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Single ventricular strain measures correlate with peak oxygen consumption in children and adolescents with Fontan circulation

Published online by Cambridge University Press:  22 July 2022

Suma Goudar ,
Daniel Forsha Open the ORCID record for Daniel Forsha [Opens in a new window] ,
David A. White Open the ORCID record for David A. White [Opens in a new window] ,
Ashley Sherman  and
Girish Shirali
Suma Goudar
Affiliation:
Children’s National Heart Institute, Department of Pediatrics, Washington, DC, USA
Daniel Forsha*
Affiliation:
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
Affiliation:
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
Affiliation:
Children’s Mercy Hospital, Department of Biostatistics, Kansas City, MO, USA
Girish Shirali
Affiliation:
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
*
Author for correspondence: Daniel Forsha MD, Ward Family Heart Center, Division of Cardiology, Children’s Mercy Hospital, 2401 Gillham Road, Kansas City, MO 64108, USA. Tel: +1 (303) 921 5878. E-mail: Deforsha@cmh.edu
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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.

Keywords

Global longitudinal strainFontansingle ventricleaerobic capacityelectro-mechanical dyssynchrony
Type
Original Article
Information
Cardiology in the Young , Volume 33 , Issue 7 , July 2023 , pp. 1136 - 1142
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Copyright
© The Author(s), 2022. Published by Cambridge University Press

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Footnotes

Dr Goudar and Dr Forsha contributed equally to this work (co-primary authors).

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