Abstract 10259: Echocardiographic Predictors of Mortality in Adults With a Fontan Circulation

Abstract

Introduction: Transthoracic echocardiographic (TTE) parameters that predict mortality have not been well-defined in Fontan-adults. Atrioventricular valve systolic to diastolic duration ratio (AVV S:D) is an echocardiographic indice that reflects global cardiac performance but has not been studied in this setting. AVV S:D may be useful in this heterogeneous group as it does not rely on geographic assumption or segmental analysis. Methods: Fontan-adults (≥18 years) in sinus or A-paced V-sensed rhythm seen at our institution since 2005 were studied prospectively. Clinical data were recorded from time of index TTE. Subjects were censored at death or most recent review. Nil had cardiac transplant. Results: In total, 128 patients (64 male) were included, mean age was 27 ± 8 years, 107 had dominant left ventricle (LV), 18 had dominant right ventricle (RV) and 3 were biventricular with large ventricular septal defect. Forty-eight had atriopulmonary connection (APC), 64 had total cavopulmonary connection (TCPC) and 16 had TCPC conversion. Time since first repair was 22 ± 7 years. Mean NYHA Class was 1.4 ± 0.6. During mean follow-up of 4.3 ± 2.8 years, 12 patients died (1 dominant RV, 11 dominant LV). Eight deaths were due to heart failure, 2 were sudden death and 2 were due to liver failure. In univariate analysis the strongest TTE predictors of mortality were AVV S:D, presence of restrictive filling using pulse and tissue Doppler parameters, subjective grade of systolic ventricular function, fractional area change and moderate to severe AVV regurgitation. Results with p ≤ 0.2 are shown in Figure 1. Cox regression analysis suggested NYHA Class and AVV S:D were independent predictors of mortality (p<0.0001 for both). Conclusions: TTE indices are predictive of mortality in Fontan-adults. Ventricular performance assessed by AVV S:D was the most important parameter and should be incorporated into routine clinical assessment of these patients.