Impact of Ventricular Morphology on Fiber Stress and Strain in Fontan Patients

Ghelani, Sunil J.; Colan, Steven D.; Azcue, Nina; Keenan, Ellen M.; Harrild, David M.; Powell, A.; Geva, Tal; Rathod, Rahul H.

doi:10.1161/circimaging.117.006738

Cited by 46 publications

(41 citation statements)

References 32 publications

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“…Furthermore, mechanical dyssynchrony, if not the major factor explaining early cardiac dysfunction, may impact RV function in older patients [27,28]. Finally, tricuspid regurgitation due to progressive RV dilatation contributes to worsening of ventricular function [29]. Consistently in our study, AV valve dysfunction was more common in the RV group than in the LV group.…”

Section: Discussionsupporting

confidence: 86%

Loss of Ventricular Function After Bidirectional Cavopulmonary Connection: Who Is at Risk?

Vincenti¹,

Qureshi

Niaz

et al. 2020

Pediatr Cardiol

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Decline of single ventricle systolic function after bidirectional cavopulmonary connection (BDCPC) is thought to be a transient phenomenon. We analyzed ventricular function after BDCPC according to ventricular morphology and correlated this evolution to long-term prognosis. A review from Mayo Clinic databases was performed. Visually estimated ejection fraction (EF) was reported from pre-BDCPC to pre-Fontan procedure. The last cardiovascular update was collected to assess longterm prognosis. A freedom from major cardiac event survival curve and a risk factor analysis were performed. 92 patients were included; 52 had left ventricle (LV) morphology and 40 had right ventricle (RV) morphology (28/40 had hypoplastic left heart syndrome (HLHS)). There were no significant differences in groups regarding BDCPC procedure or immediate post-operative outcome. EF showed a significant and relevant decrease from baseline to discharge in the HLHS group: 59 ± 4% to 49 ± 7% or − 9% (p < 0.01) vs. 58 ± 3% to 54 ± 6% or − 4% in the non-HLHS RV group (p = 0.04) and 61 ± 4% to 60 ± 4% or − 1% in the LV group (p = 0.14). Long-term recovery was the least in the HLHS group: EF prior to Fontan 54 ± 2% vs. 56 ± 6% and 60 ± 4%, respectively (p < 0.01). With a median follow-up of 8 years post-BDCPC, six patients had Fontan circulation failure, four died, and three had heart transplantation. EF less than 50% at hospital discharge after BDCPC was strongly correlated to these major cardiac events (HR 3.89; 95% Cl 1.04-14.52). Patients with HLHS are at great risk of ventricular dysfunction after BDCPC. This is not a transient phenomenon and contributes to worse prognosis.

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Section: Discussionsupporting

confidence: 86%

Loss of Ventricular Function After Bidirectional Cavopulmonary Connection: Who Is at Risk?

Vincenti¹,

Qureshi

Niaz

et al. 2020

Pediatr Cardiol

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“…A CMR T1 relaxometry study of pediatric Fontan patients indicated that myocardial fibrosis is present early on and has a negative influence on cardiac contractility [36]. Ghelani et al found that although Fontan patients with a right ventricular morphology had lower GCS compared with those with left ventricular morphology, their EF was similar [10], indicating that strain is a more sensitive marker for myocardial dysfunction. The fact that in the current study with relatively young Fontan patients, almost all patients had a preserved EF while strain values deteriorated, supports this theory.…”

Section: Dominant Ventriclementioning

confidence: 99%

“…Recently introduced, cardiac magnetic resonance (CMR) feature tracking offers potential qualitative advantages [7]. So far, cross-sectional studies have proven the feasibility of CMR feature tracking in the Fontan population [8,9], and have shown differences between left and right ventricular morphology [10], but serial data is lacking.…”

Section: Introductionmentioning

confidence: 99%

Serial cardiovascular magnetic resonance feature tracking indicates early worsening of cardiac function in Fontan patients

