Serial Strain Analysis Identifies Hypoplastic Left Heart Syndrome Infants at Risk for Cardiac Morbidity and Mortality: A Pilot Study

Colquitt, John L.; Loar, Robert W.; Morris, Shaine A.; Feagin, Douglas K.; Sami, Sarah; Pignatelli, Ricardo H.

doi:10.1016/j.echo.2019.01.006

Cited by 36 publications

(17 citation statements)

References 27 publications

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“…Several studies have correlated SV function to prognosis: qualitative SV dysfunction pre-Norwood [ 36 ], lower longitudinal and circumferential strain in the interstage period [ 37 ], and smaller tissue Doppler annular displacement pre-Stage II [ 38 ]. These issues have been associated with a shorter transplant-free survival in patients with HLHS.…”

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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“…Many geometric and nongeometric indices of systolic and diastolic function have been studied in this population, each with distinct advantages and limitations 5–13 . While these markers of single ventricle function have been well described, to date there have been no pediatric studies evaluating their longitudinal trajectory after Fontan operation.…”

Section: Introductionmentioning

confidence: 99%

Longitudinal changes in echocardiographic measures of ventricular function after Fontan operation

et al. 2020

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Background While numerous indices have been developed in an attempt to quantify ventricular function in patients with single ventricle heart disease after Fontan, there are little data on how these parameters change over time. Methods A retrospective observational study was performed of individuals who underwent Fontan operation at Children's Hospital of Philadelphia (CHOP) in 2006 and 2007. Measurements of fractional area change (FAC), tricuspid annular planar systolic excursion (TAPSE), myocardial performance index (MPI), systolic to diastolic (s/d) ratio, and myocardial strain and strain rate were made offline. A composite outcome of protein‐losing enteropathy (PLE), plastic bronchitis, transplant, or death was created, and change in function was compared between those who did and those who did not meet the outcome. Results There were 312 echocardiograms from 40 unique patients (75% male, 55% dominant right ventricle). The aggregate mean values for most assessed parameters were worse than what would be expected for a healthy age‐matched population. The global longitudinal strain rate increased (worsened) by 0.014 (1/s) per year (P = .02), and the global circumferential strain rate increased (worsened) by 0.011 (1/s) per year (P = .01). There was no difference in the rate of change of ventricular function in the 6 patients who met the composite endpoint vs those who did not. Conclusion This study demonstrates that global longitudinal strain rate and global circumferential strain rate decrease over 10 years following Fontan operation. These measures of ventricular performance may be early signs of cardiac dysfunction that predate more obvious echocardiographic signs of deterioration.

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“…1,2 Longitudinal studies demonstrate a decrease in strain over time as a particularly important marker of risk in young patients. 3,4 Inspection of the strain values reported in the hypoplastic left heart syndrome population reveals differences across patient age, palliation stage or strategy, 1,2,[5][6][7][8] and anatomic subtype 9,10 using either vendor-specific software (ie, GE EchoPac (EP), Philips 11,12 ) or vendor-independent software (ie, TomTec (TT)). 4,10 Several software-related factors influence deformation quantification and can be sources of variation and inconsistencies.…”

mentioning

confidence: 99%

“…Worse (less negative) longitudinal strain in this patient population is associated with poor clinical outcomes. 1,2 Longitudinal studies demonstrate a decrease in strain over time as a particularly important marker of risk in young patients. 3,4 Inspection of the strain values reported in the hypoplastic left heart syndrome population reveals differences across patient age, palliation stage or strategy, 1,2,[5][6][7][8] and anatomic subtype 9,10 using either vendor-specific software (ie, GE EchoPac (EP), Philips 11,12 ) or vendor-independent software (ie, TomTec (TT)).…”

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confidence: 99%

Single systemic right ventricle longitudinal strain: Intravendor reproducibility and intervendor agreement in children

et al. 2021

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Longitudinal strain derived from grayscale 2D speckle-tracking echocardiography is emerging as a useful clinical tool in the assessment of single, systemic right ventricle (sRV) function, as it provides an objective and reproducible measurement of myocardial performance. In pediatric patients with single right ventricles, there are no established thresholds that define abnormal, though longitudinal strain that is more negative (or higher in absolute number) reflects greater myocardial motion inferred as better function.

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Serial Strain Analysis Identifies Hypoplastic Left Heart Syndrome Infants at Risk for Cardiac Morbidity and Mortality: A Pilot Study

Cited by 36 publications

References 27 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?

Longitudinal changes in echocardiographic measures of ventricular function after Fontan operation

Single systemic right ventricle longitudinal strain: Intravendor reproducibility and intervendor agreement in children

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