Simultaneous Volumetric and Functional Assessment of the Right Ventricle in Hypoplastic Left Heart Syndrome After Fontan Palliation, Utilizing 3-Dimensional Speckle-Tracking Echocardiography

Abstract

Background: Right ventricular (RV) volumetric and functional assessments are both crucial for the management of patients with hypoplastic left heart syndrome (HLHS). 3-dimensional echocardiography (3DE) for volume measurements and 2D speckle-tracking echocardiography (2D-STE) for strain analysis are performed separately. 3D-STE is capable of evaluating those parameters simultaneously and providing principal strain (PS), unifying the concepts of myofiber orientation and contraction into a single, maximal contractile direction. However, the application of 3D-STE to HLHS has not been studied and so became the aim of our study. Methods and Results: 64 HLHS patients after Fontan palliation underwent 3D-STE analysis measuring RV end-diastolic volume index (EDVi), ejection fraction (EF), global PS (GPS), global circumferential strain (GCS), and global longitudinal strain (GLS). Volume measurements were compared between 3D-STE and 3DE, and strains were compared between 3D-and 2D-STE. EDVi and EF showed strong correlations between 3D-STE and 3DE (r=0.93 and 0.87, respectively). GCS and GLS showed moderate correlations between 3D-and 2D-STE (r=0.65 and 0.61, respectively). GPS showed highest magnitude and excellent correlation with EF (r=−0.95). Conclusions:Simultaneous volumetric and functional assessment by 3D-STE was a useful method in this HLHS cohort. PS is a promising parameter for evaluating the RV function of HLHS, which could be useful during longitudinal follow-up.

Assessing Univentricular Function in Adult Fontan Using 3D Echocardiography

“…Therefore, 3D echocardiography could provide an alternative method to CMR for the serial assessment of the size and function of the single ventricle. In a study of paediatric Fontan patients, it has been shown similar to this study that 2D and 3D volumes correlate strongly with each other, in addition to 3D-derived speckle tracking analysis suggesting 3D derived ejection fraction reflects cardiac mechanics as well [18]. CMR is only available in specialised centres and some patients are unable to undergo CMR due to claustrophobia or are contraindicated.…”

Unchanged right ventricular strain in repaired tetralogy of Fallot after pulmonary valve replacement with radial long-axis cine magnetic resonance images

“…We acknowledge that our strain analysis with radially reconstructed long-axis cine CMR was based on the original in-house algorithm. Although measurements of RV PS with echocardiography using commercial software have been reported 17 , 18 , no software has been established for RV PS for CMR. We considered that the values of PS, GCS, and GLS were clinically reasonable and reliable in the study populations.…”

Right Ventricular Longitudinal Strain in Patients with Heart Failure

“…Three-dimensional STE analysis for the right ventricle is shown in Figure 2 . Its accuracy and reproducibility in assessing RV function have been confirmed in patients with transplanted hearts, pulmonary hypertension, and hypoplastic left heart syndrome after Fontan palliation [ 63 , 67 , 68 , 69 ]. Moreover, we previously investigated the feasibility and accuracy of 3D-STE for the quantification of RVLS in comparison with CMR imaging in a large number of study populations with a wide variety of RVEF and cardiovascular pathologies, and found that the 3D-RVFWLS values correlated better than 2D-RVFWLS values with CMR values (0.85 vs. 0.64) with smaller bias and narrower limits of agreement.…”