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Abdulkarim M, Loomba RS, Zaidi SJ, Li Y, Wilson M, Roberson D, Farias JS, Flores S, Villarreal EG, Husayni T. Echocardiographic Strain to Predict Need for Transplant or Mortality in Fontan Patients with Hypoplastic Left Heart Syndrome. Pediatr Cardiol 2024; 45:1475-1484. [PMID: 37204486 DOI: 10.1007/s00246-023-03187-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Accepted: 05/14/2023] [Indexed: 05/20/2023]
Abstract
Despite recent advances, hypoplastic left heart syndrome (HLHS) patients subsequent to the Fontan still have significant morbidity and mortality. Some require heart transplant due to systemic ventricular dysfunction. Limited data exist on timing for transplant referral. This study aims to correlate systemic ventricular strain by echocardiography to transplant-free survival. HLHS patients who had Fontan palliation at our institution were included. Patients were divided into: 1) Required transplant or experienced mortality (composite end point); 2) Did not require transplant or survived. For those who experienced the composite endpoint, the last echocardiogram prior to the composite outcome was used, while for those who did not experience the composite endpoint the last echocardiogram obtained was used. Several qualitative and quantitative parameters were analyzed with focus on strain parameters. Ninety-five patients with HLHS Fontan palliation were identified. Sixty-six had adequate images and eight (12%) experienced transplant or mortality. These patients had greater myocardial performance index by flow Doppler (0.72 versus 0.53, p = 0.01), higher systolic/diastolic duration ratio (1.51 versus 1.13, p = 0.02), lower fractional area change (17.65 versus 33.99, p < 0.01), lower global longitudinal strain (GLS) (-8.63 versus - 17.99, p < 0.01), lower global longitudinal strain rate (GLSR) (- 0.51 versus - 0.93, p < 0.01), lower global circumferential strain (GCS) (-6.68 versus -18.25, p < 0.01), and lower (GCSR) global circumferential strain rate (-0.45 versus -1.01, p < 0.01). ROC analysis demonstrated predictive value for GLS - 7.6 (71% sensitive, 97% specific, AUC 81%), GLSR -0.58 (71% sensitive, 88% specific, AUC 82%), GCS - 10.0 (86% sensitive, 91% specific, AUC 82%), and GCSR -0.85 (100% sensitive, 71% specific, AUC 90%). GLS and GCS can help predict transplant-free survival in patients with hypoplastic left heart syndrome having undergone Fontan palliation. Higher strain values (closer to zero) may be a helpful tool in determining when transplant evaluation is warranted in these patients.
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Affiliation(s)
- Mubeena Abdulkarim
- Advocate Children's Heart Institute, Advocate Children's Hospital, Oak Lawn, IL, USA
- Department of Pediatric Cardiology, Nicklaus Children's Hospital, Miami, FL, USA
| | - Rohit S Loomba
- Advocate Children's Heart Institute, Advocate Children's Hospital, Oak Lawn, IL, USA
| | - S Javed Zaidi
- Advocate Children's Heart Institute, Advocate Children's Hospital, Oak Lawn, IL, USA
- Department of Pediatric Cardiology, Carle BroMenn Medical Center, Normal, IL, USA
| | - Yi Li
- Advocate Children's Heart Institute, Advocate Children's Hospital, Oak Lawn, IL, USA
| | - Melissa Wilson
- Advocate Children's Heart Institute, Advocate Children's Hospital, Oak Lawn, IL, USA
| | - David Roberson
- Advocate Children's Heart Institute, Advocate Children's Hospital, Oak Lawn, IL, USA
| | | | - Saul Flores
- Division of Critical Care, Texas Children's Hospital, Baylor College of Medicine, Houston, TX, USA
| | - Enrique G Villarreal
- Tecnologico de Monterrey, Escuela de Medicina Y Ciencias de La Salud, Monterrey, Nuevo Leon, Mexico.
| | - Tarek Husayni
- Advocate Children's Heart Institute, Advocate Children's Hospital, Oak Lawn, IL, USA
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Gearhart A, Bassi S, Rathod RH, Beroukhim RS, Lipsitz S, Gold MP, Harrild DM, Dionne A, Ghelani SJ. Ventricular dyssynchrony late after the Fontan operation is associated with decreased survival. J Cardiovasc Magn Reson 2023; 25:66. [PMID: 37986080 PMCID: PMC10658858 DOI: 10.1186/s12968-023-00984-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Accepted: 11/12/2023] [Indexed: 11/22/2023] Open
Abstract
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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Affiliation(s)
- Addison Gearhart
- Department of Cardiology, Boston Children's Hospital, 300 Longwood Ave, Boston, MA, 02115, USA.
- Department of Pediatrics, Harvard Medical School, Boston, MA, USA.
| | - Sunakshi Bassi
- Department of Pediatrics, Harvard Medical School, Boston, MA, USA
| | - Rahul H Rathod
- Department of Cardiology, Boston Children's Hospital, 300 Longwood Ave, Boston, MA, 02115, USA
- Department of Pediatrics, Harvard Medical School, Boston, MA, USA
| | - Rebecca S Beroukhim
- Department of Cardiology, Boston Children's Hospital, 300 Longwood Ave, Boston, MA, 02115, USA
- Department of Pediatrics, Harvard Medical School, Boston, MA, USA
| | - Stuart Lipsitz
- Department of Cardiology, Boston Children's Hospital, 300 Longwood Ave, Boston, MA, 02115, USA
- Division of General Internal Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | | | - David M Harrild
- Department of Cardiology, Boston Children's Hospital, 300 Longwood Ave, Boston, MA, 02115, USA
- Department of Pediatrics, Harvard Medical School, Boston, MA, USA
| | - Audrey Dionne
- Department of Cardiology, Boston Children's Hospital, 300 Longwood Ave, Boston, MA, 02115, USA
- Department of Pediatrics, Harvard Medical School, Boston, MA, USA
| | - Sunil J Ghelani
- Department of Cardiology, Boston Children's Hospital, 300 Longwood Ave, Boston, MA, 02115, USA
- Department of Pediatrics, Harvard Medical School, Boston, MA, USA
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Goudar S, Forsha D, White DA, Sherman A, Shirali G. Single ventricular strain measures correlate with peak oxygen consumption in children and adolescents with Fontan circulation. Cardiol Young 2023; 33:1136-1142. [PMID: 35864813 DOI: 10.1017/s1047951122002323] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
INTRODUCTION Children with a single ventricle post-Fontan palliation are at increased risk of poor outcomes with peak oxygen consumption acting as a surrogate outcome marker. The purpose of this study is to evaluate the relationship between peak oxygen consumption and echocardiographic measures of ventricular function and deformation, including ventricular global longitudinal strain and dyssynchrony, in children and adolescents following Fontan palliation. METHODS Patients (age 8-21 years) with single ventricle post-Fontan palliation were prospectively recruited and participated in an echocardiogram, including views optimised for two-dimensional speckle tracking, and a cardiopulmonary exercise test on a cycle ergometer to maximal volitional fatigue. RESULTS Thirty-eight patients (mean age 13.7 ± 2.3 years) post-Fontan palliation had either a single left ventricular (n = 20), single right ventricular (n = 14), or biventricular (n = 4) morphology. Peak oxygen consumption (24.9 ± 5.6 ml/kg/minute) was correlated with global longitudinal strain (r = -0.435, p = 0.007), a strain discoordination time to peak index (r = -0.48, p = 0.003), and the presence of an electro-mechanical dyssynchrony strain pattern (p = 0.008). On multivariate regression modelling, these three variables were associated with peak oxygen consumption independently of age and sex. The single right ventricular group had evidence of possible diastolic dysfunction by E/e' compared to the single left ventricular and biventricular groups (p = 0.001). CONCLUSIONS Strain analysis measures are correlated with peak oxygen consumption in this cohort of children, adolescents, and young adults following Fontan palliation, suggesting that ventricular mechanics may influence the efficiency of the Fontan circulation.
