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Kanngiesser LM, Freitag-Wolf S, Boroni Grazioli S, Gabbert DD, Hansen JH, Uebing AS, Voges I. Serial Assessment of Right Ventricular Deformation in Patients With Hypoplastic Left Heart Syndrome: A Cardiovascular Magnetic Resonance Feature Tracking Study. J Am Heart Assoc 2022; 11:e025332. [PMID: 35475354 PMCID: PMC9238584 DOI: 10.1161/jaha.122.025332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background As right ventricular dysfunction is a major cause of adverse outcome in patients with hypoplastic left heart syndrome, the aim was to assess right ventricular function and deformation after Fontan completion by performing 2-dimensional cardiovascular magnetic resonance feature tracking in serial cardiovascular magnetic resonance studies. Methods and Results Cardiovascular magnetic resonance examinations of 108 patients with hypoplastic left heart syndrome (female: 31) were analyzed. Short-axis cine images were used for right ventricular volumetry. Two-dimensional cardiovascular magnetic resonance feature tracking was performed using long-axis and short-axis cine images to measure myocardial global longitudinal, circumferential, and radial strain. All patients had at least 2 cardiovascular magnetic resonance examinations after Fontan completion and 41 patients had 3 examinations. Global strain values and right ventricular ejection fraction decreased from the first to the third examination with a significant decline in global longitudinal strain from the first examination to the second examination (median, first, and third quartile: -18.8%, [-20.5;-16.5] versus -16.9%, [-19.3;-14.7]) and from the first to the third examination in 41 patients (-18.6%, [-20.9;-15.7] versus -15.8%, [-18.7;-12.6]; P-values <0.004). Right ventricular ejection fraction decreased significantly from the first to the third examination (55.4%, [49.8;59.3] versus 50.2%, [45.0;55.9]; P<0.002) and from the second to the third examination (53.8%, [47.2;58.7] versus 50.2%, [45.0;55.9]; P<0.0002). Conclusions Serial assessment of cardiovascular magnetic resonance studies in patients with hypoplastic left heart syndrome after Fontan completion demonstrates a significant reduction in global strain values and right ventricular ejection fraction at follow-up. The significant reduction in global longitudinal strain between the first 2 examinations with non-significant changes in right ventricular ejection fraction suggest that global longitudinal strain measured by 2-dimensional cardiovascular magnetic resonance feature tracking might be a superior technique for the detection of changes in myocardial function.
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Affiliation(s)
- Luca Mitch Kanngiesser
- Department of Congenital Heart Disease and Pediatric Cardiology University Hospital Schleswig-Holstein Kiel Germany
| | - Sandra Freitag-Wolf
- Institute of Medical Informatics and StatisticsKiel UniversityUniversity Hospital Schleswig-Holstein Kiel Germany
| | - Simona Boroni Grazioli
- Department of Congenital Heart Disease and Pediatric Cardiology University Hospital Schleswig-Holstein Kiel Germany
| | - Dominik Daniel Gabbert
- Department of Congenital Heart Disease and Pediatric Cardiology University Hospital Schleswig-Holstein Kiel Germany.,DZHK (German Centre for Cardiovascular Research)Partner Site Hamburg/Kiel/Lübeck Kiel Germany
| | - Jan Hinnerk Hansen
- Department of Congenital Heart Disease and Pediatric Cardiology University Hospital Schleswig-Holstein Kiel Germany.,DZHK (German Centre for Cardiovascular Research)Partner Site Hamburg/Kiel/Lübeck Kiel Germany
| | - Anselm Sebastian Uebing
- Department of Congenital Heart Disease and Pediatric Cardiology University Hospital Schleswig-Holstein Kiel Germany.,DZHK (German Centre for Cardiovascular Research)Partner Site Hamburg/Kiel/Lübeck Kiel Germany
| | - Inga Voges
- Department of Congenital Heart Disease and Pediatric Cardiology University Hospital Schleswig-Holstein Kiel Germany.,DZHK (German Centre for Cardiovascular Research)Partner Site Hamburg/Kiel/Lübeck Kiel Germany
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2
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Fricke K, Mellander M, Hanséus K, Tran P, Synnergren M, Johansson Ramgren J, Rydberg A, Sunnegårdh J, Dalén M, Sjöberg G, Weismann CG, Liuba, P. Impact of Left Ventricular Morphology on Adverse Outcomes Following Stage 1 Palliation for Hypoplastic Left Heart Syndrome: 20 Years of National Data From Sweden. J Am Heart Assoc 2022; 11:e022929. [PMID: 35348003 PMCID: PMC9075443 DOI: 10.1161/jaha.121.022929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background
Hypoplastic left heart syndrome is associated with significant morbidity and mortality. We aimed to assess the influence of left ventricular morphology and choice of shunt on adverse outcome in patients with hypoplastic left heart syndrome and stage 1 palliation.
Methods and Results
This was a retrospective analysis of patients with hypoplastic left heart syndrome with stage 1 palliation between 1999 and 2018 in Sweden. Patients (n=167) were grouped based on the anatomic subtypes aortic‐mitral atresia, aortic atresia‐mitral stenosis (AA‐MS), and aortic‐mitral stenosis. The left ventricular phenotypes including globular left ventricle (Glob‐LV), miniaturized and slit‐like left ventricle (LV), and the incidence of major adverse events (MAEs) including mortality were assessed. The overall mortality and MAEs were 31% and 41%, respectively. AA‐MS (35%) was associated with both mortality (all other subtypes versus AA‐MS: interstage‐I: hazard ratio [HR], 2.7;
P
=0.006; overall: HR, 2.2;
P
=0.005) and MAEs (HR, 2.4;
P
=0.0009). Glob‐LV (57%), noticed in all patients with AA‐MS, 61% of patients with aortic stenosis‐mitral stenosis, and 19% of patients with aortic atresia‐mitral atresia, was associated with both mortality (all other left ventricular phenotypes versus Glob‐LV: interstage‐I: HR, 4.5;
P
=0.004; overall: HR, 3.4;
P
=0.0007) and MAEs (HR, 2.7;
P
=0.0007). There was no difference in mortality and MAEs between patients with AA‐MS and without AA‐MS with Glob‐LV (
P
>0.15). Patients with AA‐MS (35%) or Glob‐LV (38%) palliated with a Blalock‐Taussig shunt had higher overall mortality compared with those palliated with Sano shunts, irrespective of the stage 1 palliation year (AA‐MS: HR, 2.6;
P
=0.04; Glob‐ LV: HR, 2.1;
P
=0.03).
