ventricular function in Fontan patients at rest and after exercise at altitude

et al. 2023

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ObjectivePhysical activity at high altitude is expected to pose risks for patients with Fontan circulation and to impair systemic ventricular function. This study aims to determine the effect of high-altitude hypoxia on ventricular function in Fontan patients at rest and after exercise. We hypothesize that systemic ventricular function deteriorates under hypoxic conditions in Fontan patients.MethodsIn this prospective study, 21 Fontan patients (NYHA class I-II) and 21 age-, gender- and body mass index-matched healthy controls were enrolled (median age 17.9 and 16.9 years). Transthoracic echocardiography was performed at rest, after peak (PE) and after continuous exercise (CE) in normoxia and hypoxia at simulated altitude (2,500 m above sea level). The effect of hypoxia on echocardiographic parameters was quantified by linear mixed-effects models and the difference between normoxia and hypoxia (Δ= hypoxia-normoxia).ResultsAt rest, cardiac output (CO) estimated by outflow tract velocity time integral × heart rate and annular plane systolic excursion (APSE) were lower in hypoxia compared to normoxia in Fontan patients (CO: Δ = −12.0%, n.s.; APSE: Δ = −9.6%, p < 0.001), an increase was observed in controls (CO: Δ = 8.5%, n.s.; APSE: Δ = 2.5%, n.s.). Other parameters of systolic and diastolic function did not show relevant changes. After exercise under hypoxic conditions, Fontan patients did not show relevant deterioration of systolic function compared to normoxia. Late, active diastolic filling reflected by A-wave velocity remained unchanged in Fontan patients, but increased in controls. Under hypoxic conditions, CO and workload were higher after CE than PE in Fontan patients (CO: PE Δ = 1,530 vs. CE 1630), whereas controls showed higher work load and CO estimates after PE than CE as expected (CO: PE Δ = 2,302 vs. CE 2149).ConclusionFontan patients clinically tolerated short-term altitude exposure up to two hours and exercise and showed no consistent deterioration of systolic systemic ventricular function, but parameters of myocardial contractility, heart rate and cardiac output did not increase as observed in controls. This is likely to be multifactorial and may include intrinsic cardiac dysfunction as well as preload inadequacy and the lack of augmented atrial contraction. CE may be better tolerated than PE.

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Section: Echocardiographic Image Acquisition and Analysismentioning

confidence: 99%

Systemic ventricular function in Fontan patients at rest and after exercise at altitude

et al. 2023

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“…As such, it can be used for the routine serial assessment of these patients. However, the complex asymmetric geometry of the dominant ventricle and the potential presence of segmental wall motion abnormalities make the echocardiographic evaluation of myocardial performance in single-ventricle patients challenging [ 5 ]. Therefore, conventional 2-dimensional (2D) echo measurements of ventricle function, such as ejection fraction either by Simpson’s biplane method or by M-mode shortening fraction, cannot be used as in normal biventricular hearts [ 6 ].…”

Section: Introductionmentioning

confidence: 99%

The Role of Myocardial Strain Imaging in the Pre- and Post-Operative Assessment of Patients with Single Ventricle

Kleitsioti¹,

Koulaouzidis²,

Giannakopoulou³

et al. 2023

Rev. Cardiovasc. Med.

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The term “single ventricle” refers to a wide range of cardiac structural and functional abnormalities which cause the morphologically right or left ventricle to be hypoplastic or functionally inadequate. Patients with single-ventricle physiology have followed a series of palliative surgeries, resulting in the dominant ventricle supporting only the systemic circulation and the systemic venous return draining directly to the pulmonary arteries. Such patients present a progressive decline in myocardial performance, and their management is associated with high morbidity, mortality and resource usage. At each management step, imaging is critical in eligibility assessment, pre-procedural planning and prompt detection of myocardial dysfunction. However, the complex and asymmetric geometry of the dominant ventricle and its segmental wall motion abnormalities make the echocardiographic evaluation of myocardial performance in these patients rather challenging. Consequently, conventional 2-dimensional echo functional parameters, such as ejection fraction by Simpson’s biplane method or shortening fraction by M-mode, is complex and often not feasible to apply. On the other hand, speckle-tracking echocardiography is angle and geometry independent and has better reproducibility. As such, it constitutes an appealing method for assessing myocardial function in patients with single-ventricle hearts. Therefore, this review aims to investigate the role of myocardial strain imaging by speckle-tracking echocardiography in the pre-and post-operative assessment of patients with single-ventricle hearts.

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Atrial Reservoir Strain is Associated with Decreased Cardiac Index and Adverse Outcomes Post Fontan Operation

2020

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Echocardiographic assessment of single‐ventricle diastolic function and its correlation to short‐term outcomes after the Fontan operation

Cited by 8 publications

References 16 publications

Systemic ventricular function in Fontan patients at rest and after exercise at altitude

Systemic ventricular function in Fontan patients at rest and after exercise at altitude

The Role of Myocardial Strain Imaging in the Pre- and Post-Operative Assessment of Patients with Single Ventricle

Atrial Reservoir Strain is Associated with Decreased Cardiac Index and Adverse Outcomes Post Fontan Operation

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