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Affiliation(s)
- Suma Goudar
- Children's National Heart Institute, Department of Pediatrics, Washington, DC, USA
| | - Daniel Forsha
- Children's Mercy Hospital, Ward Family Heart Center, Department of Pediatrics, Kansas City, MO, USA
- University of Missouri-Kansas City, Department of Pediatrics, Kansas City, MO, USA
| | - David A White
- Children's Mercy Hospital, Ward Family Heart Center, Department of Pediatrics, Kansas City, MO, USA
- University of Missouri-Kansas City, Department of Pediatrics, Kansas City, MO, USA
| | - Ashley Sherman
- Children's Mercy Hospital, Department of Biostatistics, Kansas City, MO, USA
| | - Girish Shirali
- Children's Mercy Hospital, Ward Family Heart Center, Department of Pediatrics, Kansas City, MO, USA
- University of Missouri-Kansas City, Department of Pediatrics, Kansas City, MO, USA
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Balasubramanian S, Smith SN, Srinivasan P, Tacy TA, Hanley FL, Chen S, Wright GE, Peng LF, Punn R. Longitudinal Assessment of Right Ventricular Function in Hypoplastic Left Heart Syndrome. Pediatr Cardiol 2021; 42:1394-1404. [PMID: 33987707 DOI: 10.1007/s00246-021-02624-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Accepted: 04/21/2021] [Indexed: 12/31/2022]
Abstract
Overall survival of patients with hypoplastic left heart syndrome (HLHS) has shown continued improvement. Right ventricular (RV) dysfunction, in the long term, adversely affects prognosis in these patients. This study examines changes in echocardiographic markers of RV function in a longitudinal cohort. We retrospectively reviewed patients with HLHS managed at our institution from 7/1994 to 1/2016. Follow-up included surgical and clinical data, and echocardiographic measures. Measures of RV function preceding and following all three stages of single ventricular palliation were collected. Freedom from transplant-free survival was assessed by Kaplan-Meier analysis. Multivariable associations with time to death or transplant were explored using the Cox proportional hazards model. A total of 120 patients with HLHS were identified. Norwood operation was performed in all patients. The probability of survival for the cohort was 71 ± 4.4%, 69 ± 4.5% and 66 ± 4.7% at 1, 2 and 5 years respectively after stage I Norwood operation. RV fractional area change (FAC), compared to post-Norwood was decreased at all subsequent stages with the greatest change noted post-superior cavo-pulmonary shunt from 40.7 ± 9.3% to 31.1 ± 8.3% (p < 0.001). Similarly, tricuspid valve annular systolic excursion (TAPSE) Z-score declined from -2.9 ± 1.3 to -9.7 ± 1.3 (p < 0.001) with a decrement at every stage of evaluation. In comparison to patients with post-Norwood RV FAC >35% and TAPSE Z-score > -5, patients with RV FAC ≤ 35% and TAPSE Z-score ≤ -5 had a significantly lower transplant-free survival (p < 0.0001). In patients with HLHS undergoing staged palliation, decrement in RV function manifests longitudinally. Post-Norwood RV FAC and TAPSE Z-score appear to be early markers of poor outcome in this population.
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Affiliation(s)
- Sowmya Balasubramanian
- Division of Cardiology, Department of Pediatrics, Stanford Medical School, 750 Welch Road, Stanford, CA, USA. .,Division of Pediatric Cardiology, 1540 East Hospital Drive, Ann Arbor, MI, 48109, USA.
| | - Shea N Smith
- Division of Cardiology, Department of Pediatrics, Stanford Medical School, 750 Welch Road, Stanford, CA, USA
| | | | - Theresa A Tacy
- Division of Cardiology, Department of Pediatrics, Stanford Medical School, 750 Welch Road, Stanford, CA, USA
| | - Frank L Hanley
- Division of Cardiology, Department of Pediatrics, Stanford Medical School, 750 Welch Road, Stanford, CA, USA
| | - Sharon Chen
- Division of Cardiology, Department of Pediatrics, Stanford Medical School, 750 Welch Road, Stanford, CA, USA
| | - Gail E Wright
- Division of Cardiology, Department of Pediatrics, Stanford Medical School, 750 Welch Road, Stanford, CA, USA
| | - Lynn F Peng
- Division of Cardiology, Department of Pediatrics, Stanford Medical School, 750 Welch Road, Stanford, CA, USA
| | - Rajesh Punn
- Division of Cardiology, Department of Pediatrics, Stanford Medical School, 750 Welch Road, Stanford, CA, USA
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Zhong SW, Zhang YQ, Chen LJ, Zhang ZF, Wu LP, Hong WJ. Ventricular function and dyssynchrony in children with a functional single right ventricle using real time three-dimensional echocardiography after fontan operation. Echocardiography 2021; 38:1218-1227. [PMID: 34156720 DOI: 10.1111/echo.15148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Revised: 06/06/2021] [Accepted: 06/11/2021] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND This study aimed to evaluate the feasibility and clinical value of real time three-dimensional echocardiography (RT-3DE) for assessing ventricular systolic dysfunction and dyssynchrony in children with an functional single right ventricle (FSRV) having undergone the Fontan procedure. METHODS Twenty-five children with an FSRV and 25 healthy children were enrolled in our study. RV volume analysis was performed compared with magnetic resonance imaging (MRI) as the reference standard in FSRV patients. The patients were divided into wide and narrow QRS interval groups. Global and regional functions of the RV in three compartments (inflow, body, and outflow) were compared between FSRV and control subjects, including RV systolic dyssynchrony indices of maximal difference of time to minimal volume (Tmsv-Dif), standard deviation of time to minimal volume (Tmsv-SD), maximal difference of time to minimal volume corrected by R-R interval (Tmsv-Dif%), and standard deviation of time to minimal volume corrected by R-R interval (Tmsv-SD%). RESULTS RT-3DE measurements were significantly lower than MRI measurements for RV-EDV, RV-ESV, RV-SV, and RVEF (p < 0.01).Compared with controls, patients with an FRSV had significantly higher dyssynchrony indices and significantly lower global EF in both narrow QRS interval and wide QRS interval groups. Tmsv-SD% was shown to be most strongly correlated with MRI-RVEF (r = -.570, p = 0.003). CONCLUSIONS RT-3DE tended to underestimate RV ventricular volume in children with FSRV. Children with an FSRV and either a wide or narrow QRS interval had reduced ventricular function and higher dyssynchrony than normal subjects. Worsening RV dyssynchrony is associated with overall decline in function after the Fontan operation.
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Affiliation(s)
- Shu-Wen Zhong
- International Department, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Yu-Qi Zhang
- Department of Pediatric Cardiology, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Li-Jun Chen
- Department of Pediatric Cardiology, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Zhi-Fang Zhang
- Department of Pediatric Cardiology, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Lan-Ping Wu
- Department of Pediatric Cardiology, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Wen-Jing Hong
- Department of Pediatric Cardiology, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
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Mah K, Serrano Lomelin J, Colen T, Tham EB, Lin L, Eckersley L, Smallhorn JF, Becher H, Mertens L, Khoo NS. Right Ventricular Remodeling in Hypoplastic Left Heart Syndrome is Minimally Impacted by Cardiopulmonary Bypass: A Comparison of Norwood vs. Hybrid. Pediatr Cardiol 2021; 42:294-301. [PMID: 33040260 DOI: 10.1007/s00246-020-02482-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2020] [Accepted: 09/29/2020] [Indexed: 10/23/2022]
Abstract
Right ventricular (RV) remodeling in hypoplastic left heart syndrome (HLHS) begins prenatally and continues through staged palliations. However, it is unclear if the most marked observed remodeling post-Norwood is secondary to cardiopulmonary bypass (CPB) exposure or if it is an adaptation intrinsic to the systemic RV. This study aims to determine the impact of CPB on RV remodeling in HLHS. Echocardiograms of HLHS survivors undergoing stage 1 Norwood (n = 26) or Hybrid (n = 20) were analyzed at pre- and post-stage 1, pre- and post-bidirectional cavo-pulmonary anastomosis (BCPA), and pre-Fontan. RV fractional area change (FAC), vector velocity imaging for longitudinal & derived circumferential deformation (global radial shortening (GRS) = peak radial displacement/end-diastolic diameter), and deformation ratio (longitudinal/ circumferential) were assessed. Both groups had similar age, clinical status and functional parameters pre-stage 1. No difference in RV size and sphericity at any stage between groups. RVFAC was normal (> 35%) throughout for both groups. Both Norwood and Hybrid patients had increased GRS (p = 0.0001) post-stage 1 and corresponding unchanged longitudinal strain, resulting in decreased deformation ratio (greater relative RV circumferential contraction), p = 0.0001. Deformation ratio remained decreased in both groups in subsequent stages. Irrespective of timing of the first CPB exposure, both Norwood and Hybrid patients underwent similar RV remodeling, with relative increase in circumferential to longitudinal contraction soon after stage 1 palliation. The observed RV remodeling in HLHS survivors were minimally impacted by CPB.
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Affiliation(s)
- Kandice Mah
- Division of Pediatric Cardiology, Stollery Children's Hospital, 8440 112 St NW, unit 4C2.36, Edmonton, AB, T6G2B7, Canada
| | - Jesus Serrano Lomelin
- Division of Pediatric Cardiology, Stollery Children's Hospital, 8440 112 St NW, unit 4C2.36, Edmonton, AB, T6G2B7, Canada
| | - Timothy Colen
- Division of Pediatric Cardiology, Stollery Children's Hospital, 8440 112 St NW, unit 4C2.36, Edmonton, AB, T6G2B7, Canada
| | - Edythe B Tham
- Division of Pediatric Cardiology, Stollery Children's Hospital, 8440 112 St NW, unit 4C2.36, Edmonton, AB, T6G2B7, Canada
| | - Lily Lin
- Division of Pediatric Cardiology, Stollery Children's Hospital, 8440 112 St NW, unit 4C2.36, Edmonton, AB, T6G2B7, Canada
| | - Luke Eckersley
- Division of Pediatric Cardiology, Stollery Children's Hospital, 8440 112 St NW, unit 4C2.36, Edmonton, AB, T6G2B7, Canada
| | - Jeffrey F Smallhorn
- Division of Pediatric Cardiology, Stollery Children's Hospital, 8440 112 St NW, unit 4C2.36, Edmonton, AB, T6G2B7, Canada
| | - Harald Becher
- Mazankowski Alberta Heart Institute, Alberta Health Services, 11220 83 Ave NW, Edmonton, AB, T6G 2B7, Canada
| | - Luc Mertens
- Labatt Family Heart Centre, The Hospital for Sick Children, 555 University Ave, Toronto, ON, M5G1X8, Canada
| | - Nee Scze Khoo
- Division of Pediatric Cardiology, Stollery Children's Hospital, 8440 112 St NW, unit 4C2.36, Edmonton, AB, T6G2B7, Canada.