Conclusions
Glob‐LV and AA‐MS are independent morphological risk factors for adverse short‐ and long‐ term outcome, especially if a Blalock‐Taussig shunt is used as part of stage 1 palliation. These findings are important for the clinical management of patients with hypoplastic left heart syndrome.
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Affiliation(s)
- Katrin Fricke
- Cardiology Pediatric Heart Centre Skåne University Hospital Lund Sweden
- Pediatrics Department of Clinical Sciences Lund University Lund Sweden
| | - Mats Mellander
- Department of Pediatrics Institute of Clinical SciencesSahlgrenska Academy Gothenburg Sweden
- Children´s Heart Centre Sahlgrenska University Hospital Gothenburg Sweden
| | - Katarina Hanséus
- Cardiology Pediatric Heart Centre Skåne University Hospital Lund Sweden
- Pediatrics Department of Clinical Sciences Lund University Lund Sweden
| | - Phan‐Kiet Tran
- Pediatrics Department of Clinical Sciences Lund University Lund Sweden
- Cardiac Surgery Pediatric Heart Centre Skåne University Hospital Lund Sweden
| | - Mats Synnergren
- Department of Pediatrics Institute of Clinical SciencesSahlgrenska Academy Gothenburg Sweden
- Children´s Heart Centre Sahlgrenska University Hospital Gothenburg Sweden
| | - Jens Johansson Ramgren
- Pediatrics Department of Clinical Sciences Lund University Lund Sweden
- Cardiac Surgery Pediatric Heart Centre Skåne University Hospital Lund Sweden
| | - Annika Rydberg
- Department of Clinical Sciences, Pediatrics Umeå University Umeå Sweden
| | - Jan Sunnegårdh
- Department of Pediatrics Institute of Clinical SciencesSahlgrenska Academy Gothenburg Sweden
- Children´s Heart Centre Sahlgrenska University Hospital Gothenburg Sweden
| | - Magnus Dalén
- Department of Cardiothoracic Surgery Karolinska University Hospital Stockholm Sweden
- Department of Molecular Medicine and Surgery Karolinska Institute Stockholm Sweden
| | - Gunnar Sjöberg
- Department of Women's and Children's Health Karolinska Institute Stockholm Sweden
| | - Constance G. Weismann
- Cardiology Pediatric Heart Centre Skåne University Hospital Lund Sweden
- Pediatrics Department of Clinical Sciences Lund University Lund Sweden
| | - Petru Liuba,
- Cardiology Pediatric Heart Centre Skåne University Hospital Lund Sweden
- Pediatrics Department of Clinical Sciences Lund University Lund Sweden
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3
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Rickers C, Wegner P, Silberbach M, Madriago E, Gabbert DD, Kheradvar A, Voges I, Scheewe J, Attmann T, Jerosch-Herold M, Kramer HH. Myocardial Perfusion in Hypoplastic Left Heart Syndrome. Circ Cardiovasc Imaging 2021; 14:e012468. [PMID: 34610753 DOI: 10.1161/circimaging.121.012468] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND The status of the systemic right ventricular coronary microcirculation in hypoplastic left heart syndrome (HLHS) is largely unknown. It is presumed that the systemic right ventricle's coronary microcirculation exhibits unique pathophysiological characteristics of HLHS in Fontan circulation. The present study sought to quantify myocardial blood flow by cardiac magnetic resonance imaging and evaluate the determinants of microvascular coronary dysfunction and myocardial ischemia in HLHS. METHODS One hundred nineteen HLHS patients (median age, 4.80 years) and 34 healthy volunteers (median age, 5.50 years) underwent follow-up cardiac magnetic resonance imaging ≈1.8 years after total cavopulmonary connection. Right ventricle volumes and function, myocardial perfusion, diffuse fibrosis, and late gadolinium enhancement were assessed in 4 anatomic HLHS subtypes. Myocardial blood flow (MBF) was quantified at rest and during adenosine-induced hyperemia. Coronary conductance was estimated from MBF at rest and catheter-based measurements of mean aortic pressure (n=99). RESULTS Hyperemic MBF in the systemic ventricle was lower in HLHS compared with controls (1.89±0.57 versus 2.70±0.84 mL/g per min; P<0.001), while MBF at rest normalized by the rate-pressure product, was similar (1.25±0.36 versus 1.19±0.33; P=0.446). Independent risk factors for a reduced hyperemic MBF were an HLHS subtype with mitral stenosis and aortic atresia (P=0.017), late gadolinium enhancement (P=0.042), right ventricular diastolic dysfunction (P=0.005), and increasing age at total cavopulmonary connection (P=0.022). The coronary conductance correlated negatively with systemic blood oxygen saturation (r, -0.29; P=0.02). The frequency of late gadolinium enhancement increased with age at total cavopulmonary connection (P=0.014). CONCLUSIONS The coronary microcirculation of the systemic ventricle in young HLHS patients shows significant differences compared with controls. These hypothesis-generating findings on HLHS-specific risk factors for microvascular dysfunction suggest a potential benefit from early relief of frank cyanosis by total cavopulmonary connection.
