P679 Subpulmonary left ventricular dysfunction is associated with severity of heart failure in patients with systemic right ventricle

Abstract

Abstract Background Dysfunction of systemic right ventricle (SRV) in patients with congenitally corrected transposition of great arteries (ccTGA) or simple transposition (TGA) is commonly associated with exercise intolerance, heart failure and death. However, the relevance of subpulmonary left ventricular (LV) function in these settings is unknown. Purpose To examine the relation between severity of heart failure and echocardiographic parameters of subpulmonary LV size and function in patients with SRV. Methods We identified all patients with SRV from our digital echocardiographic database between 2014 and 2018. The size and function of SRV and subpulmonary LV were assessed in the most recent examination. Clinical data were collected from electronic patient records. Results We included 157 patients with SRV, median age 40.6 [33.1; 46.8] years, 57% male. 133 (85%) patients had NYHA functional class 1-2 and 24 (15%) NYHA class 3-4. Patients with NYHA class 3-4 were older, had larger SRV and subpulmonary LV with poorer function and higher BNP level (Table, Figure A). LV fractional area change (FAC) had higher sensitivity and specificity in differentiation of patients with severe heart failure than SRV FAC (Figurel B) with LV FAC cut-off value <39.2% showing the highest accuracy in prediction of NYHA class 3-4 (Se 83% and Sp 88%) and 86% Sp in predicting BNP > 100 ng/l. LV end-diastolic diameter and area, MAPSE and FAC significantly correlated with BNP level (p < 0.0001; p = 0.001; p = 0.007; and p = 0.0002, respectively). In Multivariate Cox regression analysis LV FAC and RV FAC were the only independent associates of NYHA class 3-4 (HR 0.69 [95%CI 0.55-0.86], p = 0.001 and HR 0.71 [95%CI 0.55-0.93], p = 0.012, respectively), while age, degree of tricuspid regurgitation and BNP were not. Conclusions Subpulmonary LV dysfunction is strongly associated with NYHA class 3-4 heart failure in patients with SRV. LV FAC is more accurate than SRV FAC in predicting heart failure symptoms. Subpulmonary LV should be accurately assessed in all SRV patients and be taken into account in clinical decision making and timing for interventions. Characteristics of 157 patients with SRV Parameter NYHA Class 1-2 (N = 133) NYHA Class 3-4 (N = 24) P value Age, years 39.1 (31.9; 45.7) 46.5 (43.9; 58.1) <0.0001 RV EDAi, cm2/m2 17.4 (15.2; 20.1) 21.8 (17.5; 25.6) 0.0002 RV FAC, % 29.5 (23; 35) 22 (20; 27) <0.0001 LV EDAi, cm2/m2 12.0 (10.1; 14.1) 16.4 (11.6; 19.1) 0.0008 Reduced LV function by eyeballing 3 (2%) 18 (75%) <0.0001 BNP, ng/l 66 (35; 109) 356 (196; 512) <0.0001 Data presented as median (25th; 75th percentiles) Abstract P679 Figure.