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Vincenti M, Qureshi MY, Niaz T, Seisler DK, Nelson TJ, Cetta F. Loss of Ventricular Function After Bidirectional Cavopulmonary Connection: Who Is at Risk? Pediatr Cardiol 2020; 41:1714-1724. [PMID: 32780223 PMCID: PMC7695669 DOI: 10.1007/s00246-020-02433-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Accepted: 08/04/2020] [Indexed: 11/17/2022]
Abstract
Decline of single ventricle systolic function after bidirectional cavopulmonary connection (BDCPC) is thought to be a transient phenomenon. We analyzed ventricular function after BDCPC according to ventricular morphology and correlated this evolution to long-term prognosis. A review from Mayo Clinic databases was performed. Visually estimated ejection fraction (EF) was reported from pre-BDCPC to pre-Fontan procedure. The last cardiovascular update was collected to assess long-term prognosis. A freedom from major cardiac event survival curve and a risk factor analysis were performed. 92 patients were included; 52 had left ventricle (LV) morphology and 40 had right ventricle (RV) morphology (28/40 had hypoplastic left heart syndrome (HLHS)). There were no significant differences in groups regarding BDCPC procedure or immediate post-operative outcome. EF showed a significant and relevant decrease from baseline to discharge in the HLHS group: 59 ± 4% to 49 ± 7% or - 9% (p < 0.01) vs. 58 ± 3% to 54 ± 6% or - 4% in the non-HLHS RV group (p = 0.04) and 61 ± 4% to 60 ± 4% or - 1% in the LV group (p = 0.14). Long-term recovery was the least in the HLHS group: EF prior to Fontan 54 ± 2% vs. 56 ± 6% and 60 ± 4%, respectively (p < 0.01). With a median follow-up of 8 years post-BDCPC, six patients had Fontan circulation failure, four died, and three had heart transplantation. EF less than 50% at hospital discharge after BDCPC was strongly correlated to these major cardiac events (HR 3.89; 95% Cl 1.04-14.52). Patients with HLHS are at great risk of ventricular dysfunction after BDCPC. This is not a transient phenomenon and contributes to worse prognosis.
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Affiliation(s)
- Marie Vincenti
- Todd and Karen Wanek Program for Hypoplastic Left Heart Syndrome, Rochester, MN, USA
| | - M Yasir Qureshi
- Todd and Karen Wanek Program for Hypoplastic Left Heart Syndrome, Rochester, MN, USA.
- Division of Pediatric Cardiology, Mayo Clinic, 200 First Street S.W, Rochester, MN, 55905, USA.
| | - Talha Niaz
- Division of Pediatric Cardiology, Mayo Clinic, 200 First Street S.W, Rochester, MN, 55905, USA
| | - Drew K Seisler
- Todd and Karen Wanek Program for Hypoplastic Left Heart Syndrome, Rochester, MN, USA
| | - Timothy J Nelson
- Todd and Karen Wanek Program for Hypoplastic Left Heart Syndrome, Rochester, MN, USA
- Division of Pediatric Cardiology, Mayo Clinic, 200 First Street S.W, Rochester, MN, 55905, USA
| | - Frank Cetta
- Todd and Karen Wanek Program for Hypoplastic Left Heart Syndrome, Rochester, MN, USA
- Division of Pediatric Cardiology, Mayo Clinic, 200 First Street S.W, Rochester, MN, 55905, USA
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Haller C, Friedberg MK, Laflamme MA. The role of regenerative therapy in the treatment of right ventricular failure: a literature review. Stem Cell Res Ther 2020; 11:502. [PMID: 33239066 PMCID: PMC7687832 DOI: 10.1186/s13287-020-02022-w] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Accepted: 11/09/2020] [Indexed: 01/13/2023] Open
Abstract
Right ventricular (RV) failure is a commonly encountered problem in patients with congenital heart disease but can also be a consequence of left ventricular disease, primary pulmonary hypertension, or RV-specific cardiomyopathies. Improved survival of the aforementioned pathologies has led to increasing numbers of patients suffering from RV dysfunction, making it a key contributor to morbidity and mortality in this population. Currently available therapies for heart failure were developed for the left ventricle (LV), and there is clear evidence that LV-specific strategies are insufficient or inadequate for the RV. New therapeutic strategies are needed to address this growing clinical problem, and stem cells show significant promise. However, to properly evaluate the prospects of a potential stem cell-based therapy for RV failure, one needs to understand the unique pathophysiology of RV dysfunction and carefully consider available data from animal models and human clinical trials. In this review, we provide a comprehensive overview of the molecular mechanisms involved in RV failure such as hypertrophy, fibrosis, inflammation, changes in energy metabolism, calcium handling, decreasing RV contractility, and apoptosis. We also summarize the available preclinical and clinical experience with RV-specific stem cell therapies, covering the broad spectrum of stem cell sources used to date. We describe two different scientific rationales for stem cell transplantation, one of which seeks to add contractile units to the failing myocardium, while the other aims to augment endogenous repair mechanisms and/or attenuate harmful remodeling. We emphasize the limitations and challenges of regenerative strategies, but also highlight the characteristics of the failing RV myocardium that make it a promising target for stem cell therapy.
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Affiliation(s)
- Christoph Haller
- Division of Cardiovascular Surgery, The Labatt Family Heart Centre, The Hospital for Sick Children, Toronto, Canada.,Department of Surgery, University of Toronto, Toronto, Canada.,McEwen Stem Cell Institute, Peter Munk Cardiac Centre, University Health Network, Toronto, Canada
| | - Mark K Friedberg
- Division of Cardiology, The Labatt Family Heart Centre, The Hospital for Sick Children, Toronto, Canada.,Department of Pediatrics, University of Toronto, Toronto, Canada.,Department of Physiology, University of Toronto, Toronto, Canada
| | - Michael A Laflamme
- McEwen Stem Cell Institute, Peter Munk Cardiac Centre, University Health Network, Toronto, Canada. .,Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Canada. .,McEwen Stem Cell Institute, Toronto Medical Discovery Tower, 101 College Street, Toronto, Ontario, M5G 1L7, Canada.
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9
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Tsuda T, Kernizan D, Del Grippo E, Thacker D, Kharouf R, Srivastava S. Echocardiographic assessment of ventricular function: Conventional and advanced technologies and their clinical applications. PROGRESS IN PEDIATRIC CARDIOLOGY 2020. [DOI: 10.1016/j.ppedcard.2020.101269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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10
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Alphonso N, Angelini A, Barron DJ, Bellsham-Revell H, Blom NA, Brown K, Davis D, Duncan D, Fedrigo M, Galletti L, Hehir D, Herberg U, Jacobs JP, Januszewska K, Karl TR, Malec E, Maruszewski B, Montgomerie J, Pizzaro C, Schranz D, Shillingford AJ, Simpson JM. Guidelines for the management of neonates and infants with hypoplastic left heart syndrome: The European Association for Cardio-Thoracic Surgery (EACTS) and the Association for European Paediatric and Congenital Cardiology (AEPC) Hypoplastic Left Heart Syndrome Guidelines Task Force. Eur J Cardiothorac Surg 2020; 58:416-499. [DOI: 10.1093/ejcts/ezaa188] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Affiliation(s)
- Nelson Alphonso
- Queensland Pediatric Cardiac Service, Queensland Children’s Hospital, University of Queensland, Brisbane, QLD, Australia
| | - Annalisa Angelini
- Department of Cardiac, Thoracic Vascular Sciences and Public health, University of Padua Medical School, Padua, Italy
| | - David J Barron
- Department of Cardiovascular Surgery, Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | | | - Nico A Blom
- Division of Pediatric Cardiology, Department of Pediatrics, Leiden University Medical Center, Leiden, Netherlands
| | - Katherine Brown
- Paediatric Intensive Care, Heart and Lung Division, Great Ormond Street Hospital NHS Foundation Trust, London, UK
| | - Deborah Davis
- Department of Anesthesiology, Thomas Jefferson University, Philadelphia, PA, USA
- Nemours Cardiac Center, A.I. Du Pont Hospital for Children, Wilmington, DE, USA
| | - Daniel Duncan
- Nemours Cardiac Center, A.I. Du Pont Hospital for Children, Wilmington, DE, USA
| | - Marny Fedrigo
- Department of Cardiac, Thoracic Vascular Sciences and Public Health, University of Padua Medical School, Padua, Italy
| | - Lorenzo Galletti
- Unit of Pediatric Cardiac Surgery, Bambino Gesù Children's Hospital, Rome, Italy
| | - David Hehir
- Division of Cardiology, Children’s Hospital of Philadelphia, Philadelphia, PA, USA
| | - Ulrike Herberg
- Department of Pediatric Cardiology, University Hospital Bonn, Bonn, Germany
| | | | - Katarzyna Januszewska
- Division of Pediatric Cardiac Surgery, University Hospital Muenster, Westphalian-Wilhelm’s-University, Muenster, Germany
| | | | - Edward Malec
- Division of Pediatric Cardiac Surgery, University Hospital Muenster, Westphalian-Wilhelm’s-University, Muenster, Germany
| | - Bohdan Maruszewski
- Department for Pediatric Cardiothoracic Surgery, Children's Memorial Health Institute, Warsaw, Poland
| | - James Montgomerie
- Department of Anesthesia, Birmingham Children’s Hospital, Birmingham, UK
| | - Christian Pizzaro
- Nemours Cardiac Center, A.I. Du Pont Hospital for Children, Wilmington, DE, USA
- Department of Surgery, Thomas Jefferson University, Philadelphia, PA, USA
| | - Dietmar Schranz
- Pediatric Heart Center, Justus-Liebig University, Giessen, Germany
| | - Amanda J Shillingford
- Division of Cardiology, Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
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11
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Karikari Y, Abdulkarim M, Li Y, Loomba RS, Zimmerman F, Husayni T. The Progress and Significance of QRS Duration by Electrocardiography in Hypoplastic Left Heart Syndrome. Pediatr Cardiol 2020; 41:141-148. [PMID: 31722042 DOI: 10.1007/s00246-019-02237-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2019] [Accepted: 10/30/2019] [Indexed: 01/06/2023]
Abstract
Patients with hypoplastic left heart syndrome (HLHS) are now surviving through to Fontan palliation and beyond, however, with increased morbidity and mortality. Prolonged QRSd has become one of the predictors of morbidity and mortality in certain congenital heart diseases. There is limited data characterizing the QRSd in patients with HLHS. We aimed to describe the changes in QRSd at various times during the lifetime and to evaluate whether QRSd correlates with a higher risk of developing a composite endpoint of heart failure, heart transplant, or death. We conducted a retrospective chart review of patients with HLHS who survived Fontan palliation. QRSd was measured on ECGs at various stages pre- and postsurgical palliations and subsequently at 5 year intervals. Patients with a composite endpoint were compared to those without. A total of 89 patients were included in the final analysis. The QRSd increased significantly with time from 68.7 ± 9.0 ms prior to Norwood to 91.0 ± 14.0 ms immediately following Fontan and 104.7 ± 13.6 ms 15 years after Fontan (p < 0.001). The composite endpoint was observed in 28 patients (31.4%). The time trends of QRSd differ so that the patients having the composite endpoint experienced a greater increase in QRSd over time (p = 0.009). Ever having a QRSd of 120 ms or more predicted the composite endpoint with 93% specificity. The area under the curve of the receiver operator curve analysis was 0.596. A Cox regression analysis demonstrated that QRS duration > 120 ms was independently related to a greater frequency of composite endpoint and this was confirmed by a Kaplan-Meier analysis (p = 0.011). This study unveils a novel relationship between QRSd of 120 ms or more with the composite endpoint. Despite the low sensitivity, this finding on a routine surveillance ECG could help identify HLHS Fontan patients at risk for heart failure, heart transplant, or death.