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Affiliation(s)
- Carsten Rickers
- University Heart Center, Adult Congenital Heart Disease Unit, University Hospital Hamburg-Eppendorf, Hamburg, Germany (C.R.)
| | - Philip Wegner
- Department of Congenital Heart Disease and Pediatric Cardiology (P.W., D.D.G., I.V., H.-H.K.) University Hospital Schleswig-Holstein, Kiel, Germany
| | - Michael Silberbach
- Department of Pediatric Cardiology, Doernbecher Children's Hospital, Oregon Health and Science University, Portland (M.S., E.M.)
| | - Erin Madriago
- Department of Pediatric Cardiology, Doernbecher Children's Hospital, Oregon Health and Science University, Portland (M.S., E.M.)
| | - Dominik Daniel Gabbert
- Department of Congenital Heart Disease and Pediatric Cardiology (P.W., D.D.G., I.V., H.-H.K.) University Hospital Schleswig-Holstein, Kiel, Germany
| | - Arash Kheradvar
- Edwards Lifesciences Center for Advanced Cardiovascular Technology, University of California Irvine (A.K.)
| | - Inga Voges
- Department of Congenital Heart Disease and Pediatric Cardiology (P.W., D.D.G., I.V., H.-H.K.) University Hospital Schleswig-Holstein, Kiel, Germany
| | - Jens Scheewe
- Department of Cardiovascular Surgery (J.S., T.A.), University Hospital Schleswig-Holstein, Kiel, Germany
| | - Tim Attmann
- Department of Cardiovascular Surgery (J.S., T.A.), University Hospital Schleswig-Holstein, Kiel, Germany
| | - Michael Jerosch-Herold
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (M.J.-H.)
| | - Hans-Heiner Kramer
- Department of Congenital Heart Disease and Pediatric Cardiology (P.W., D.D.G., I.V., H.-H.K.) University Hospital Schleswig-Holstein, Kiel, Germany
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4
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Linden K, Winkler C, Breuer J, Herberg U. Assessment of pressure-volume relations in univentricular hearts: Comparison of obtainment by real-time 3D echocardiography and mini pressure-wire with conductance technology. PLoS One 2021; 16:e0246031. [PMID: 33524066 PMCID: PMC7850469 DOI: 10.1371/journal.pone.0246031] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Accepted: 01/12/2021] [Indexed: 11/18/2022] Open
Abstract
Objectives The gold standard to obtain pressure-volume relations (PVR) of the heart, the conductance technology (PVRCond), is rarely used in children. PVR can also be obtained by 3D-echocardiography volume data combined with simultaneously measured pressure data by a mini pressure-wire (PVR3DE). We sought to investigate the feasibility of both methods in patients with univentricular hearts and to compare them, including hemodynamic changes. Methods We studied 19 patients (age 2–29 years). PVR3DE and PVRCond were assessed under baseline conditions and stimulation with dobutamine. Results Obtaining PVR3DE was successful in all patients. Obtaining PVRCond was possible in 15 patients during baseline (79%) and in 12 patients under dobutamine (63%). Both methods showed that end-systolic elastance (Ees) and arterial elastance (Ea) increased under dobutamine and that Tau showed a statistically significant decrease. Intraclass correlation (95% confidence interval) showed moderate to good agreement between methods: Ees: 0.873 (0.711–0.945), Ea: 0.709 (0.336–0.873), Tau: 0.867 (0.697–0.942). Bland-Altman analyses showed an acceptable bias with wider limits of agreement: Ees: 1.63 mmHg/ml (-3.83–7.08 mmHg/ml), Ea: 0.53 mmHg/ml (-5.23–6.28 mmHg/ml), Tau: -0,76 ms (-10.73–9.21 ms). Conclusion Changes of PVR-specific parameters under dobutamine stimulation were reflected in the same way by both methods. However, the absolute values for these parameters could vary between methods and, therefore, methods are not interchangeable. Obtaining PVR3DE in a single ventricle was easier, faster and more successful than PVRCond. PVR3DE provides a promising and needed alternative to the conductance technology for the assessment of cardiac function in univentricular hearts.
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Affiliation(s)
- Katharina Linden
- Department of Pediatric Cardiology, Children’s Hospital, University Hospital Bonn, Bonn, Germany
- * E-mail:
| | - Christian Winkler
- Department of Pediatric Cardiology, Children’s Hospital, University Hospital Bonn, Bonn, Germany
| | - Johannes Breuer
- Department of Pediatric Cardiology, Children’s Hospital, University Hospital Bonn, Bonn, Germany
| | - Ulrike Herberg
- Department of Pediatric Cardiology, Children’s Hospital, University Hospital Bonn, Bonn, Germany
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5
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Wang AP, Kelle AM, Hyun M, Reece CL, Young PM, O'Leary PW, Qureshi MY. Negative Impact of the Left Ventricular Remnant Morphology on Systemic Right Ventricular Myocardial Deformation in Hypoplastic Left Heart Syndrome. Pediatr Cardiol 2021; 42:278-288. [PMID: 33104855 DOI: 10.1007/s00246-020-02480-2] [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: 03/25/2020] [Accepted: 09/29/2020] [Indexed: 12/01/2022]
Abstract
Left ventricular (LV) morphology may affect right ventricular (RV) function before and after Fontan palliation in patients with hypoplastic left heart syndrome (HLHS). We sought to assess the potential impact of LV morphology on RV function in patients with HLHS using cardiac magnetic resonance (CMR) imaging. A retrospective analysis of available CMR scans from all patients with HLHS was performed. LV morphology was categorized as absent/slit-like or globular/miniaturized. Volumetric analysis was performed using manual disc-summation method on steady-state free precession (SSFP) stack obtained in short-axis orientation of the ventricles. 4-chamber and short-axis SSFP images were used to measure strain on a semi-automated feature-tracking (FT) module. Two sample t-test was used to compare the groups. A total of 48 CMR scans were analyzed. Of those, 12 patients had absent/slit-like and 36 had globular/miniaturized LV morphology. Averaged 4-chamber longitudinal RV strain was significantly higher for absent/slit-like (- 17.6 ± 4.7%) than globular/miniaturized (- 13.4 ± 3.5; P = 0.002). Averaged 4-chamber radial RV strain was also significantly higher for absent/slit-like (33.1 ± 14.9%) than globular/miniaturized (21.6 ± 7.1; P = 0.001). For globular/miniaturized LV morphology, the decreases of 4-chamber longitudinal and radial strains were mainly attributable to the septal basilar and septal mid-ventricular segments. No differences were found in short-axis RV global circumferential strain between the morphologic subtypes (absent/slit-like - 15.0 ± 6.5, globular/miniaturized - 15.7 ± 4.7; P = 0.68). Larger LV remnants, with globular/miniaturized LV morphology, demonstrated diminished strain in the septal base and mid-ventricle segments. Patients with globular/miniaturized LV morphology may benefit with closer monitoring and lower threshold to start heart failure medications. These results exemplify the utility of including both septal and regional deformation in systemic RV strain analysis.
