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

Abstract

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.

Integrated Clinical and Magnetic Resonance Imaging Assessments Late After Fontan Operation

“…The endocardial border of the combined ventricular unit including both the dominant and hypoplastic ventricle was manually traced (19), and the software automatically tracked the border throughout the cardiac cycle (Figure 1). If tracking was judged to be suboptimal by visual inspection, the endocardial border was retraced until satisfactory tracking was accomplished.…”

Imaging of complications following Fontan circulation in children — diagnosis and surveillance

“…6 ). Reliable quantification of the function is difficult in single-ventricle physiology because of the complex diverse anatomy and lack of normal reference values and functional indexes for a non-left ventricular systemic ventricle [ 28 ].

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“…Cardiac MR with anatomical and functional investigation should be performed every 2–3 years and CT angiography when clinically indicated [ 47 ]. Cardiac catheterization is recommended once every 10 years or when clinically indicated [ 28 ].…”

“…8) [37][38][39]. MR strain analysis and feature tracking are, like echocardiography, newer techniques that are garnering more attention to how diastolic and systolic function perform in the single-ventricle circulation and also in pediatric patients [28,34].…”

Quantification of Myocardial Deformation Applying CMR-Feature-Tracking—All About the Left Ventricle?

“…In patients with hypoplastic left heart syndrome, CMR-FT-based RV strain assessments showed impaired deformation in those with globular/ miniaturised LV morphology compared to patients with absent /slit -l ike LV morphol ogy, represent ing a dyssynchronous septal deformation and encouraging closer monitoring and lower thresholds to start HF medications in these collectives [121]. Since LVEF is less suitable in functionally univentricular hearts, CMR-FT deformation analyses of both the dominant and the hypoplastic ventricle revealed significantly worse strain values than measurements of the dominant ventricle alone representing more accurate assessments of the total ventricular performance [122]. Moreover, despite a preserved LVEF impaired CMR-FT-based strain parameters in patients with repaired coarctation of the aorta identified adverse long-term consequences of surgical or transcatheter interventional therapy attributing CMR-FT deformation indices an important role for the clinical follow-up of these patients [123].…”