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Affiliation(s)
- Yaa Karikari
- Division of Cardiology, Advocate Children's Hospital, 4440 95th street, Chicago, IL, 60453, USA
| | - Mubeena Abdulkarim
- Division of Cardiology, Advocate Children's Hospital, 4440 95th street, Chicago, IL, 60453, USA
| | - Yi Li
- Division of Cardiology, Advocate Children's Hospital, 4440 95th street, Chicago, IL, 60453, USA
| | - Rohit S Loomba
- Division of Cardiology, Advocate Children's Hospital, 4440 95th street, Chicago, IL, 60453, USA.
| | - Frank Zimmerman
- Division of Cardiology, Advocate Children's Hospital, 4440 95th street, Chicago, IL, 60453, USA
| | - Tarek Husayni
- Division of Cardiology, Advocate Children's Hospital, 4440 95th street, Chicago, IL, 60453, USA
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12
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Huntgeburth M, Germund I, Geerdink LM, Sreeram N, Udink Ten Cate FEA. Emerging clinical applications of strain imaging and three-dimensional echocardiography for the assessment of ventricular function in adult congenital heart disease. Cardiovasc Diagn Ther 2019; 9:S326-S345. [PMID: 31737540 DOI: 10.21037/cdt.2018.11.08] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Management of congenital heart disease (CHD) in adults (ACHD) remains an ongoing challenge due to the presence of residual hemodynamic lesions and development of ventricular dysfunction in a large number of patients. Echocardiographic imaging plays a central role in clinical decision-making and selection of patients who will benefit most from catheter interventions or cardiac surgery.. Recent advances in both strain imaging and three-dimensional (3D)-echocardiography have significantly contributed to a greater understanding of the complex pathophysiological mechanisms involved in CHD. The aim of this paper is to provide an overview of emerging clinical applications of speckle-tracking imaging and 3D-echocardiography in ACHD with focus on functional assessment, ventriculo-ventricular interdependency, mechanisms of electromechanical delay, and twist abnormalities in adults with tetralogy of Fallot (TOF), a systemic RV after atrial switch repair or in double discordance ventricles, and in those with a Fontan circulation.
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Affiliation(s)
- Michael Huntgeburth
- Center for Grown-ups with congenital heart disease (GUCH), Clinic III for Internal Medicine, Department of Cardiology, Heart Center, University Hospital of Cologne, Germany
| | - Ingo Germund
- Department of Pediatric Cardiology, Heart Center, University Hospital of Cologne, Germany
| | - Lianne M Geerdink
- Academic Center for Congenital Heart Disease (ACAHA), Department of Pediatric Cardiology, Amalia Children's Hospital, Radboud University Medical Center, Nijmegen.,Division of Pediatric Cardiology, Department of Pediatrics, Sophia Children's Hospital, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Narayanswami Sreeram
- Department of Pediatric Cardiology, Heart Center, University Hospital of Cologne, Germany
| | - Floris E A Udink Ten Cate
- Academic Center for Congenital Heart Disease (ACAHA), Department of Pediatric Cardiology, Amalia Children's Hospital, Radboud University Medical Center, Nijmegen.,Division of Pediatric Cardiology, Department of Pediatrics, Sophia Children's Hospital, Erasmus Medical Center, Rotterdam, The Netherlands
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13
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Forsha D, Li L, Joseph N, Kutty S, Friedberg MK. Association of left ventricular size with regional right ventricular mechanics in Hypoplastic Left Heart Syndrome. Int J Cardiol 2019; 298:66-71. [PMID: 31402159 DOI: 10.1016/j.ijcard.2019.07.090] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Revised: 07/19/2019] [Accepted: 07/30/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND In Hypoplastic Left Heart Syndrome (HLHS), RV dysfunction is associated with poor outcomes. However, the effect of varying LV size on regional RV mechanics and outcome has not been studied. METHODS Twenty newborns (0-7 days) with HLHS had pre-stage 1 and pre-stage 2 echocardiograms prospectively protocoled for strain analysis of the apical 4-chamber view. RV longitudinal strain was analyzed, and LV size was classified as diminutive (no visible LV chamber) or moderate size (visible LV chamber). Clinical outcome was reported as alive vs death or transplant (D-TP) at final clinical follow-up (pre-stage 3). Groups were compared with t-test, Fisher's Exact, and ANOVA tests as appropriate. RESULTS At pre-stage 1, infants with a diminutive LV (7/20, 35%) vs a moderately hypoplastic LV (13/20, 65%) did not have significantly different global RV strain (-18.4 ± 2.6% vs -18.8 ± 3.2%; p = 0.83). However, basal septal strain was significantly diminished in the moderately hypoplastic LV group vs the diminutive LV group (-4.4 ± 6.0% vs -14.7 ± 3.3%; p < 0.005). There was severely diminished septal strain in nearly all (11/13) of the moderately hypoplastic group. At the pre-stage II echo, global RV strain between groups remained similar (p = 0.76) as did the diminished septal strain in the moderate LV group (p = 0.86). The moderately hypoplastic LV group had worse clinical outcomes (6/13 D-TP vs 0/7 D-TP; p = 0.05). CONCLUSIONS In this small HLHS cohort, diminished septal strain leading to asymmetric RV mechanics may be associated with poor outcomes in those with larger LV/septal size.
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Affiliation(s)
- Daniel Forsha
- Division of Cardiology, Ward Family Heart Center, Children's Mercy Hospital, Kansas City, MO, United States of America.
| | - Ling Li
- Division of Pediatric Cardiology, University of Nebraska Medical Center, Children's Hospital and Medical Center, Omaha, NE, United States of America.
| | - Navya Joseph
- Division of Pediatric Cardiology, University of Nebraska Medical Center, Children's Hospital and Medical Center, Omaha, NE, United States of America.
| | - Shelby Kutty
- Division of Pediatric Cardiology, University of Nebraska Medical Center, Children's Hospital and Medical Center, Omaha, NE, United States of America.
| | - Mark K Friedberg
- Department of Cardiology, Labatt Family Heart Centre, Hospital for Sick Children, Toronto, ON, Canada; Department of Pediatrics, University of Toronto, Toronto, ON, Canada.
