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Role of cardiac MRI in the prediction of pre-Fontan end-diastolic ventricular pressure

Part of: Advanced Imaging

Published online by Cambridge University Press:  28 December 2021

Alessandra Pizzuto Open the ORCID record for Alessandra Pizzuto [Opens in a new window] ,
Lamia Ait-Ali Open the ORCID record for Lamia Ait-Ali [Opens in a new window] ,
Chiara Marrone ,
Stefano Salvadori ,
Magdalena Cuman ,
Vitali Pak ,
Giuseppe Santoro  and
Pierluigi Festa
Alessandra Pizzuto*
Affiliation:
Foundation “G. Monasterio”, Heart Hospital “G. Pasquinucci”, Pediatric Cardiology and GUCH Unit, Massa, Italy
Lamia Ait-Ali
Affiliation:
Foundation “G. Monasterio”, Heart Hospital “G. Pasquinucci”, Pediatric Cardiology and GUCH Unit, Massa, Italy Institute of Clinical Physiology, National Research Council (NRC), Massa, Italy
Chiara Marrone
Affiliation:
Foundation “G. Monasterio”, Heart Hospital “G. Pasquinucci”, Pediatric Cardiology and GUCH Unit, Massa, Italy
Stefano Salvadori
Affiliation:
Institute of Clinical Physiology, National Research Council (NRC), Massa, Italy
Magdalena Cuman
Affiliation:
Foundation “G. Monasterio”, Heart Hospital “G. Pasquinucci”, Pediatric Cardiology and GUCH Unit, Massa, Italy
Vitali Pak
Affiliation:
Foundation “G. Monasterio”, Heart Hospital “G. Pasquinucci”, Pediatric Cardiology and GUCH Unit, Massa, Italy
Giuseppe Santoro
Affiliation:
Foundation “G. Monasterio”, Heart Hospital “G. Pasquinucci”, Pediatric Cardiology and GUCH Unit, Massa, Italy
Pierluigi Festa
Affiliation:
Foundation “G. Monasterio”, Heart Hospital “G. Pasquinucci”, Pediatric Cardiology and GUCH Unit, Massa, Italy
*
Author for correspondence: A. Pizzuto, MD, Foundation “G. Monasterio”, Pediatric Cardiology and GUCH Unit, Heart Hospital “G. Pasquinucci”, Via Aurelia Sud, Massa 54100, Italy. Tel: +3933341596865; Fax: +390585493616. E-mail: apizzuto@ftgm.it
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Abstract

Background:

Growing evidence has emphasised the importance of ventricular performance in functionally single-ventricle patients, particularly concerning diastolic function. Cardiac MRI has been proposed as non-invasive alternative to pre-Fontan cardiac catheterisation in selected patients.

Aim of the study:

To identify clinical and cardiac magnetic resonance predictors of high pre-Fontan end-diastolic ventricular pressure.

Method:

In a retrospective single-centre study, 38 patients with functionally univentricular heart candidate for Fontan intervention, who underwent pre-Fontan cardiac catheterisation, beside a comprehensive cardiac MRI, echocardiographic, and clinical assessment were included. Medical and surgical history, cardiac magnetic resonance, cardiac catheterisation, echocardiographic, and clinical data were recorded. We investigated the association between non-invasive parameters and cardiac catheterisation pre-Fontan risk factors, in particular with end-diastolic ventricular pressure. Moreover, the impact of conventional invasive pre-Fontan risk factor on post-operative outcome as also assessed.

Results:

Post-operative complications were associated with higher end-diastolic ventricular pressure and Mayo Clinic indexes (p < 0.01 and p = 0.05, respectively). At receiver operating characteristic curve analysis end-diastolic ventricular pressure ≥ 10.5 mmHg predicted post-operative complications with a sensitivity of 75% and specificity of 88% (AUC: 0.795, 95% CI 0.576;1.000, p < 0.05). At multivariate analysis, both systemic right ventricle (OR: 23.312, 95% CI: 2.704–200.979, p < 0.01) and superior caval vein indexed flow (OR: 0.996, 95% CI: 0.993–0.999, p < 0.05) influenced end-diastolic ventricular pressure ≥ 10.5 mmHg.

Conclusions:

A reduced superior caval vein flow, evaluated at cardiac magnetic resonance, is associated with higher end-diastolic ventricular pressure a predictor of early adverse outcome in post-Fontan patients.

Keywords

Fontancardiac magnetic resonanceuniventricular heartcardiac catheterisationend-diastolic ventricular pressure
Type
Original Article
Information
Cardiology in the Young , Volume 32 , Issue 12 , December 2022 , pp. 1930 - 1937
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Copyright
© The Author(s), 2022. Published by Cambridge University Press

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Footnotes

Alessandra Pizzuto and Lamia Ait-Ali have equally collaborated to the work.

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