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Affiliation(s)
- Alan P Wang
- Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN, USA
| | - Angela M Kelle
- Division of Pediatric Cardiology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.,Department of Pediatrics, Division of Pediatric Cardiology, Penn State Hershey Medical Center, Hershey, PA, USA
| | - Meredith Hyun
- Division of Biostatistics, Mayo Clinic, Rochester, MN, USA
| | - Chelsea L Reece
- Division of Pediatric Cardiology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | | | - Patrick W O'Leary
- Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN, USA.,Division of Pediatric Cardiology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - M Yasir Qureshi
- Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN, USA. .,Division of Pediatric Cardiology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.
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6
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Borrelli N, Di Salvo G, Sabatino J, Ibrahim A, Avesani M, Sirico D, Josen M, Penco M, Fraisse A, Michielon G. Serial changes in longitudinal strain are associated with outcome in children with hypoplastic left heart syndrome. Int J Cardiol 2020; 317:56-62. [DOI: 10.1016/j.ijcard.2020.03.085] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2020] [Accepted: 03/30/2020] [Indexed: 11/25/2022]
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7
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BAKOURI MOHSEN, SIKKANDAR MOHAMEDYACIN. NUMERICAL INVESTIGATION ON PRELOAD AND AFTERLOAD SENSITIVITY FOR USING VENTRICULAR ASSIST DEVICE ON HEART FAILURE PATIENTS. J MECH MED BIOL 2020. [DOI: 10.1142/s0219519420500426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
A left ventricular assist device (LVAD) is a surgically implanted mechanical pump being used for patients with end-stage heart failure (HF). One of the significant clinical challenges in using LVADs is its remarkable changes in hemodynamic parameters during a change in body position from supine to standing. In standing position, vasodilatation of veins occurs in the legs, which decreases left ventricular end-diastolic pressure, and, in turn, the preload to the LVAD. In this research, a numerical investigation is carried out to evaluate the effect of LVAD in cardiac hemodynamic parameters such as cardiac output (CO) and stroke work (SW) under preload, normal, and afterload conditions. A Proportional–integral–derivative (PID) controller associated with an LVAD pump model and cardiovascular system (CVS) model is developed to study the cardiac hemodynamic and its performance during HF condition by changing system parameters in one cardiac cycle. The performance of the proposed model is then evaluated using a pump cannulae model, real-time status detection of the aortic valve (av), and left ventricular stroke volume. The model parameters associated with HF, including contractility of the left and right ventricle ([Formula: see text] & [Formula: see text]), systemic peripheral resistance ([Formula: see text]) and total blood volume ([Formula: see text]) were set 0.71[Formula: see text]mmHg.s.mL[Formula: see text], 0.53[Formula: see text]mmHg.s.mL[Formula: see text], 1.11[Formula: see text]mmHg.s.mL[Formula: see text] and 5800[Formula: see text]mL, respectively, to allow simulation of HF conditions. The findings of this study show that the CO is increasing linearly with end-diastolic left ventricular volume (LVEDV) and end-diastolic right ventricular volume (RVEDV). However, other vital parameters behavior has a nonlinear relation to CO. Results of this study prove that the LVAD model is more sensitive to preload than afterload condition under different hemodynamical conditions.