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14
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Right Ventricular Mechanical Dyssynchrony in Hypoplastic Left Heart Syndrome: Correlation with Systolic Function and QRS Duration. Pediatr Cardiol 2019; 40:934-942. [PMID: 30895330 DOI: 10.1007/s00246-019-02091-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Accepted: 03/13/2019] [Indexed: 10/27/2022]
Abstract
The single right ventricle (RV) in hypoplastic left heart syndrome (HLHS) often develops systolic dysfunction with time and this affects prognosis. Mechanical dyssynchrony has been reported in HLHS but has not consistently correlated with systolic function or electrical dyssynchrony. The aims of this study were to assess the relationship between RV mechanical dyssynchrony, RV systolic function, and QRS duration on surface electrocardiography. We hypothesized that surface QRS duration would not be an adequate indicator of mechanical dyssynchrony compared with dyssynchrony parameters. Retrospective analysis of echocardiograms of patients with HLHS divided into preserved vs reduced RV function. We measured two RV function parameters: (1) fractional area change (FAC) and (2) global longitudinal strain (RVGLS). We measured two dyssynchrony parameters: (1) the standard deviation of the time to peak strain for 9 segments (tPS-9) and (2) time difference between the earliest and latest time to peak strain (RV dyssynchrony index or RVDI) both corrected for R-R interval. We also measured the QRS duration from surface EKG. Mechanical dyssynchrony parameters were compared to both RV systolic function and to QRS duration. 41 patients with HLHS were identified: 21 had preserved function and 20 had reduced function defined by a FAC < 35%. The reduced function group had a significantly lower mean FAC and RVGLS. RVDI was higher in the dysfunction group and had a modest correlation with FAC (r = 0.48) and RVGLS (r = 0.57). tPS-9 was longer in the dysfunction group and had a modest correlation with FAC (r = 0.45) and RVGLS (r = 0.57). QRS duration was longer in the dysfunction group and had a modest correlation with FAC (r = 0.56) and RVGLS (r = 0.56). The weakest correlations were between QRS duration and tPS-9 (r = 0.32) and QRS duration and RVDI (r = 0.10). RV dysfunction measured by FAC was associated with mechanical dyssynchrony measured by increased RVDI and tPS-9. QRS duration was longer in the group with dysfunction but did not correlate with directly measured mechanical dyssynchrony. This may have potential implications for cardiac resynchronization therapy in univentricular patients as assessed by mechanical dyssynchrony parameters rather than QRS duration alone.
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15
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Serial Assessment of Right Ventricular Strain in Hypoplastic Left Heart Syndrome: Deformation Imaging in Deformed Hearts. J Am Soc Echocardiogr 2019; 32:651-654. [DOI: 10.1016/j.echo.2019.03.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2019] [Indexed: 02/02/2023]
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16
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Abstract
Cardiac resynchronization therapy (CRT) is an electrical therapy to resolve an electrical problem. Any method to predict CRT response must specifically reflect the electrical substrate. Time-to-peak dyssynchrony is too unspecific for prediction of response because dyssynchrony by this approach may reflect the presence of scar or fibrosis even in the absence of conduction delay. New methods are based on the actual physiology of activation delay-induced heart failure (HF) and are superior to time-to-peak methods in predicting CRT response. Time-to-peak dyssynchrony may be used for prognosis in HF patients without signs of delayed ventricular activation and for monitoring CRT response.
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Affiliation(s)
- Bhupendar Tayal
- Department of Cardiology, Aalborg University Hospital, Hobrovej 18-22, Aalborg 9100, Denmark
| | - Peter Sogaard
- Department of Cardiology, Aalborg University Hospital, Hobrovej 18-22, Aalborg 9100, Denmark.
| | - Niels Risum
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, Copenhagen 2100, Denmark
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17
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Chen LJ, Zhang YQ, Bao SF, Zhong SW, Sun AM, Zhang ZF. Velocity vector imaging for the assessment of segmental ventricular function in children with a single right ventricle after cavopulmonary anastomosis. Curr Med Res Opin 2019; 35:203-210. [PMID: 29611724 DOI: 10.1080/03007995.2018.1460337] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
OBJECTIVE Ventricular function assessment is very important for the treatment and prognostic classification of children with a single right ventricle (SRV) after cavopulmonary anastomosis (CPA). However, unusual ventricular shapes can result in inaccurate measurements. The aim of this study was to evaluate velocity vector imaging (VVI) for assessing segmental ventricular function in children with SRV after CPA. METHODS Twenty-one children with SRV after CPA and 21 age- and sex-matched children with normal biventricular anatomy and function were included. The longitudinal velocity, displacement, strain and strain rate were measured in the two groups in six segments by VVI. The velocity, displacement, strain and strain rate of the SRVs were compared with max(dp/dt) measured during simultaneous cardiac catheterization in the SRV subjects. RESULTS The control group consisted of 13 males and 8 females (69% males) with a mean age of 6.7 ± 3.5 years and mean weight of 20.5 ± 6.5 kg, and the study group consisted of 13 males and 8 females with a mean age 6.7 ± 3.7 years and mean weight of 20.6 ± 6.8 kg. Age, weight and sex distribution were similar between the groups (all, p > .05). Strain and strain rate values in all six segments were significantly lower in the study group than in the control group (all, p < .05). The max(dp/dt) of the SRV was 522.84 ± 158.32 mmHg/s, and the strain rate of the basal segment at the rudimentary chamber correlated best with max(dp/dt) (r = 0.74, p < .01). CONCLUSIONS Segmental ventricular dysfunction was present in children with SRV after CPA, and it could be assessed using VVI.
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Affiliation(s)
- Li-Jun Chen
- a Department of Pediatric Cardiology , Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine , Shanghai , China
| | - Yu-Qi Zhang
- a Department of Pediatric Cardiology , Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine , Shanghai , China
| | - Sheng-Fang Bao
- a Department of Pediatric Cardiology , Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine , Shanghai , China
| | - Shu-Wen Zhong
- a Department of Pediatric Cardiology , Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine , Shanghai , China
| | - Ai-Min Sun
- b Department of Medical Imaging , Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine , Shanghai , China
| | - Zhi-Fang Zhang
- a Department of Pediatric Cardiology , Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine , Shanghai , China
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18
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Rösner A, Khalapyan T, Pedrosa J, Dalen H, McElhinney DB, Friedberg MK, Lui GK. Ventricular mechanics in adolescent and adult patients with a Fontan circulation: Relation to geometry and wall stress. Echocardiography 2018; 35:2035-2046. [DOI: 10.1111/echo.14169] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2018] [Revised: 09/21/2018] [Accepted: 09/24/2018] [Indexed: 01/30/2023] Open
Affiliation(s)
- Assami Rösner
- Department of Cardiology; Division of Cardiothoracic and Respiratory Medicine; University Hospital of North Norway; Tromsø Norway
| | - Tigran Khalapyan
- Department of Cardiothoracic Surgery; Stanford University School of Medicine; Stanford California
| | - João Pedrosa
- Department of Cardiovascular Sciences; K.U. Leuven; Leuven Belgium
| | - Håvard Dalen
- Department of Medicine; Levanger Hospital; Nord-Trøndelag Hospital Trust; Levanger Norway
- Department of Cardiology; St. Olav's University Hospital; Trondheim Norway
- Department of Circulation and Medical Imaging; Norwegian University of Science and Technology; Trondheim Norway
| | - Doff B. McElhinney
- Division of Pediatric Cardiology; Department of Pediatrics; Stanford University School of Medicine; Stanford California
| | - Mark K. Friedberg
- Division of Pediatric Cardiology; Hospital for Sick Children; Toronto Ontario Canada
| | - George K. Lui
- Division of Pediatric Cardiology; Department of Pediatrics; Stanford University School of Medicine; Stanford California
- Division of Cardiovascular Medicine; Department of Medicine; Stanford University School of Medicine; Stanford California
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19
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Rösner A, Khalapyan T, Dalen H, McElhinney DB, Friedberg MK, Lui GK. Classic-Pattern Dyssynchrony in Adolescents and Adults With a Fontan Circulation. J Am Soc Echocardiogr 2018; 31:211-219. [DOI: 10.1016/j.echo.2017.10.018] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2017] [Indexed: 11/25/2022]
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20
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Ruotsalainen HK, Pihkala J, Salminen J, Hornberger LK, Sairanen H, Ojala T. Initial shunt type at the Norwood operation impacts myocardial function in hypoplastic left heart syndrome†. Eur J Cardiothorac Surg 2017; 52:234-240. [DOI: 10.1093/ejcts/ezx102] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2016] [Accepted: 02/26/2017] [Indexed: 12/31/2022] Open
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21
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Ruotsalainen HK, Bellsham-Revell HR, Bell AJ, Pihkala JI, Ojala TH, Simpson JM. Right ventricular systolic function in hypoplastic left heart syndrome: A comparison of manual and automated software to measure fractional area change. Echocardiography 2017; 34:587-593. [PMID: 28191731 DOI: 10.1111/echo.13470] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Quantitative echocardiographic assessment of right ventricular function is important in children with hypoplastic left heart syndrome (HLHS). The aim of this study was to examine the repeatability of different echocardiographic techniques, both manual and automated, to measure fractional area change (FAC) in patients with HLHS and to correlate these measurements with magnetic resonance imaging (MRI)-derived ejection fraction (EF). METHODS Fifty-one children with HLHS underwent transthoracic echocardiography and cardiac MRI under the same general anesthetic as part of routine inter-stage assessment. FAC was measured from the apical four-chamber view using three different techniques: velocity vector imaging (VVI) (Syngo USWP 3.0; Siemens Healthineers), QLAB (Q-lab R 10.0; Philips Healthcare), and manual endocardial contour tracing (Xcelera, Philips Healthcare). Intra- and inter-observer variability was calculated using intra-class correlation coefficient (ICC). FAC was correlated with MRI EF calculated using a single standard method. RESULTS Fractional area change had a good correlation with MRI-derived EF with an R value for VVI, QLAB, and manual methods of .7, .6, and .4, respectively. Intra- and inter-observer variability for FAC was good for automated echocardiographic methods (ICC>.85) but worse for manual method particularly inter-observer variability of FAC and end-systolic area. Both automated techniques tended to produce higher FAC values compared with manual measurements (P<.001). CONCLUSION Automation improves the repeatability of FAC in HLHS. There are some differences between automated software in terms of correlation with MRI-derived EF. Measurement bias and wide limits of agreement mean that the same echocardiographic technique should be used during the follow-up of individual patients.
