Two-Dimensional Global Longitudinal Strain Rate Is a Preload Independent Index of Systemic Right Ventricular Contractility in Hypoplastic Left Heart Syndrome Patients After Fontan Operation

Abstract

Background— Assessment of systemic right ventricular (RV) function in patients with hypoplastic left heart syndrome is important during long-term follow-up after Fontan repair. Traditional echocardiographic parameters to evaluate systolic ventricular function are affected by loading conditions. The only generally accepted load-independent parameter of systolic function, end systolic elastance ( E es ), requires invasive catheterization. Therefore, we sought to determine if parameters obtained by 2-dimensional speckle tracking (2DST) were affected by acute changes in preload and correlated with catheterization-derived indices of RV contractility in hypoplastic left heart syndrome patients after Fontan palliation. Methods and Results— Fifty-two patients with hypoplastic left heart syndrome (median age, 6.6; range 2.9–22.2 years) were prospectively enrolled to have echocardiography and conductance catheter studies performed simultaneously. We compared traditional echo, 2-dimensional speckle tracking and catheterization-derived parameters during different states of preload at baseline and during dobutamine infusion. Global longitudinal strain (S) showed a tendency to decrease with preload reduction, whereas global longitudinal strain rate (SR) did not change (S: −17.7±3.4% versus −16.9±3.8%, P =0.08; SR: −1.30±0.29 versus −1.34±0.34 s −1 , P =0.3). S did not change with dobutamine infusion (−17.7±3.4% versus −18.4±3.9%, P =0.24), whereas SR increased significantly (−1.30±0.29 versus −2.26±0.49 s −1 , P <0.001). RV E es correlated with SR ( r s = −0.47, P <0.001), but not with S ( r s =0.07, P =0.5) or other echocardiographic parameters. Conclusions— In contrast to S, SR was not affected by preload and correlated with E es of the systemic RV. SR may be a useful noninvasive surrogate of RV contractility and suitable for follow-up of patients with hypoplastic left heart syndrome after Fontan palliation.

Right ventricular morphology and function following stage I palliation with a modified Blalock–Taussig shunt versus a right ventricle-to-pulmonary artery conduit

“…As would be expected from the altered RV geometry, systemic RV strain values were markedly different from those of the healthy LV [10] and healthy RV [21]. Values were comparable to existing measures taken in those with HLHS via echocardiography [22]. The altered strain in the RVPA conduit group may represent dyskinesia caused by the scar, though increased volume loading from pulmonary regurgitation through the RVPA conduit may also play a role.…”

Two‐Dimensional Speckle Tracking of the Fetal Heart

“…[44][45][46][47][48][49][50][51][52][53][54][55][56] Figure 14. Transverse and longitudinal strain using the 17-segment model.…”

“…Deformation analysis has been evaluated in fetuses with twin-twin transfusion syndrome, intrauterine growth restriction, maternal diabetes, as well as other fetal conditions. [44][45][46][47][48][49][50][51][52][53][54][55][56] The problem with its adaptation by the ultrasound community of noncardiologists is that the software used for analysis was initially only available on dedicated cardiovascular ultrasound machines that were not generally available to the broader medical community (Table 1). With changes in imaging technology and the availability of machine-independent software, it is now possible to obtain DICOM clips from virtually any ultrasound machine used for fetal imaging and to analyze deformation of the fetal heart with machine-independent software (Table 1).…”

Ventricular function and vascular dimensions after Norwood and hybrid palliation of hypoplastic left heart syndrome

“…The observed heart rate and stroke volume dependency of the strain values clearly support this suggestion. In contrast, RV strain rate is known to be a more load-independent parameter of RV function in patients with HLHS as recently shown in an invasive conductance-catheter study 22. The lower systolic strain rate values in the hybrid group therefore reflects impaired intrinsic RV myocardial performance that cannot be explained by altered loading conditions due to anaesthesia.…”