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Affiliation(s)
- MOHSEN BAKOURI
- Department of Medical Equipment Technology, College of Applied Medical Science, Majmaah University, Majmaah City 11952, Saudi Arabia
- Health and Basic Sciences Research Center, Majmaah University, Majmaah City 11952, Saudi Arabia
- Department of Physics, College of Arts, Sebha University, Traghen, Libya
| | - MOHAMED YACIN SIKKANDAR
- Department of Medical Equipment Technology, College of Applied Medical Science, Majmaah University, Majmaah City 11952, Saudi Arabia
- Health and Basic Sciences Research Center, Majmaah University, Majmaah City 11952, Saudi Arabia
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8
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Serial cardiovascular magnetic resonance feature tracking indicates early worsening of cardiac function in Fontan patients. Int J Cardiol 2020; 303:23-29. [DOI: 10.1016/j.ijcard.2019.12.041] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Revised: 10/18/2019] [Accepted: 12/19/2019] [Indexed: 12/18/2022]
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9
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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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10
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Impact of Right Ventricular Geometry and Left Ventricular Hypertrophy on Right Ventricular Mechanics and Clinical Outcomes in Hypoplastic Left Heart Syndrome. J Am Soc Echocardiogr 2019; 32:1350-1358. [PMID: 31351794 DOI: 10.1016/j.echo.2019.06.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Revised: 06/05/2019] [Accepted: 06/06/2019] [Indexed: 11/23/2022]
Abstract
BACKGROUND Right ventricular (RV) function is a major determinant of survival in hypoplastic left heart syndrome (HLHS). However, the relation of RV geometry to myocardial mechanics and their relation to transplant-free survival are incompletely characterized. METHODS We retrospectively studied 48 HLHS patients from the Hospital for Sick Children, Toronto, (median age, 2.2; interquartile range, 3.62 years) at different surgical stages. Patients were grouped by the presence (n = 23) or absence (n = 25) of RV "apical bulging" defined as a sigmoid-shaped septum with the RV leftward apical segment contiguous with the left ventricular (LV) lateral wall. Regional and global RV strain were measured using speckle-tracking echocardiography, and regional strains were analyzed for patterns and peak values. These were compared between HLHS anatomical subtypes and between patients with versus without apical bulging. We further investigated the association between RV geometry and dysfunction with the outcomes of heart failure, death, or transplant. RESULTS RV global (-7.3% ± 2.8% vs -11.2% ± 4.4%; P = .001), basal septal (-3.8% ± 3.2% vs -11.4% ± 5.8%; P = .0001) and apicolateral (-5.1% ± 3.5% vs -8.0% ± 5.8%, P = .001) longitudinal strain were lower in patients with versus without apical bulging, respectively. Apical bulging was equally prevalent in all HLHS anatomical variants. Twenty of 22 (91%) patients with apical bulging displayed hypertrophy of the LV apical and lateral segments. Death or transplantation were approximately equal in both groups but related to reduced RV global strain in patients with (seven of seven) and not in those without apical bulging (two of eight; P = .022). CONCLUSIONS These results suggest that the finding of apical bulging is related to the presence of a hypertrophied hypoplastic LV, with a negative impact on regional and global RV function. Therefore, analysis of RV and LV geometry and mechanics may aid in the assessment and prognostication of this high-risk population.
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11
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Abstract
Evaluation of fetal cardiac function is one of the most important components of fetal echocardiography. Fetal cardiac dysfunction is closely linked to risk of intrauterine fetal demise, in many, but not all cases is indicative of worse postnatal prognosis and may prompt the use of medications or interventions to optimize outcomes. There may be implications for termination versus continuation of pregnancy, an indication for early delivery, a change in location and even mode of delivery. In extreme cases, fetal cardiac dysfunction may prompt prenatal or early neonatal listing for cardiac transplantation. There are several important differences between the fetal and postnatal circulatory physiology which affect echocardiographic assessment of cardiac dysfunction. In this review, we examine the echocardiographic findings according to their underlying pathophysiology with reference to common causes.
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Affiliation(s)
- Luke Eckersley
- Fetal & Neonatal Cardiology Program, Echocardiography Laboratory, Division of Cardiology, Departments of Pediatrics, Women & Children's Health Research, Mazankowski Alberta Heart Institutes, and Cardiovascular Research Centre, University of Alberta, Edmonton, AB, Canada
| | - Lisa K Hornberger
- Fetal & Neonatal Cardiology Program, Echocardiography Laboratory, Division of Cardiology, Departments of Pediatrics, Women & Children's Health Research, Mazankowski Alberta Heart Institutes, and Cardiovascular Research Centre, University of Alberta, Edmonton, AB, Canada.,Departments of Obstetrics & Gynecology, Women & Children's Health Research, Mazankowski Alberta Heart Institutes, and Cardiovascular Research Centre, University of Alberta, Edmonton, AB, Canada
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12
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Cohen MS, Dagincourt N, Zak V, Baffa JM, Bartz P, Dragulescu A, Dudlani G, Henderson H, Krawczeski CD, Lai WW, Levine JC, Lewis AB, McCandless RT, Ohye RG, Owens ST, Schwartz SM, Slesnick TC, Taylor CL, Frommelt PC. The Impact of the Left Ventricle on Right Ventricular Function and Clinical Outcomes in Infants with Single-Right Ventricle Anomalies up to 14 Months of Age. J Am Soc Echocardiogr 2018; 31:1151-1157. [PMID: 29980396 PMCID: PMC6475580 DOI: 10.1016/j.echo.2018.05.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2018] [Indexed: 12/26/2022]
Abstract
BACKGROUND Children with single-right ventricle anomalies such as hypoplastic left heart syndrome (HLHS) have left ventricles of variable size and function. The impact of the left ventricle on the performance of the right ventricle and on survival remains unclear. The aim of this study was to identify whether left ventricular (LV) size and function influence right ventricular (RV) function and clinical outcome after staged palliation for single-right ventricle anomalies. METHODS In the Single Ventricle Reconstruction trial, echocardiography-derived measures of LV size and function were compared with measures of RV systolic and diastolic function, tricuspid regurgitation, and outcomes (death and/or heart transplantation) at baseline (preoperatively), early after Norwood palliation, before stage 2 palliation, and at 14 months of age. RESULTS Of the 522 subjects who met the study inclusion criteria, 381 (73%) had measurable left ventricles. The HLHS subtype of aortic atresia/mitral atresia was significantly less likely to have a measurable left ventricle (41%) compared with the other HLHS subtypes: aortic stenosis/mitral stenosis (100%), aortic atresia/mitral stenosis (96%), and those without HLHS (83%). RV end-diastolic and end-systolic volumes were significantly larger, while diastolic indices suggested better diastolic properties in those subjects with no left ventricles compared with those with measurable left ventricles. However, RV ejection fraction was not different on the basis of LV size and function after staged palliation. Moreover, there was no difference in transplantation-free survival to Norwood discharge, through the interstage period, or at 14 months of age between those subjects who had measurable left ventricles compared with those who did not. CONCLUSIONS LV size varies by anatomic subtype in infants with single-right ventricle anomalies. Although indices of RV size and diastolic function were influenced by the presence of a left ventricle, there was no difference in RV systolic function or transplantation-free survival on the basis of LV measures.