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Affiliation(s)
- Hanna K Ruotsalainen
- Department of Pediatric Cardiology, Children's Hospital, University Hospital of Helsinki and University of Helsinki, Helsinki, Finland.,Department of Pediatrics, Kuopio University Hospital, Kuopio, Finland
| | - Hannah R Bellsham-Revell
- Department of Congenital Heart Disease, Evelina London Children's Hospital, London, United Kingdom
| | - Aaron J Bell
- Department of Congenital Heart Disease, Evelina London Children's Hospital, London, United Kingdom
| | - Jaana I Pihkala
- Department of Pediatric Cardiology, Children's Hospital, University Hospital of Helsinki and University of Helsinki, Helsinki, Finland
| | - Tiina H Ojala
- Department of Pediatric Cardiology, Children's Hospital, University Hospital of Helsinki and University of Helsinki, Helsinki, Finland
| | - John M Simpson
- Department of Congenital Heart Disease, Evelina London Children's Hospital, London, United Kingdom
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22
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Echocardiography and magnetic resonance imaging based strain analysis of functional single ventricles: a study of intra- and inter-modality reproducibility. Int J Cardiovasc Imaging 2016; 32:1113-20. [DOI: 10.1007/s10554-016-0882-4] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2016] [Accepted: 03/18/2016] [Indexed: 11/27/2022]
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23
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Forsha D, Slorach C, Chen CK, Sherman A, Mertens L, Barker P, Kisslo J, Friedberg MK. Patterns of Mechanical Inefficiency in Pediatric Dilated Cardiomyopathy and Their Relation to Left Ventricular Function and Clinical Outcomes. J Am Soc Echocardiogr 2016; 29:226-36. [DOI: 10.1016/j.echo.2015.11.011] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2015] [Indexed: 01/04/2023]
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24
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Ruotsalainen H, Bellsham-Revell H, Bell A, Pihkala J, Ojala T, Simpson J. Right ventricular systolic function in hypoplastic left heart syndrome: a comparison of velocity vector imaging and magnetic resonance imaging. Eur Heart J Cardiovasc Imaging 2015; 17:687-92. [PMID: 26323279 DOI: 10.1093/ehjci/jev196] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2015] [Accepted: 07/14/2015] [Indexed: 11/13/2022] Open
Abstract
AIMS Velocity vector imaging (VVI) is an echocardiographic technique based on speckle tracking, which has been validated for the left ventricle (LV). It has not been validated to assess the systemic right ventricle (RV) in patients with hypoplastic left heart syndrome (HLHS). The aim of this study was to evaluate whether VVI measurements reliably reflect RV systolic function in patients with HLHS when compared with RV ejection fraction (EF) calculated using magnetic resonance imaging (MRI). METHODS AND RESULTS In this prospective study, 49 children with HLHS underwent transthoracic echocardiography and cardiac MRI under the same general anaesthetic as a part of routine assessment between the different stages of palliative surgery. Global RV fractional area change (FAC-VVI), strain (S), strain rate (SR), and peak systolic velocity (V) were analysed from the apical four-chamber view using the VVI technique. MRI-derived EF was calculated from a short-axis cine stack of images. Intra- and interobserver reproducibility was excellent for all VVI parameters (intraclass correlation coefficient >0.9). All VVI-derived parameters, except myocardial velocity, correlated with MRI-derived EF (FAC-VVI: R = 0.7, P < 0.001; S: R = -0.5, P < 0.001; SR: R = 0.5, P = 0.001, and V: R = 0.1, P = 0.4). CONCLUSIONS All VVI-derived parameters, except V, correlate with MRI-derived EF, with FAC being the best predictor of it. Reproducibility of all VVI parameters is excellent. VVI provides a useful tool for the follow-up of RV function during the staged treatment protocol for HLHS.
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Affiliation(s)
- Hanna Ruotsalainen
- Department of Pediatric Cardiology, Children's Hospital, University Hospital of Helsinki and University of Helsinki, Stenbackinkatu 11, PL 281, Helsinki 00029 HUS, Finland Department of Pediatrics, Kuopio University Hospital, Kuopio, Finland
| | | | - Aaron Bell
- Department of Congenital Heart Disease, Evelina London Children's Hospital, London, UK
| | - Jaana Pihkala
- Department of Pediatric Cardiology, Children's Hospital, University Hospital of Helsinki and University of Helsinki, Stenbackinkatu 11, PL 281, Helsinki 00029 HUS, Finland
| | - Tiina Ojala
- Department of Pediatric Cardiology, Children's Hospital, University Hospital of Helsinki and University of Helsinki, Stenbackinkatu 11, PL 281, Helsinki 00029 HUS, Finland
| | - John Simpson
- Department of Congenital Heart Disease, Evelina London Children's Hospital, London, UK
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25
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Materna O, Kubuš P, Janoušek J. Right ventricular resynchronization in a child with hypoplastic left heart syndrome. Heart Rhythm 2014; 11:2303-5. [DOI: 10.1016/j.hrthm.2014.09.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2014] [Indexed: 10/24/2022]
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26
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Stiver C, Nadorlik H, Nicholson L, Janevski I, Belfrage K, Wheller J, Cua CL. Diastolic Dyssynchrony Differences in Patients with Single Right Ventricles vs. Control Patients. CONGENIT HEART DIS 2014; 10:326-32. [DOI: 10.1111/chd.12234] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/02/2014] [Indexed: 11/30/2022]
Affiliation(s)
- Corey Stiver
- The Heart Center; Nationwide Children's Hospital; Columbus Ohio USA
| | - Holly Nadorlik
- The Heart Center; Nationwide Children's Hospital; Columbus Ohio USA
| | - Lisa Nicholson
- The Heart Center; Nationwide Children's Hospital; Columbus Ohio USA
| | - Ilija Janevski
- The Heart Center; Nationwide Children's Hospital; Columbus Ohio USA
| | | | - John Wheller
- The Heart Center; Nationwide Children's Hospital; Columbus Ohio USA
| | - Clifford L. Cua
- The Heart Center; Nationwide Children's Hospital; Columbus Ohio USA
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27
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Assessment of longitudinal systolic ventricular dysfunction and asynchrony using velocity vector imaging in children with a single right ventricle. Pediatr Cardiol 2014; 35:1147-54. [PMID: 24771060 DOI: 10.1007/s00246-014-0908-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2013] [Accepted: 03/26/2014] [Indexed: 11/27/2022]
Abstract
Assessment of ventricular dysfunction and asynchrony is very important in predicting the outcome for children with a single right ventricle. However, the assessment is inaccurate and subjective because of the unusual ventricular shape. This study aimed to evaluate the feasibility and clinical value of velocity vector imaging for assessing longitudinal systolic ventricular dysfunction and intraventricular asynchrony in children with a single right ventricle. The study enrolled 36 children with a single right ventricle and 36 age-matched children with a normal heart. Peak systolic velocity, peak displacement, strain, strain rate, time to peak systolic velocity, and time to peak systolic strain were measured via velocity vector imaging using the Siemens Sequoia C512 echocardiography instrument. The maximum positive rate of ventricular pressure change (Max [dp/dt]) was obtained by cardiac catheterization for all the children with a single right ventricle. In the children with a single right ventricle, the maximal temporal differences and the standard deviations of the times to peak systolic velocity and peak systolic strain were higher (P < 0.01) than in the children with a normal heart. Moreover, the strain and strain rate values were significantly lower in all six segments (P < 0.05). The strain rate of the basal segment adjacent to the rudimentary chamber correlated best with Max (dp/dt) (r = 0.86; P < 0.01). Longitudinal systolic dysfunction and intraventricular asynchrony could be assessed accurately using velocity vector imaging in children with a single right ventricle.
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Motonaga KS, Dubin AM. Cardiac resynchronization therapy for pediatric patients with heart failure and congenital heart disease: a reappraisal of results. Circulation 2014; 129:1879-91. [PMID: 24799504 DOI: 10.1161/circulationaha.113.001383] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Abstract
Significant improvement in survival of children with congenital cardiac malformations has resulted in an increasing population of adolescent and adult patients with congenital heart disease. Of the long-term cardiac problems, ventricular dysfunction remains an important issue of concern. Despite corrective or palliative repair of congenital heart lesions, the right ventricle, which may be the subpulmonary or systemic ventricular chamber, and the functional single ventricle are particularly vulnerable to functional impairment. Regular assessment of cardiac function constitutes an important aspect in the long-term follow up of patients with congenital heart disease. Echocardiography remains the most useful imaging modality for longitudinal monitoring of cardiac function. Conventional echocardiographic assessment has focused primarily on quantification of changes in ventricular size and blood flow velocities during the cardiac cycles. Advances in echocardiographic technologies including tissue Doppler imaging and speckle tracking echocardiography have enabled direct interrogation of myocardial deformation. In this review, the issues of ventricular dysfunction in congenital heart disease, conventional echocardiographic and novel myocardial deformation imaging techniques, and clinical applications of these techniques in the functional assessment of congenital heart disease are discussed.
