A preliminary comparison of two‐dimensional speckle tracking echocardiography and pressure–volume loop analysis in patients with Fontan physiology: The role of ventricular morphology

Abstract

Objective Speckle tracking echocardiography (STE) may be a useful modality for assessing ventricular performance in patients with single ventricle physiology. However, STE’s ability to accurately assess ventricular performance in this population is unknown. The objective of this study was to perform a preliminary comparison of STE measures of myocardial deformation to reference standard measures of function derived from pressure–volume loop (PVL) analysis. Design This was a secondary analysis of a prospective study investigating PVLs in patients with Fontan physiology. PVLs were recorded using microconductance catheters. PVL indices included end-systolic elastance (Ees), arterial elastance (Ea), ventriculo-arterial coupling (Ea/Ees), and the isovolumic relaxation time constant (tau). Patients were included if they had an echocardiogram within 1 month of their catheterization. STE was performed retrospectively using vendor independent software. Results Seventeen patients had echocardiograms available for analysis, 12 were right ventricular (RV) dominant. The median age was 8 years (IQR 5–17 years). Circumferential strain (r=−.72, P≤.01) and strain rate (r=−.61, P=.04) correlated with Ea/Ees in those with RV-dominant morphology. Longitudinal strain rate correlated with Ees in those with LV-dominant morphology (r=−.98, P≤.01). Longitudinal EDSR correlated with tau in those with LV-dominant morphology (r=−.90, P=.04). Conclusions In this limited sample, circumferential measures of deformation correlated with PVL measures better in patients with RV morphology, while longitudinal measures correlated better with PVL measures in patients with LV morphology. Further validation and investigation into the clinical usefulness of these measures are warranted.

Diastolic Heart Failure in Patients With the Fontan Circulation

“…Averin et al demonstrated that patients with Fontan circulation with borderline end-diastolic pressures at baseline respond to a volume load with evidence of significant diastolic dysfunction (end-diastolic pressures >15 mm Hg) (Figure 3C). Data from speckle tracking echocardiographic imaging have been shown to correlate with results of invasively measured pressure-volume loops, which suggests that accurate tracking of diastolic function might be achieved noninvasively . However, further work is needed to experimentally validate noninvasive methods of computing pressure-volume loops and associated quantitative measures in the single-ventricle population.…”

Management of People With a Fontan Circulation: a Cardiac Society of Australia and New Zealand Position statement

“…Nevertheless, there are significant limitations to its use in this population that arise from poor image quality, especially in older patients, and reliance on geometric indices of ventricular size and function, which are not designed for heterogeneous ventricular morphologies [32]. Newer measures of diastolic and systolic performance may be helpful in people with a Fontan circulation [51][52][53][54][55][56][57][58]. Deformation assessment is the most promising, but small studies to date have not shown consistent results or prognostic correlation [52,56,[59][60][61].…”

Single ventricular strain measures correlate with peak oxygen consumption in children and adolescents with Fontan circulation

“…A growing body of literature has explored single ventricular strain analysis across various ventricular morphologies in the Fontan population. 10,11,26,27 Ventricular global longitudinal strain has been correlated with exercise capacity in other CHD populations 28 and predicts poor outcomes in Fontan populations. 8,29,30 However, only one other study Rato and colleagues studied the relationship between novel speckle tracking derived assessment of global longitudinal strain and peak oxygen consumption.…”