Serial cardiovascular magnetic resonance feature tracking indicates early worsening of cardiac function in Fontan patients

https://doi.org/10.1016/j.ijcard.2019.12.041Get rights and content
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Highlights

  • This study showed a decrease in cardiac strain over 2 years in Fontan patients.

  • Cardiac strain might be a sensitive early indicator of systolic ventricular decline.

  • combined strain of the hypoplastic and dominant ventricles is an accurate representation of cardiac strain.

Abstract

Background

In Fontan patients, attrition of ventricular function is well recognized, but early detection of ventricular dysfunction is difficult. The aim of this study is to longitudinally assess ventricular strain in Fontan patients using a new method for cardiac magnetic resonance (CMR) feature tracking, and to investigate the relationship between ventricular strain and cardiac systolic function.

Methods and results

In this prospective, standardized follow-up study in 51 Fontan patients, age ≥ 10 years, CMR and concomitant clinical assessment was done at the start of the study and after 2 years. CMR feature tracking was done combining the dominant and hypoplastic ventricles. Global longitudinal strain (GLS) (−17.3% versus −15.9%, P = 0.041) and global circumferential strain (GCS) (−17.7 versus −16.1, P = 0.047) decreased over 2 years' time. Ejection fraction (EF) (57%), cardiac index (CI) (2.7 l/min/m2) and NYHA functional class (97% in class I/II) were preserved. The strain values of the combined dominant and hypoplastic ventricles were significantly worse compared to those of the dominant ventricle only (GLS −16.8 (−19.5 to −14.0) versus −18.8 (−21.3 to −15.3) respectively, P = 0.001, GCS −18.3 (−22.1 to −14.8) versus −22.5 (−26.3 to −19.4) respectively, P < 0.001).

Conclusions

This study showed a decrease in cardiac strain over 2 years in Fontan patients without clinical signs of Fontan failure, where EF, CI and clinical status were still preserved. Cardiac strain might be a sensitive early indicator of systolic ventricular decline. Furthermore, combined strain of the hypoplastic and dominant ventricles seems a more accurate representation of cardiac strain in functionally univentricular hearts.

Keywords

Fontan circulation
Functionally univentricular heart
Feature tracking
Global longitudinal strain
Global circumferential strain

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All above mentioned authors take responsibility for all aspects of the reliability and freedom from bias of the data presented and their discussed interpretation.