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Affiliation(s)
- Yiu-Fai Cheung
- Division of Paediatric Cardiology, Department of Paediatrics and Adolescent Medicine, Queen Mary Hospital, The University of Hong Kong, Hong Kong, China
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Insights into the evolution of myocardial dysfunction in the functionally single right ventricle between staged palliations using speckle-tracking echocardiography. J Am Soc Echocardiogr 2013; 27:314-22. [PMID: 24373489 DOI: 10.1016/j.echo.2013.11.012] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2013] [Indexed: 11/21/2022]
Abstract
BACKGROUND The long-term prognosis of hypoplastic left heart syndrome is limited by progressive right ventricular dysfunction. The aim of this study was to determine the trends in single right ventricular systolic function between staged palliative surgeries using speckle-tracking and conventional echocardiography. METHODS There were 76 patients with functionally single right ventricles at the (1) pre-Norwood (n = 26), (2) pre-bidirectional cavopulmonary anastomosis (BCPA; n = 19), (3) pre-Fontan (n = 16), and (4) post-Fontan (n = 15) stages, compared with 30 controls of similar ages. Speckle-tracking-derived longitudinal and circumferential strain and strain rate, postsystolic strain index, and mechanical dyssynchrony index were compared with conventional measures of ventricular function. Differences between stages were analyzed using analysis of variance (P < .05). RESULTS Strain rate was highest at the pre-Norwood stage and decreased at the other stages (longitudinal P < .0001, circumferential P = .0002), as opposed to controls, in whom strain rate was maintained. Longitudinal strain was significantly decreased at the pre-BCPA stage compared with the pre-Norwood stage (P = .004), but circumferential strain was maintained, resulting in a corresponding decrease in the ratio of longitudinal to circumferential strain, which failed to resemble that of controls. Longitudinal (P = .003) and circumferential (P = .002) postsystolic strain indices were greatest at the pre-BCPA stage. CONCLUSIONS A decline in contractility occurred at the pre-BCPA stage. Although there was evidence of adaptation of the single right ventricle, this failed to resemble the normal left ventricle and may be insufficient to handle the chronic volume load or insult from previous surgery. These findings suggest an intrinsic inability of the single right ventricular myocardium to fully adapt to chronic systemic pressures.
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Stiver C, Gokhale J, Husain N, Nicholson L, Cordier J, Van Lente L, Holzer RJ, Cua CL. Catheterization diastolic pressures correlate with diastolic dyssynchrony in patients with single right ventricles. Echocardiography 2013; 31:370-4. [PMID: 24298988 DOI: 10.1111/echo.12373] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
INTRODUCTION Diastolic dyssynchrony has correlated with pulmonary capillary wedge pressures in patients with normal cardiac anatomy. No data exist in single right ventricle (sRV) patients. Goal of this study was to determine if diastolic dyssynchrony in sRV patients correlates with ventricular end-diastolic pressures (VEDP). METHODS Tissue Doppler imaging (TDI) and strain rate (SR) analysis of sRV patients undergoing catheterization were performed. Time interval from onset of QRS to peak TDI e'-wave was obtained. Differences in intervals were calculated: QRS (RV) - QRS (IVS) and QRS (RV) - QRS (LV). Time interval from onset of QRS to peak strain rate early diastolic wave (SRe) was obtained for the 6 segment model sRV. Standard deviation of the 6 SRe time intervals was calculated. Correlation of VEDP with timing intervals was analyzed. RESULTS Forty sRV patients were evaluated. Age was 2.8 ± 3.5 years. Catheterization VEDP of the sRV was 9.3 ± 3.9 mmHg (median 8 mmHg range 4-24 mmHg). QRS (RV) - QRS (IVS) was 22.3 ± 18.1 msec and QRS (RV) - QRS (LV) was 23.7 ± 19.0 msec. SRe standard deviation of the sRV was 61.6 ± 23.9 msec. There was no significant correlation with VEDP and QRS (RV) - QRS (IVS) (r = 0.1, P = NS) or with QRS (RV) - QRS (LV) (r = 0.2, P = NS). There was a significant correlation of VEDP with the SRe standard deviation value (r = 0.4, P < 0.05). CONCLUSION Diastolic dyssynchrony correlated with VEDP in patients with sRV physiology. Future studies are needed to determine the significance of these findings.
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Affiliation(s)
- Corey Stiver
- Heart Center, Nationwide Children's Hospital, Columbus, Ohio
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Marx GR, Shirali G, Levine JC, Guey LT, Cnota JF, Baffa JM, Border WL, Colan S, Ensing G, Friedberg MK, Goldberg DJ, Idriss SF, John JB, Lai WW, Lu M, Menon SC, Ohye RG, Saudek D, Wong PC, Pearson GD. Multicenter study comparing shunt type in the norwood procedure for single-ventricle lesions: three-dimensional echocardiographic analysis. Circ Cardiovasc Imaging 2013; 6:934-42. [PMID: 24097422 DOI: 10.1161/circimaging.113.000304] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND The Pediatric Heart Network's Single Ventricle Reconstruction (SVR) trial randomized infants with single right ventricles (RVs) undergoing a Norwood procedure to a modified Blalock-Taussig or RV-to-pulmonary artery shunt. This report compares RV parameters in the 2 groups using 3-dimensional echocardiography. METHODS AND RESULTS Three-dimensional echocardiography studies were obtained at 10 of 15 SVR centers. Of the 549 subjects, 314 underwent 3-dimensional echocardiography studies at 1 to 4 time points (pre-Norwood, post-Norwood, pre-stage II, and 14 months) for a total of 757 3-dimensional echocardiography studies. Of these, 565 (75%) were acceptable for analysis. RV volume, mass, mass:volume ratio, ejection fraction, and severity of tricuspid regurgitation did not differ by shunt type. RV volumes and mass did not change after the Norwood, but increased from pre-Norwood to pre-stage II (end-diastolic volume [milliliters]/body surface area [BSA](1.3), end-systolic volume [milliliters]/BSA(1.3), and mass [grams]/BSA(1.3) mean difference [95% confidence interval]=25.0 [8.7-41.3], 19.3 [8.3-30.4], and 17.9 [7.3-28.5], then decreased by 14 months (end-diastolic volume/BSA(1.3), end-systolic volume/BSA(1.3), and mass/BSA(1.3) mean difference [95% confidence interval]=-24.4 [-35.0 to -13.7], -9.8 [-17.9 to -1.7], and -15.3 [-22.0 to -8.6]. Ejection fraction decreased from pre-Norwood to pre-stage II (mean difference [95% confidence interval]=-3.7 [-6.9 to -0.5]), but did not decrease further by 14 months. CONCLUSIONS We found no statistically significant differences between study groups in 3-dimensional echocardiography measures of RV size and function, or magnitude of tricuspid regurgitation. Volume unloading was seen after stage II, as expected, but ejection fraction did not improve. This study provides insights into the remodeling of the operated univentricular RV in infancy.
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Right Ventricular Mechanical Dyssynchrony and Asymmetric Contraction in Hypoplastic Heart Syndrome are Associated with Tricuspid Regurgitation. J Am Soc Echocardiogr 2013; 26:1214-1220. [DOI: 10.1016/j.echo.2013.06.015] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2012] [Indexed: 11/23/2022]
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Prenatal Diagnosis Improves the Postnatal Cardiac Function in a Population-Based Cohort of Infants with Hypoplastic Left Heart Syndrome. J Am Soc Echocardiogr 2013; 26:1073-9. [DOI: 10.1016/j.echo.2013.05.005] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2012] [Indexed: 11/20/2022]
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Shuhaiber JH, Pigula FA. Left ventricle after palliation of hypoplastic left heart syndrome: friend, fiend, or innocent bystander? Pediatr Cardiol 2013; 34:1063-72. [PMID: 23519686 DOI: 10.1007/s00246-013-0677-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2012] [Accepted: 02/13/2013] [Indexed: 12/29/2022]
Abstract
Hypoplasia of the left side of the heart is the most common cause of death from congenital heart disease in the first weeks of life. Once considered a surgically fatal disease, hypoplasia has been successfully palliated for more than 30 years. Although the palliative route is staged by an early differential bypass of the systemic outflow and the venous inflow to the right ventricle, the left ventricle remains anatomically and biologically influential throughout. Given the variation of the left ventricle, contemporary outcomes for different hypoplastic left heart subsets can vary both early after palliation and long term. This review critically examines the contemporary understanding of the structure and function of the hypoplastic ventricle in this syndrome. It also provides insight into future research directions relevant to clinicians and surgeons.
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Affiliation(s)
- Jeffrey H Shuhaiber
- Rhode Island Hospital and Hasbro Children Hospital, The Cardiovascular Institute, Brown Medical School, 2 Dudley Street, MOC 360, Providence, RI 02905, USA.