Ridderbos

Wolff

Eshuis

et al. 2020

International Journal of Cardiology

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Background: In Fontan patients, attrition of ventricular function is well recognized, but early detection of ventricular dysfunction is difficult. The aim of this study is to longitudinally assess ventricular strain in Fontan patients using a new method for cardiac magnetic resonance (CMR) feature tracking, and to investigate the relationship between ventricular strain and cardiac systolic function. Methods and results: In this prospective, standardized follow-up study in 51 Fontan patients, age ≥ 10 years, CMR and concomitant clinical assessment was done at the start of the study and after 2 years. CMR feature tracking was done combining the dominant and hypoplastic ventricles. Global longitudinal strain (GLS) (−17.3% versus −15.9%, P = 0.041) and global circumferential strain (GCS) (−17.7 versus −16.1, P = 0.047) decreased over 2 years' time. Ejection fraction (EF) (57%), cardiac index (CI) (2.7 l/min/m 2) and NYHA functional class (97% in class I/II) were preserved. The strain values of the combined dominant and hypoplastic ventricles were significantly worse compared to those of the dominant ventricle only (GLS −16.8 (−19.5 to −14.0) versus −18.8 (−21.3 to −15.3) respectively, P = 0.001, GCS −18.3 (−22.1 to −14.8) versus −22.5 (−26.3 to −19.4) respectively, P b 0.001). Conclusions: This study showed a decrease in cardiac strain over 2 years in Fontan patients without clinical signs of Fontan failure, where EF, CI and clinical status were still preserved. Cardiac strain might be a sensitive early indicator of systolic ventricular decline. Furthermore, combined strain of the hypoplastic and dominant ventricles seems a more accurate representation of cardiac strain in functionally univentricular hearts.

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“…25 In addition, Ghelani et al indicate that not only ventricular dilation but also a decreasing GCS are associated with worse outcome. 26 Therefore, 3D-STE, which can assess ventricular volume and strain simultaneously, may be a valuable tool for predicting the outcome of HLHS patients.…”

Section: Contribution Of Strains To Rv Function In Hlhsmentioning

confidence: 99%

Simultaneous Volumetric and Functional Assessment of the Right Ventricle in Hypoplastic Left Heart Syndrome After Fontan Palliation, Utilizing 3-Dimensional Speckle-Tracking Echocardiography

Sato

Calderon

Klas

et al. 2020

Circ J

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Background: Right ventricular (RV) volumetric and functional assessments are both crucial for the management of patients with hypoplastic left heart syndrome (HLHS). 3-dimensional echocardiography (3DE) for volume measurements and 2D speckle-tracking echocardiography (2D-STE) for strain analysis are performed separately. 3D-STE is capable of evaluating those parameters simultaneously and providing principal strain (PS), unifying the concepts of myofiber orientation and contraction into a single, maximal contractile direction. However, the application of 3D-STE to HLHS has not been studied and so became the aim of our study. Methods and Results: 64 HLHS patients after Fontan palliation underwent 3D-STE analysis measuring RV end-diastolic volume index (EDVi), ejection fraction (EF), global PS (GPS), global circumferential strain (GCS), and global longitudinal strain (GLS). Volume measurements were compared between 3D-STE and 3DE, and strains were compared between 3D-and 2D-STE. EDVi and EF showed strong correlations between 3D-STE and 3DE (r=0.93 and 0.87, respectively). GCS and GLS showed moderate correlations between 3D-and 2D-STE (r=0.65 and 0.61, respectively). GPS showed highest magnitude and excellent correlation with EF (r=−0.95). Conclusions:Simultaneous volumetric and functional assessment by 3D-STE was a useful method in this HLHS cohort. PS is a promising parameter for evaluating the RV function of HLHS, which could be useful during longitudinal follow-up.

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Impact of Ventricular Morphology on Fiber Stress and Strain in Fontan Patients

Cited by 46 publications

References 32 publications

Loss of Ventricular Function After Bidirectional Cavopulmonary Connection: Who Is at Risk?

Loss of Ventricular Function After Bidirectional Cavopulmonary Connection: Who Is at Risk?

Serial cardiovascular magnetic resonance feature tracking indicates early worsening of cardiac function in Fontan patients

Simultaneous Volumetric and Functional Assessment of the Right Ventricle in Hypoplastic Left Heart Syndrome After Fontan Palliation, Utilizing 3-Dimensional Speckle-Tracking Echocardiography

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