Classic-Pattern Dyssynchrony Is Associated with Outcome in Patients with Fontan Circulation

Røsner, Assami; McElhinney, Doff B.; Diab, Simone Goa; Friedberg, Mark K.

doi:10.1016/j.echo.2022.01.012

Cited by 8 publications

(8 citation statements)

References 42 publications

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“…The mean or median age ranged from 20 to 41 years. The study of Rösner et al included also adolescents (median 20, [12-70] years), 9 and we made this specific exception, since this was the only study assessing the prognostic value of strain in patients with a single-ventricle circulation after a Fontan palliation. It was deemed to provide important unique information relevant for the ACHD cardiologist.…”

Section: Resultsmentioning

confidence: 99%

“…Of these patients, 39% had a univentricular morphological LV, 33% a univentricular, morphological right ventricle, 6% a univentricular but morphological undefinable ventricle, and 22% had a biventricular system. The dominant ventricles were analysed for longitudinal (apical long‐axis) and circumferential strain (parasternal short axis) 9 . Furthermore, the strain curve plots were also visually inspected for the extent and synchronicity of contraction.…”

Section: Resultsmentioning

confidence: 99%

“…The dominant ventricles were analysed for longitudinal (apical long-axis) and circumferential strain (parasternal short axis). 9 Furthermore, the strain curve plots were also visually inspected for the extent and synchronicity of contraction. The classic dyssynchrony (CPD) pattern, where earlier systolic contraction of one of the walls results in an opposite-directed outward stretch and subsequent rebound of the opposing wall, and thereby limiting the total extent of contraction of the first contracting wall, was identified in 15% of the patients.…”

Section: Miscellaneousmentioning

confidence: 99%

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Prognostic significance of echocardiographic deformation imaging in adult congenital heart disease

van Rosendael,

Taha,

Guglielmo

et al. 2024

Eur J Clin Investigation

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BackgroundDue to medical and surgical advancements, the population of adult patients with congenital heart disease (ACHD) is growing. Despite successful therapy, ACHD patients face structural sequalae, placing them at increased risk for heart failure and arrhythmias. Left and right ventricular function are important predictors for adverse clinical outcomes. In acquired heart disease it has been shown that echocardiographic deformation imaging is of superior prognostic value as compared to conventional parameters as ejection fraction. However, in adult congenital heart disease, the clinical significance of deformation imaging has not been systematically assessed and remains unclear.MethodsAccording to the Preferred Reporting Items for Systematic Reviews checklist, this systematic review included studies that reported on the prognostic value of echocardiographic left and/or right ventricular strain by 2‐dimensional speckle tracking for hard clinical end‐points (death, heart failure hospitalization, arrhythmias) in the most frequent forms of adult congenital heart disease.ResultsIn total, 19 contemporary studies were included. Current data shows that left ventricular and right ventricular global longitudinal strain (GLS) predict heart failure, transplantation, ventricular arrhythmias and mortality in patients with Ebstein's disease and tetralogy of Fallot, and that GLS of the systemic right ventricle predicts heart failure and mortality in patients post atrial switch operation or with a congenitally corrected transposition of the great arteries.ConclusionsDeformation imaging can potentially impact the clinical decision making in ACHD patients. Further studies are needed to establish disease‐specific reference strain values and ranges of impaired strain that would indicate the need for medical or structural intervention.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Miscellaneousmentioning

confidence: 99%

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Prognostic significance of echocardiographic deformation imaging in adult congenital heart disease

van Rosendael,

Taha,

Guglielmo

et al. 2024

Eur J Clin Investigation

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“…The dyssynchronous segments showed an early shortening (“flash”), followed by a systolic stretching; while segments with conduction delay showed early stretching, followed by delayed contraction. A recent study ( 91 ) demonstrated this dyssynchronous pattern was associated with a worse outcome in patients with Fontan circulation. 3D echocardiography allows the evaluation of univentricular dimensions and function without geometrical assumptions.…”

Section: Univentricular Heartmentioning

confidence: 98%

The mechanics of congenital heart disease: from a morphological trait to the functional echocardiographic evaluation

Avesani,

Sabatino,

Borrelli

et al. 2024

Front. Cardiovasc. Med.

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Advances in pediatric cardiac surgery have resulted in a recent growing epidemic of children and young adults with congenital heart diseases (CHDs). In these patients, congenital defects themselves, surgical operations and remaining lesions may alter cardiac anatomy and impact the mechanical performance of both ventricles. Cardiac function significantly influences outcomes in CHDs, necessitating regular patient follow-up to detect clinical changes and relevant risk factors. Echocardiography remains the primary imaging method for CHDs, but clinicians must understand patients' unique anatomies as different CHDs exhibit distinct anatomical characteristics affecting cardiac mechanics. Additionally, the use of myocardial deformation imaging and 3D echocardiography has gained popularity for enhanced assessment of cardiac function and anatomy. This paper discusses the role of echocardiography in evaluating cardiac mechanics in most significant CHDs, particularly its ability to accommodate and interpret the inherent anatomical substrate in these conditions.

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“…This pattern was characterised by an early shortening of the dyssynchronous segments (‘flash’), followed by systolic stretching; while, on the contrary, segments with a conduction delay showed early stretching, followed by delayed contraction. Among the different functional parameters, the presence of electromechanical dyssynchrony was the strongest predictor for mortality and heart transplantation [ 20 ].…”

Section: Echocardiography In Fontan Circulationmentioning

confidence: 99%

Role of Cardiovascular Imaging in the Follow-Up of Patients with Fontan Circulation

et al. 2022

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Since its first description in 1971, the Fontan procedure and its modifications have led to a substantial improvement in the survival rates of patients with a variety of types of complex Congenital Heart Disease (CHD) characterised by the presence of a single, dominant ventricle. However, despite the significant improvement of the prognosis over the years, Fontan patients are still exposed to several cardiovascular and systemic complications. It is, therefore, important to fully understand the pitfalls hidden behind a Fontan anatomy and the potential predictors of ventricular failure. Cardiovascular imaging plays a key role in this context, allowing for the early identification of complications with important prognostic implications. Echocardiography remains the first-line imaging modality for serial evaluation of Fontan patients. However, there is a growing role of cardiovascular magnetic resonance and cardiac computed tomography from pre-operative assessment to longitudinal follow-up. The aim of this paper will be to provide a comprehensive overview of the role, strengths, and weaknesses of each imaging modality in the assessment of congenital cardiac conditions palliated with the Fontan procedure.

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Classic-Pattern Dyssynchrony Is Associated with Outcome in Patients with Fontan Circulation

Cited by 8 publications

References 42 publications

Prognostic significance of echocardiographic deformation imaging in adult congenital heart disease

Prognostic significance of echocardiographic deformation imaging in adult congenital heart disease

The mechanics of congenital heart disease: from a morphological trait to the functional echocardiographic evaluation

Role of Cardiovascular Imaging in the Follow-Up of Patients with Fontan Circulation

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