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Forsey J, Friedberg MK, Mertens L. Speckle Tracking Echocardiography in Pediatric and Congenital Heart Disease. Echocardiography 2013; 30:447-59. [DOI: 10.1111/echo.12131] [Citation(s) in RCA: 69] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Affiliation(s)
- Jonathan Forsey
- The Labatt Family Heart Center; The Hospital for Sick Children; The University of Toronto; Toronto; Ontario; Canada
| | - Mark K Friedberg
- The Labatt Family Heart Center; The Hospital for Sick Children; The University of Toronto; Toronto; Ontario; Canada
| | - Luc Mertens
- The Labatt Family Heart Center; The Hospital for Sick Children; The University of Toronto; Toronto; Ontario; Canada
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Echocardiographic Assessment of Ventricular Synchrony in Congenital and Acquired Heart Disease in Children. Echocardiography 2013; 30:460-71. [DOI: 10.1111/echo.12110] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Pauliks L. Tissue Doppler Myocardial Velocity Imaging in Infants and Children-a Window into Developmental Changes of Myocardial Mechanics. Echocardiography 2013; 30:439-46. [DOI: 10.1111/echo.12179] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Affiliation(s)
- Linda Pauliks
- Penn State Hershey Medical College; Hershey; Pennsylvania
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McCandless RT, Minich LL, Wilkinson SE, McFadden ML, Tani LY, Menon SC. Myocardial strain and strain rate in Kawasaki disease. Eur Heart J Cardiovasc Imaging 2013; 14:1061-8. [PMID: 23515218 DOI: 10.1093/ehjci/jet041] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
AIMS We sought to determine whether velocity vector imaging (VVI)-derived left ventricular (LV) myocardial deformation indices could detect subtle myocardial abnormalities in acute Kawasaki disease (KD). METHODS AND RESULTS The study cohort of children with KD was divided by coronary artery dilation (CAD, Z-score >2.5) and/or uncomplicated vs. treatment-resistant (persistent/recrudescent fever) cases and compared with age-matched controls. Peak systolic LV myocardial strain (ε) and strain rate (SR) were obtained using VVI on pre-treatment echocardiograms. Comparisons were made between controls and (i) the entire KD group, (ii) KD group subdivided by CAD, and (iii) KD group subdivided by treatment resistance. The KD group consisted of 32 children (66% male, 24 ± 20 months). Of these, 17 had CAD and 14 had resistant KD. The control group consisted of 22 children (55% male, 20 ± 17 months). Routine echo indices of LV systolic function were normal for both groups. Compared with controls, KD patients had lower global longitudinal ε (-15.29 vs. -12.94, P = 0.04) and SR (-1.12 vs. -0.87, P = 0.003). On subgroup analysis compared with controls, KD patients with CAD (n = 17) had lower longitudinal ε (-15.29 vs. -11.87, P = 0.02) and SR (-1.12 vs. -0.86, P = 0.005). Subdivided by treatment resistance, compared with controls, those with resistant KD had lower longitudinal ε (-15.29 vs. -11.8, P = 0.01) and SR (-1.12 vs. -0.82, P = 0.003). CONCLUSION Despite normal LV systolic function by routine echocardiographic measurements, KD patients have reduced longitudinal LV ε and SR, which may be more sensitive indicators of myocardial inflammation and may provide supportive criteria to avoid delayed diagnosis of KD.
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Affiliation(s)
- Rachel T McCandless
- Division of Cardiology, Department of Pediatrics, Primary Children's Medical Center and the University of Utah, 100 N. Mario Capecchi Drive, Salt Lake City, UT, USA
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Echocardiography for Assessment of Mechanical Dyssynchrony in Children: The Search Must Go On. J Am Soc Echocardiogr 2013; 26:160-4. [DOI: 10.1016/j.echo.2012.12.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Gokhale J, Husain N, Nicholson L, Texter KM, Zaidi AN, Cua CL. QRS duration and mechanical dyssynchrony correlations with right ventricular function after fontan procedure. J Am Soc Echocardiogr 2012; 26:154-9. [PMID: 23218964 DOI: 10.1016/j.echo.2012.10.018] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2012] [Indexed: 11/17/2022]
Abstract
BACKGROUND In studies of adult patients, increased QRS duration and mechanical dyssynchrony have been associated with decreased ventricular function. The aim of this study was to test the hypothesis that similar findings would be present in a population of patients with hypoplastic left heart syndrome (HLHS) after the Fontan procedure. METHODS A retrospective cross-sectional study was conducted. All patients with HLHS after the Fontan procedure were eligible. QRS duration was measured using 12-lead electrocardiography. Echocardiographic measurements of mechanical dyssynchrony included Doppler tissue imaging (DTI) QRS to onset of s' wave difference between the left ventricle and the right ventricle, time to peak strain, time to peak systolic strain rate (SRs), the standard deviation of time to peak strain rate (modified Yu strain), and the standard deviation of time to peak SRs (modified Yu SRs). Right ventricular (RV) functional measurements included DTI s' wave, DTI RV myocardial performance index, global strain, global SRs, and RV fractional area change. Pearson's correlations were performed between the variables. RESULTS Thirty-one echocardiographic studies were performed on 26 patients. The median age was 5.3 years (range, 2.5-15.4 years). QRS duration was correlated significantly with global SRs (r = 0.42). Time to peak SRs was correlated significantly with DTI s' wave (r = -0.48) and global SRs (r = 0.37). Modified Yu SRs was correlated significantly with global strain (r = 0.35) and RV fractional area change (r = -0.35). CONCLUSIONS Both QRS duration and mechanical dyssynchrony were correlated with RV function, albeit weakly. The clinical significance of these findings is intriguing, but only larger studies will determine if these measurements are reliable in guiding treatment options for this complex patient population.
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Affiliation(s)
- Janaki Gokhale
- The Heart Center, Nationwide Children's Hospital, Columbus, Ohio, USA.
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Kaneko S, Khoo NS, Smallhorn JF, Tham EB. Single Right Ventricles Have Impaired Systolic and Diastolic Function Compared to Those of Left Ventricular Morphology. J Am Soc Echocardiogr 2012; 25:1222-30. [DOI: 10.1016/j.echo.2012.08.005] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/29/2012] [Indexed: 11/16/2022]
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Huang XZ, Wang ZY, Dai XH, Yun-Zhang, Zhang M. Velocity vector imaging of longitudinal mechanical properties of upstream and downstream shoulders and fibrous cap tops of human carotid atherosclerotic plaque. Echocardiography 2012; 30:211-8. [PMID: 23095047 DOI: 10.1111/echo.12005] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
AIMS Atherosclerotic plaque rupture is closely related to high regional mechanical stress in the plaque itself. We aimed to explore the longitudinal mechanical properties of upstream and downstream shoulders and fibrous cap tops of human atherosclerotic plaques in vivo by velocity vector imaging (VVI) combined with acoustic densitometry (AD) imaging. METHODS AND RESULTS We included 135 patients with carotid atherosclerotic plaque. VVI and AD were used to examine 3 regions of carotid plaque along the longitudinal-axis view. A total of 405 regions were classified with low or high AD values by corrected averages image intensity (AIIc%) < or ≥50, respectively. Peak systolic strain, strain rate (SR), and velocity were significantly greater for upstream than downstream shoulders and fibrous cap tops of carotid plaque (P < 0.05 for both). AIIc% was significantly lower for upstream than downstream plaque shoulders (P < 0.05). Peak systolic SR of the plaque regions was negatively correlated with corresponding AIIc% (R(2) = 0.499, P < 0.05). CONCLUSIONS The longitudinal strain of human carotid atherosclerotic plaques as derived by VVI is associated with its corresponding AD but also in part with the internal position of the strain, with values greater for upstream than downstream shoulders and fibrous cap tops.
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Stephenson EA. It is all in the timing: mechanical and electrical dyssynchrony in hypoplastic left heart syndrome. Heart Rhythm 2012; 9:2016-7. [PMID: 23085126 DOI: 10.1016/j.hrthm.2012.10.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2012] [Indexed: 11/29/2022]
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Deformation Imaging in Selected Congenital Heart Disease: Is It Evolving to Clinical Use? J Am Soc Echocardiogr 2012; 25:919-31. [DOI: 10.1016/j.echo.2012.06.008] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2011] [Indexed: 11/21/2022]
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Ho PK, Lai CT, Wong SJ, Cheung YF. Three-Dimensional Mechanical Dyssynchrony and Myocardial Deformation of the Left Ventricle in Patients with Tricuspid Atresia after Fontan Procedure. J Am Soc Echocardiogr 2012; 25:393-400. [DOI: 10.1016/j.echo.2012.01.003] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2011] [Indexed: 01/15/2023]
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Petko C, Hansen JH, Scheewe J, Rickers C, Kramer HH. Comparison of Longitudinal Myocardial Deformation and Dyssynchrony in Children with Left and Right Ventricular Morphology after the Fontan Operation Using Two-dimensional Speckle Tracking. CONGENIT HEART DIS 2011; 7:16-23. [DOI: 10.1111/j.1747-0803.2011.00607.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Cua CL, Feltes TF. Echocardiographic evaluation of the single right ventricle in congenital heart disease: results of new techniques. Circ J 2011; 76:22-31. [PMID: 22139360 DOI: 10.1253/circj.cj-11-1267] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Right ventricular (RV) function is increasingly recognized as having prognostic significance in various disease processes. The current gold standard for noninvasive measurement of RV function is cardiac magnetic resonance imaging; however, because of practical considerations, echocardiography remains the most often used modality for evaluating the RV. In the past, because of its complex morphology, echocardiographic assessment of the RV was usually qualitative in nature. Current advances in echocardiographic techniques have been able to overcome some of the previous limitations and thus quantification of RV function is increasingly being performed. In addition, recent echocardiographic guidelines for evaluating the RV have been published to aid in standardizing practice. The evaluation of RV function almost certainly has no greater importance than in the congenital heart population, especially in those patients that have a single RV acting as the systemic ventricle. As this complex population continues to increase in number, accurate and precise evaluation of RV function will be a major issue in determining clinical care.
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Affiliation(s)
- Clifford L Cua
- Heart Center, Nationwide Children's Hospital, Columbus, OH 43205, USA.
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