Atrio-ventricular deformation and heart failure in Ebstein's Anomaly — A cardiovascular magnetic resonance study

Michael Steinmetz,Marike Broder,Olga Hösch,Pablo Lamata,Shelby Kutty,Johannes T Kowallick,Wieland Staab,Christian Oliver Ritter,Gerd Hasenfuß,Thomas Paul,Joachim Lotz,Andreas Schuster

doi:10.1016/j.ijcard.2017.11.097

Abstract

PurposeWe aimed to quantify atrial and ventricular myocardial deformation in Ebstein's Anomaly (EA) in a case-control study with cardiovascular magnetic resonance (CMR) feature tracking and to correlate changes in cardiac performance with the severity of disease and clinical heart failure parameters. Materials and methodsAtrial and ventricular deformation was measured using CMR feature tracking in 30 EA and 20 healthy control subjects. Atrial performance was characterized using longitudinal strain and strain rate parameters for reservoir function, conduit function and booster pump function. Ventricular performance was characterized using RV and LV global longitudinal strain (εl) and LV circumferential and radial strain (εc and εr). Volumetric measurements for the ventricles including the Total Right/Left-Volume-Index (R/L-Volume-Index) and heart failure markers (BNP, NYHA class) were also quantified. ResultsEA patients showed significantly impaired right atrial performance, which correlated with heart failure markers (NYHA, BNP, R/L-Volume-Index). LA function in EA patients was also impaired with atrial contractile function correlating with NYHA class. EA patients exhibited impaired RV myocardial deformation, also with a significant correlation with heart failure markers. ConclusionCMR feature tracking can be used to quantify ventricular and atrial function in a complex cardiac malformation such as EA. EA is characterized by impaired quantitative right heart atrio-ventricular deformation, which is associated with heart failure severity. While LV function remains preserved, there is also significant impairment of LA function. These quantitative performance parameters may represent early markers of cardiac deterioration of potential value in the clinical management of EA.

Highlights

The contractile phase or booster pump function describes the intensity of atrial contraction resulting in augmentation of ventricular filling during late ventricular diastole and can be quantified measuring global longitudinal active strain and global peak late-negative strain rate (SR) (SRa) during atrial contraction [12]
Exclusion of atrial segments was predominantly associated with poor tracking quality due to insertion of pulmonary veins in the LA and poor imaging quality associated with breathing motion
A lack of correlation between RV volumes and EF with New York Heart Association (NYHA) and brain natriuretic peptide (BNP) was observed in the present study, as well, but we identified a correlation of RV strain and several Right atrial (RA) metrics (Table 2)

Summary

Introduction

The contractile phase or booster pump function describes the intensity of atrial contraction resulting in augmentation of ventricular filling during late ventricular diastole and can be quantified measuring global longitudinal active strain (εa) and global peak late-negative SR (SRa) during atrial contraction [12]. These parameters have been studied in non-symptomatic participants of the Multi-Ethnic-Study of Arteriosclerosis [13,14] demonstrating prognostic value in heart failure prediction and in patients with atrial fibrillation showing a close link to stroke occurrence

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