Abstract
Cardiac MR (CMR) is a standard modality for assessing ventricular function of single ventricles. CMR feature-tracking (CMR-FT) is a novel application enabling strain measurement on cine MR images and is used in patients with congenital heart diseases. We sought to assess the feasibility of CMR-FT in Fontan patients and analyze the correlation between CMR-FT strain values and conventional CMR volumetric parameters, clinical findings, and biomarkers. Global circumferential (GCS) and longitudinal (GLS) strain were retrospectively measured by CMR-FT on Steady-State Free Precession cine images. Data regarding post-operative course at Fontan operation, and medication, exercise capacity, invasive hemodynamics, and blood biomarkers at a time interval ± 6 months from CMR were collected. Forty-seven patients underwent CMR 11 ± 6 years after the Fontan operation; age at CMR was 15 ± 7 years. End-diastolic volume (EDV) of the SV was 93 ± 37 ml/m2, end-systolic volume (ESV) was 46 ± 23 ml/m2, and ejection fraction (EF) was 51 ± 11%. Twenty (42%) patients had a single right ventricle (SRV). In single left ventricle (SLV), GCS was higher (p < 0.001), but GLS was lower (p = 0.04) than in SRV. GCS correlated positively with EDV (p = 0.005), ESV (p < 0.001), and EF (p ≤ 0.0001). GLS correlated positively with EF (p = 0.002), but not with ventricular volumes. Impaired GCS correlated with decreased ventricular function (p = 0.03) and atrioventricular valve regurgitation (p = 0.04) at echocardiography, direct atriopulmonary connection (p = 0.02), post-operative complications (p = 0.05), and presence of a rudimentary ventricle (p = 0.01). A reduced GCS was associated with increased NT-pro-BNP (p = 0.05). Myocardial deformation can be measured by CMR-FT in Fontan patients. SLVs have higher GCS, but lower GLS than SRVs. GCS correlates with ventricular volumes and EF, whereas GLS correlates with EF only. Myocardial deformation shows a relationship with several clinical parameters and NT-pro-BNP.
Highlights
Treatment of patients with a single ventricle (SV) consists of a staged procedure, the last step being the Fontan operation [1]
The aim of this study was to assess the feasibility of Cardiac MR (CMR)-FT in Fontan patients and to evaluate potential correlation between strain values measured by CMR feature-tracking (CMR-FT) and clinical data such as patient characteristics, post-operative complications, hemodynamic measures, and blood biomarkers
Shortaxis images could be acquired in all 47 patients, while longaxis images were available in 37 patients
Summary
Treatment of patients with a single ventricle (SV) consists of a staged procedure, the last step being the Fontan operation [1]. Thanks to the significant developments in the surgical, interventional and medical techniques, survival has dramatically improved in the last decades [1]. Better survival demasks the morbidity occurring during long-term follow-up in these patients, whose circulation is demanded to function based on unphysiological hemodynamics [1, 2]. During the staged surgical procedures, the SV myocardium is exposed to different pressure- and volume loading conditions. These may lead to unfavorable ventricular remodeling and to diastolic and/or systolic dysfunction, and eventually to cardiac failure and clinical deterioration [1, 3].
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