Right Ventricular Mechanical Dyssynchrony in Hypoplastic Left Heart Syndrome: Correlation with Systolic Function and QRS Duration

Zaidi, S. Javed; Penk, Jamie; Cui, Vivian W.; Roberson, David A.

doi:10.1007/s00246-019-02091-6

Cited by 10 publications

(8 citation statements)

References 25 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].…”

Section: Discussionmentioning

confidence: 99%

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: Discussionmentioning

confidence: 99%

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

Vincenti¹,

Qureshi

Niaz

et al. 2020

Pediatr Cardiol

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“…to improve the selection of suitable patients for CRT. 3 In our study, children with an FSRV who had undergone the Fontan operation had increased dyssynchrony in both wide and narrow QRS intervals. Our study was consistent with Friedberg et al, 29 But…”

Section: Discussionmentioning

confidence: 47%

“…33 Zadi et al demonstrated dyssynchrony was significantly worse in the HLHS group of patients with reduced systolic dysfunction. 3 Motonaga et al showed that patients with HLHS had significant RV mechanical dyssynchrony compared to healthy controls despite normal RV function. 34 Since dyssynchrony could precede ventricular dysfunction, we speculate that dyssynchrony may lead to ventricular dysfunction in patients with FSRV.…”

Section: Discussionmentioning

confidence: 99%

“…Zadi et al provided the cutoff values for dyssynchrony parameters to help identify RV systolic dysfunction. 3 With reproducility, most revalent to gobal function, Tmsv-SD of three compartmens performed by RT-3DE is an important index to evaluate ventricular ventricular dyssynchrony and may provide better identification of patients with FSRV after Fontan operation who would benefit from CRT .…”

Section: Discussionmentioning

confidence: 99%

“…2 The synchronization of electrical conduction and mechanical activity of the heart is the premise of normal systolic function, and worsening RV mechanical dyssynchrony may be associated with an overall decline in RV function. 3 Therefore, quantitative assessment of ventricular function and dyssynchrony is important for predicting the outcome of the Fontan operation in children with an FSRV.…”

Section: Introductionmentioning

confidence: 99%

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Ventricular function and dyssynchrony in children with a functional single right ventricle using real time three‐dimensional echocardiography after fontan operation

et al. 2021

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Background: This study aimed to evaluate the feasibility and clinical value of real time three-dimensional echocardiography (RT-3DE) for assessing ventricular systolic dysfunction and dyssynchrony in children with an functional single right ventricle (FSRV) having undergone the Fontan procedure.Methods: Twenty-five children with an FSRV and 25 healthy children were enrolled in our study. RV volume analysis was performed compared with magnetic resonance imaging (MRI) as the reference standard in FSRV patients. The patients were divided into wide and narrow QRS interval groups. Global and regional functions of the RV in three compartments (inflow, body, and outflow) were compared between FSRV and control subjects, including RV systolic dyssynchrony indices of maximal difference of time to minimal volume (Tmsv-Dif), standard deviation of time to minimal volume (Tmsv-SD), maximal difference of time to minimal volume corrected by R-R interval (Tmsv-Dif%), and standard deviation of time to minimal volume corrected by R-R interval (Tmsv-SD%).Results: RT-3DE measurements were significantly lower than MRI measurements for RV-EDV, RV-ESV, RV-SV, and RVEF (p < 0.01).Compared with controls, patients with an FRSV had significantly higher dyssynchrony indices and significantly lower global EF in both narrow QRS interval and wide QRS interval groups. Tmsv-SD% was shown to be most strongly correlated with MRI-RVEF (r = −.570, p = 0.003).Conclusions: RT-3DE tended to underestimate RV ventricular volume in children with FSRV. Children with an FSRV and either a wide or narrow QRS interval had reduced ventricular function and higher dyssynchrony than normal subjects. Worsening RV dyssynchrony is associated with overall decline in function after the Fontan operation.

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The Progress and Significance of QRS Duration by Electrocardiography in Hypoplastic Left Heart Syndrome

Karikari

Abdulkarim

et al. 2019

Pediatr Cardiol

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Right Ventricular Mechanical Dyssynchrony in Hypoplastic Left Heart Syndrome: Correlation with Systolic Function and QRS Duration

Cited by 10 publications

References 25 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?

Ventricular function and dyssynchrony in children with a functional single right ventricle using real time three‐dimensional echocardiography after fontan operation

The Progress and Significance of QRS Duration by Electrocardiography in Hypoplastic Left Heart Syndrome

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