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Affiliation(s)
- Meryl S Cohen
- Division of Cardiology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.
| | | | - Victor Zak
- New England Research Institutes, Boston, Massachusetts
| | - Jeanne Marie Baffa
- Division of Cardiology, A.I. DuPont Hospital for Children, Wilmington, Delaware
| | - Peter Bartz
- Division of Cardiology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Andreea Dragulescu
- Labatt Family Heart Centre, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Gul Dudlani
- Division of Cardiology, Johns Hopkins All Children's Heart Institute, St. Petersburg, Florida
| | - Heather Henderson
- Division of Pediatric Cardiology, Duke University Medical Center, Raleigh, North Carolina
| | | | - Wyman W Lai
- Division of Cardiology, Morgan Stanley Children's Hospital, New York, New York
| | - Jami C Levine
- Department of Cardiology, Children's Hospital, Boston, Boston, Massachusetts
| | - Alan B Lewis
- Division of Cardiology, Children's Hospital Los Angeles, Los Angeles, California
| | | | - Richard G Ohye
- Division of Cardiac Surgery, University of Michigan Health System, Ann Arbor, Michigan
| | - Sonal T Owens
- Division of Pediatric Cardiology, University of Michigan Health System, Ann Arbor, Michigan
| | - Steven M Schwartz
- Labatt Family Heart Centre, The Hospital for Sick Children, Toronto, Ontario, Canada
| | | | - Carolyn L Taylor
- Division of Pediatric Cardiology, Medical University of South Carolina, Charleston, South Carolina
| | - Peter C Frommelt
- Division of Cardiology, Medical College of Wisconsin, Milwaukee, Wisconsin
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Lin LQ, Conway J, Alvarez S, Goot B, Serrano-Lomelin J, Colen T, Tham EB, Kutty S, Li L, Khoo NS. Reduced Right Ventricular Fractional Area Change, Strain, and Strain Rate before Bidirectional Cavopulmonary Anastomosis is Associated with Medium-Term Mortality for Children with Hypoplastic Left Heart Syndrome. J Am Soc Echocardiogr 2018; 31:831-842. [PMID: 29655509 DOI: 10.1016/j.echo.2018.02.001] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2017] [Indexed: 11/16/2022]
Abstract
BACKGROUND Ventricular dysfunction is associated with increased morbidity and mortality in children with hypoplastic left heart syndrome. The aim of this study was to assess the diagnostic performance of conventional and speckle-tracking echocardiographic measures of right ventricular (RV) function before bidirectional cavopulmonary anastomosis palliation in predicting death or need for heart transplantation (HTx). METHODS RV fractional area change (RVFAC) and longitudinal and circumferential strain and strain rate (SR) were measured in 64 prospectively recruited patients with hypoplastic left heart syndrome from echocardiograms obtained before bidirectional cavopulmonary anastomosis surgery. The composite end point of death or HTx was examined. Receiver operating characteristic analysis was performed, and cutoff values optimizing sensitivity and specificity were derived. RESULTS At a median follow-up of 5.0 years (interquartile range, 2.8-6.4 years), 13 patients meeting the composite end point had lower longitudinal strain and SR, circumferential SR, and RVFAC compared with survivors (n = 51). The conventional cutoff of RVFAC < 35% was specific for death or HTx (86%) but had poor sensitivity (46%), with an area under the curve of 0.73. Speckle-tracking echocardiographic variables showed similar areas under the curve (range, 0.69-0.79), with negative predictive values >90%. Addition of speckle-tracking echocardiographic variables to RVFAC < 35% showed no added benefit. However, in a subpopulation of patients with RVFAC ≥ 35% (n = 44), those meeting the composite end point (n = 7) had lower longitudinal SR (median, -1.0 1/sec [interquartile range, -0.8 to -1.1 1/sec] vs -1.21/sec [interquartile range, -1.0 to -1.3 1/sec], P = .03). Interobserver reproducibility was superior for longitudinal strain and SR (intraclass correlation coefficient > 0.92) compared with RVFAC (intraclass correlation coefficient = 0.75). CONCLUSIONS Children with hypoplastic left heart syndrome with normal RVFAC and ventricular deformation before bidirectional cavopulmonary anastomosis have a low likelihood of death or HTx in the medium term. In the presence of reduced RVFAC, speckle-tracking echocardiography does not provide additional prognostic value. However, in patients with "normal" RVFAC, it may have a role in improving outcome prediction and warrants further investigation.
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Affiliation(s)
- Lily Q Lin
- Division of Pediatric Cardiology, Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada.
