Abstract 9820: Catheterization Diastolic Pressures Correlate With Diastolic Dyssynchrony in Patients With Single Right Ventricles

Abstract

Introduction: Diastolic dyssynchrony is increasingly being recognized in both the adult and pediatric population. Increasing diastolic dyssynchrony has correlated with increased pulmonary capillary wedge pressures and worse clinical outcomes in patients with normal cardiac anatomy. No data exist in patients with single right ventricle (sRV) physiology. Goal of this study was to determine if diastolic dyssynchrony in patients with sRV physiology correlates with ventricular end-diastolic pressures (VEDP) obtained via cardiac catheterization. Methods: Tissue Doppler imaging (TDI) and strain rate (SR) analysis of sRV patients undergoing catheterization were performed. TDI analysis was performed at the level of the atrioventricular valve. Time interval from onset of QRS to peak TDI e’ wave of the respective walls was obtained. Differences in intervals were calculated: QRS(RV) - QRS(IVS) and QRS(RV) - QRS(LV). The sRV was separated into a six segment model for SR analysis. Time interval from onset of QRS to peak SR early diastolic wave (SRe) wave was obtained for the six segment model sRV. Standard deviation of the six SRe time intervals was calculated. VEDP was obtained from the catheterization report. Correlation of VEDP with timing intervals was analyzed via Pearson correlation. Results: Forty sRV patients were evaluated: 27 hypoplastic left heart syndrome, 9 double outlet right ventricles, 4 unbalanced atrioventricular septal defects. Age was 2.8 ± 3.5 years. Catheterization VEDP of the sRV was 9.3 ± 3.9 mmHg (median 8 mmHg range 4 - 24 mmHg). QRS(RV) - QRS(IVS) was 22.3 ± 18.1 msec and QRS(RV) - QRS(LV) was 23.7 ± 19.0 msec. SRe standard deviation of the sRV was 61.6 ± 23.9 msec. There was no significant correlation with VEDP and QRS(RV) - QRS(VS) (r = 0.1, p = NS) or with QRS(RV) - QRS(LV) (r = 0.2, p = NS). There was a significant correlation of VEDP with the SRe standard deviation value (r = 0.4, p < 0.05). Conclusion: Diastolic dyssynchrony, measured via SR analysis, correlated with VEDP in patients with sRV physiology. Future studies are needed to determine if this measurement is beneficial for either monitoring or treatment purposes in this complex patient population.