Single Ventricular Torsional Mechanics After Fontan Palliation and Their Impact on Outcomes

Gearhart, Addison; Bassi, Sunakshi; Liddle, David; Thatte, Nikhil; Harrington, Jamie K.; Rathod, Rahul H.; Ghelani, Sunil J.

doi:10.1016/j.jacadv.2023.100360

JACC: Advances

2023

DOI: 10.1016/j.jacadv.2023.100360

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Single Ventricular Torsional Mechanics After Fontan Palliation and Their Impact on Outcomes

Addison Gearhart

Sunakshi Bassi

David Liddle

et al.

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Cited by 3 publications

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“…In this issue of JACC: Advances , the work by Gearhart et al 5 examines torsional mechanics after total cavopulmonary anastomosis, the Fontan procedure, for single ventricle physiology. The research group characterized ventricular mechanics by cardiac magnetic resonance imaging in the single ventricle patient compared to patients with normal circulation and to determine if some ventricular characteristics correlated with adverse events such as heart transplantation or death.…”

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confidence: 99%

Is Our Assessment of Ventricular Function Now Twisted?

Punn

2023

JACC: Advances

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mentioning

confidence: 99%

Is Our Assessment of Ventricular Function Now Twisted?

Punn

2023

JACC: Advances

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Echocardiographic strain imaging in the pediatric heart: clinical value and utility in decision making

Martinez,

Ganieva,

Harrington

2024

Current Opinion in Pediatrics

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Purpose of review Speckle tracking echocardiography (STE)-derived measures of myocardial mechanics, referred to herewithin as strain measurements, directly assess myocardial contractility and provide a nuanced assessment of ventricular function. This review provides an overview of strain measurements and their current clinical value and utility in decision making in pediatric cardiology. Recent findings Strain measurements are advancing understanding of how cardiac dysfunction occurs in children with acquired and congenital heart disease (CHD). Global strain measurements can detect early changes in cardiac function and are reliable methods of serially monitoring systolic function in children. Global strain measurements are increasingly reported in echocardiographic assessment of ventricular function alongside ejection fraction. Research is increasingly focused on how strain measurements can help improve clinical management, risk stratification, and prognostic insight. Although more research is needed, preliminary studies provide hope that there will be clinical benefit for strain in pediatric cardiology management. Summary Strain measurements provide a more detailed assessment of ventricular function than conventional measures of echocardiographic functional assessment. Strain measurements are increasingly being used to advance understanding of normal and abnormal myocardial contractility, to increase sensitivity to detect early cardiac dysfunction, and to improve prognostic management in children with acquired and CHD.

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Ventricular dyssynchrony late after the Fontan operation is associated with decreased survival

Gearhart,

Bassi,

Rathod

et al. 2023

Journal of Cardiovascular Magnetic Resonance

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Background Ventricular dyssynchrony and its relationship to clinical outcomes is not well characterized in patients following Fontan palliation. Methods Single-center retrospective analysis of cardiac magnetic resonance (CMR) imaging of patients with a Fontan circulation and an age-matched healthy comparison cohort as controls. Feature tracking was performed on all slices of a ventricular short-axis cine stack. Circumferential and radial strain, strain rate, and displacement were measured; and multiple dyssynchrony metrics were calculated based on timing of these measurements (including standard deviation of time-to-peak, maximum opposing wall delay, and maximum base-to-apex delay). Primary endpoint was a composite measure including time to death, heart transplant or heart transplant listing (D/HTx). Results A total of 503 cases (15 y; IQR 10, 21) and 42 controls (16 y; IQR 11, 20) were analyzed. Compared to controls, Fontan patients had increased dyssynchrony metrics, longer QRS duration, larger ventricular volumes, and worse systolic function. Dyssynchrony metrics were higher in patients with right ventricular (RV) or mixed morphology compared to those with LV morphology. At median follow-up of 4.3 years, 11% had D/HTx. Multiple risk factors for D/HTx were identified, including RV morphology, ventricular dilation, dysfunction, QRS prolongation, and dyssynchrony. Ventricular dilation and RV morphology were independently associated with D/HTx. Conclusions Compared to control LVs, single right and mixed morphology ventricles in the Fontan circulation exhibit a higher degree of mechanical dyssynchrony as evaluated by CMR-FT. Dyssynchrony indices correlate with ventricular size and function and are associated with death or need for heart transplantation. These data add to the growing understanding regarding factors that can be used to risk-stratify patients with the Fontan circulation.

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Single Ventricular Torsional Mechanics After Fontan Palliation and Their Impact on Outcomes

Cited by 3 publications

References 29 publications

Is Our Assessment of Ventricular Function Now Twisted?

Is Our Assessment of Ventricular Function Now Twisted?

Echocardiographic strain imaging in the pediatric heart: clinical value and utility in decision making

Ventricular dyssynchrony late after the Fontan operation is associated with decreased survival

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