| | - Jennifer Conway
- Division of Pediatric Cardiology, Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| | - Silvia Alvarez
- Division of Pediatric Cardiology, Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| | - Benjamin Goot
- Division of Pediatric Cardiology, Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| | | | - Timothy Colen
- Division of Pediatric Cardiology, Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| | - Edythe B Tham
- Division of Pediatric Cardiology, Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| | - Shelby Kutty
- Division of Pediatric Cardiology, University of Nebraska Medical Center, Children's Hospital and Medical Center, Omaha, Nebraska
| | - Ling Li
- Division of Pediatric Cardiology, University of Nebraska Medical Center, Children's Hospital and Medical Center, Omaha, Nebraska
| | - Nee Scze Khoo
- Division of Pediatric Cardiology, Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
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Veldtman GR, Opotowsky AR, Wittekind SG, Rychik J, Penny DJ, Fogel M, Marino BS, Gewillig M. Cardiovascular adaptation to the Fontan circulation. CONGENIT HEART DIS 2017; 12:699-710. [DOI: 10.1111/chd.12526] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2017] [Accepted: 07/17/2017] [Indexed: 11/28/2022]
Affiliation(s)
- Gruschen R. Veldtman
- Adolescent and Adult Congenital Program; Heart Institute, Cincinnati Children's Hospital Medical Centre; Cincinnati Ohio, USA
| | | | - Samuel G. Wittekind
- Adolescent and Adult Congenital Program; Heart Institute, Cincinnati Children's Hospital Medical Centre; Cincinnati Ohio, USA
| | - Jack Rychik
- The Cardiac Center at The Children's Hospital of Philadelphia, Professor of Pediatrics, Perelman School of Medicine at the University of Pennsylvania; Philadelphia Pennsylvania, USA
| | - Daniel J. Penny
- Department of Cardiology; Texas Children's Hospital and Department of Pediatrics, Baylor College of Medicine; Houston Texas, USA
| | - Mark Fogel
- The Cardiac Center at The Children's Hospital of Philadelphia, Professor of Pediatrics, Perelman School of Medicine at the University of Pennsylvania; Philadelphia Pennsylvania, USA
| | - Bradley S. Marino
- Ann & Robert H. Lurie Children's Hospital of Chicago; Chicago Illinois, USA
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Logoteta J, Ruppel C, Hansen J, Fischer G, Becker K, Kramer HH, Uebing A. Ventricular function and ventriculo-arterial coupling after palliation of hypoplastic left heart syndrome: A comparative study with Fontan patients with LV morphology. Int J Cardiol 2017; 227:691-697. [DOI: 10.1016/j.ijcard.2016.10.076] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2016] [Accepted: 10/28/2016] [Indexed: 11/25/2022]
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3D Real-Time Echocardiography Combined with Mini Pressure Wire Generate Reliable Pressure-Volume Loops in Small Hearts. PLoS One 2016; 11:e0165397. [PMID: 27776179 PMCID: PMC5077139 DOI: 10.1371/journal.pone.0165397] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2016] [Accepted: 10/11/2016] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Pressure-volume loops (PVL) provide vital information regarding ventricular performance and pathophysiology in cardiac disease. Unfortunately, acquisition of PVL by conductance technology is not feasible in neonates and small children due to the available human catheter size and resulting invasiveness. The aim of the study was to validate the accuracy of PVL in small hearts using volume data obtained by real-time three-dimensional echocardiography (3DE) and simultaneously acquired pressure data. METHODS In 17 piglets (weight range: 3.6-8.0 kg) left ventricular PVL were generated by 3DE and simultaneous recordings of ventricular pressure using a mini pressure wire (PVL3D). PVL3D were compared to conductance catheter measurements (PVLCond) under various hemodynamic conditions (baseline, alpha-adrenergic stimulation with phenylephrine, beta-adrenoreceptor-blockage using esmolol). In order to validate the accuracy of 3D volumetric data, cardiac magnetic resonance imaging (CMR) was performed in another 8 piglets. RESULTS Correlation between CMR- and 3DE-derived volumes was good (enddiastolic volume: mean bias -0.03ml ±1.34ml). Computation of PVL3D in small hearts was feasible and comparable to results obtained by conductance technology. Bland-Altman analysis showed a low bias between PVL3D and PVLCond. Systolic and diastolic parameters were closely associated (Intraclass-Correlation Coefficient for: systolic myocardial elastance 0.95, arterial elastance 0.93, diastolic relaxation constant tau 0.90, indexed end-diastolic volume 0.98). Hemodynamic changes under different conditions were well detected by both methods (ICC 0.82 to 0.98). Inter- and intra-observer coefficients of variation were below 5% for all parameters. CONCLUSIONS PVL3D generated from 3DE combined with mini pressure wire represent a novel, feasible and reliable method to assess different hemodynamic conditions of cardiac function in hearts comparable to neonate and infant size. This methodology may be integrated into clinical practice and cardiac catheterization programs and has the capability to contribute to clinical decision making even in small hearts.
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Mechanics of the Functionally Univentricular Heart—How Little Do We Understand and Why Does It Matter? Can J Cardiol 2016; 32:1033.e11-8. [DOI: 10.1016/j.cjca.2015.11.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2015] [Revised: 11/03/2015] [Accepted: 11/03/2015] [Indexed: 11/18/2022] Open
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Right Ventricular Systolic-to-Diastolic Time Index: Hypoplastic Left Heart Fetuses Differ Significantly from Normal Fetuses. J Am Soc Echocardiogr 2016; 29:143-9. [DOI: 10.1016/j.echo.2015.08.014] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2015] [Indexed: 12/19/2022]
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Schlangen J, Petko C, Hansen JH, Michel M, Hart C, Uebing A, Fischer G, Becker K, Kramer HH. 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. Circ Cardiovasc Imaging 2014; 7:880-6. [PMID: 25270741 DOI: 10.1161/circimaging.114.002110] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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 (Ees), 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 Ees correlated with SR (rs= -0.47, P<0.001), but not with S (rs=0.07, P=0.5) or other echocardiographic parameters. CONCLUSIONS In contrast to S, SR was not affected by preload and correlated with Ees 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.
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Affiliation(s)
- Jana Schlangen
- From the Department for Congenital Heart Disease and Paediatric Cardiology, University Hospital of Schleswig-Holstein, Campus Kiel, Kiel, Germany (J.S., C.P., J.H.H., M.M., C.H., G.F., K.B., H.-H.K.); Department of Pediatric, Fetal and Congenital Cardiology, Hawaii Permanente Medical Group, Kaiser Permanente Moanalua Medical Center, Honolulu, HI (C.P.); and Adult Congenital Heart Disease Centre and National Centre for Pulmonary Hypertension, Royal Brompton and Harefield NHS Foundation Trust, London, United Kingdom (A.U.).
| | - Colin Petko
- From the Department for Congenital Heart Disease and Paediatric Cardiology, University Hospital of Schleswig-Holstein, Campus Kiel, Kiel, Germany (J.S., C.P., J.H.H., M.M., C.H., G.F., K.B., H.-H.K.); Department of Pediatric, Fetal and Congenital Cardiology, Hawaii Permanente Medical Group, Kaiser Permanente Moanalua Medical Center, Honolulu, HI (C.P.); and Adult Congenital Heart Disease Centre and National Centre for Pulmonary Hypertension, Royal Brompton and Harefield NHS Foundation Trust, London, United Kingdom (A.U.)
| | - Jan H Hansen
- From the Department for Congenital Heart Disease and Paediatric Cardiology, University Hospital of Schleswig-Holstein, Campus Kiel, Kiel, Germany (J.S., C.P., J.H.H., M.M., C.H., G.F., K.B., H.-H.K.); Department of Pediatric, Fetal and Congenital Cardiology, Hawaii Permanente Medical Group, Kaiser Permanente Moanalua Medical Center, Honolulu, HI (C.P.); and Adult Congenital Heart Disease Centre and National Centre for Pulmonary Hypertension, Royal Brompton and Harefield NHS Foundation Trust, London, United Kingdom (A.U.)
| | - Miriam Michel
- From the Department for Congenital Heart Disease and Paediatric Cardiology, University Hospital of Schleswig-Holstein, Campus Kiel, Kiel, Germany (J.S., C.P., J.H.H., M.M., C.H., G.F., K.B., H.-H.K.); Department of Pediatric, Fetal and Congenital Cardiology, Hawaii Permanente Medical Group, Kaiser Permanente Moanalua Medical Center, Honolulu, HI (C.P.); and Adult Congenital Heart Disease Centre and National Centre for Pulmonary Hypertension, Royal Brompton and Harefield NHS Foundation Trust, London, United Kingdom (A.U.)
| | - Christopher Hart
- From the Department for Congenital Heart Disease and Paediatric Cardiology, University Hospital of Schleswig-Holstein, Campus Kiel, Kiel, Germany (J.S., C.P., J.H.H., M.M., C.H., G.F., K.B., H.-H.K.); Department of Pediatric, Fetal and Congenital Cardiology, Hawaii Permanente Medical Group, Kaiser Permanente Moanalua Medical Center, Honolulu, HI (C.P.); and Adult Congenital Heart Disease Centre and National Centre for Pulmonary Hypertension, Royal Brompton and Harefield NHS Foundation Trust, London, United Kingdom (A.U.)
| | - Anselm Uebing
- From the Department for Congenital Heart Disease and Paediatric Cardiology, University Hospital of Schleswig-Holstein, Campus Kiel, Kiel, Germany (J.S., C.P., J.H.H., M.M., C.H., G.F., K.B., H.-H.K.); Department of Pediatric, Fetal and Congenital Cardiology, Hawaii Permanente Medical Group, Kaiser Permanente Moanalua Medical Center, Honolulu, HI (C.P.); and Adult Congenital Heart Disease Centre and National Centre for Pulmonary Hypertension, Royal Brompton and Harefield NHS Foundation Trust, London, United Kingdom (A.U.)
| | - Gunther Fischer
- From the Department for Congenital Heart Disease and Paediatric Cardiology, University Hospital of Schleswig-Holstein, Campus Kiel, Kiel, Germany (J.S., C.P., J.H.H., M.M., C.H., G.F., K.B., H.-H.K.); Department of Pediatric, Fetal and Congenital Cardiology, Hawaii Permanente Medical Group, Kaiser Permanente Moanalua Medical Center, Honolulu, HI (C.P.); and Adult Congenital Heart Disease Centre and National Centre for Pulmonary Hypertension, Royal Brompton and Harefield NHS Foundation Trust, London, United Kingdom (A.U.)
| | - Kolja Becker
- From the Department for Congenital Heart Disease and Paediatric Cardiology, University Hospital of Schleswig-Holstein, Campus Kiel, Kiel, Germany (J.S., C.P., J.H.H., M.M., C.H., G.F., K.B., H.-H.K.); Department of Pediatric, Fetal and Congenital Cardiology, Hawaii Permanente Medical Group, Kaiser Permanente Moanalua Medical Center, Honolulu, HI (C.P.); and Adult Congenital Heart Disease Centre and National Centre for Pulmonary Hypertension, Royal Brompton and Harefield NHS Foundation Trust, London, United Kingdom (A.U.)
| | - Hans-Heiner Kramer
- From the Department for Congenital Heart Disease and Paediatric Cardiology, University Hospital of Schleswig-Holstein, Campus Kiel, Kiel, Germany (J.S., C.P., J.H.H., M.M., C.H., G.F., K.B., H.-H.K.); Department of Pediatric, Fetal and Congenital Cardiology, Hawaii Permanente Medical Group, Kaiser Permanente Moanalua Medical Center, Honolulu, HI (C.P.); and Adult Congenital Heart Disease Centre and National Centre for Pulmonary Hypertension, Royal Brompton and Harefield NHS Foundation Trust, London, United Kingdom (A.U.)
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Schlangen J, Fischer G, Petko C, Hansen JH, Voges I, Rickers C, Kramer HH, Uebing A. Arterial elastance and its impact on intrinsic right ventricular function in palliated hypoplastic left heart syndrome. Int J Cardiol 2013; 168:5385-9. [DOI: 10.1016/j.ijcard.2013.08.052] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2013] [Revised: 07/24/2013] [Accepted: 08/18/2013] [Indexed: 10/26/2022]
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Herberg U, Gatzweiler E, Breuer T, Breuer J. Ventricular pressure–volume loops obtained by 3D real-time echocardiography and mini pressure wire—a feasibility study. Clin Res Cardiol 2013; 102:427-38. [DOI: 10.1007/s00392-013-0548-3] [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: 07/05/2012] [Accepted: 01/28/2013] [Indexed: 01/01/2023]
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