Classic-Pattern Dyssynchrony in Adolescents and Adults With a Fontan Circulation

Assami Rösner; Tigran Khalapyan; Håvard Dalen; Doff B McElhinney; Mark K Friedberg; George K Lui

doi:10.1016/j.echo.2017.10.018

Classic-Pattern Dyssynchrony in Adolescents and Adults With a Fontan Circulation

J Am Soc Echocardiogr. 2018 Feb;31(2):211-219. doi: 10.1016/j.echo.2017.10.018. Epub 2017 Dec 8.

Authors

Assami Rösner¹, Tigran Khalapyan², Håvard Dalen³, Doff B McElhinney², Mark K Friedberg⁴, George K Lui⁵

Affiliations

¹ Department of Cardiology, Division of Cardiothoracic and Respiratory Medicine, University Hospital of North Norway, Tromsø, Norway. Electronic address: assami.rosner@unn.no.
² Department of Cardiothoracic Surgery, Stanford University School of Medicine, Stanford, California.
³ Cardiac Exercise Research Group, Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway; Department of Cardiology, St Olavs Hospital, Trondheim, Norway; Department of Medicine, Levanger Hospital, Nord-Trøndelag Health Trust, Levanger, Norway.
⁴ Division of Pediatric Cardiology, Hospital for Sick Children, Toronto, Ontario, Canada.
⁵ Division of Cardiovascular Medicine, Department of Medicine, Stanford University School of Medicine, Stanford, California; Division of Pediatric Cardiology, Department of Pediatrics, Stanford University School of Medicine, Stanford, California.

PMID: 29229494
DOI: 10.1016/j.echo.2017.10.018

Abstract

Background: Previous studies have suggested the presence of dyssynchrony in the functionally single ventricle. The aim of this study was to investigate the presence of classic-pattern dyssynchrony (CPD), characterized by typical early and late deformation of opposite walls, and its relation to QRS duration and myocardial function in patients with single-ventricle physiology after Fontan palliation.

Methods: In a retrospective cross-sectional study, 101 adolescent and adult patients with single-ventricle physiology after the Fontan procedure were investigated. Strain curves were visually assessed for the presence of CPD. Systolic and diastolic function were assessed using echocardiography.

Results: One hundred one patients were included, with varying anatomic morphology: two sizable ventricular components (n = 21), right dominant (n = 21), left dominant (n = 49), and undefined anatomy (n = 10). Fifteen of 101 Fontan patients had CPD. Forty-three percent of patients with two sizable ventricular masses displayed CPD, mostly with prolonged QRS, while the number of patients with CPD with right-dominant (9%) and left-dominant (6%) morphology was significantly lower (P = .016). Those with CPD displayed significantly (P < .05) larger QRS widths (142 ± 22 vs 112 ± 24 msec), lower ejection fractions (31 ± 14% vs 45 ± 14%), lower global early diastolic strain rates (0.7 ± 0.5 vs 1.2 ± 0.8 sec^-1), and global systolic circumferential (-10 ± 5% vs -16 ± 7%) and longitudinal (-9 ± 5% vs -14 ± 5%) strain, respectively.

Conclusions: CPD is present in a proportion of adolescent and adult patients after Fontan palliation. The presence of CPD is associated with reduced systolic and diastolic function compared with Fontan patients without CPD. Because the presence of CPD appears to be a promising predictor for response to cardiac resynchronization therapy in patients with biventricular circulation, these findings may have important potential for prospective evaluation of cardiac resynchronization therapy in patients with univentricular circulation.

Keywords: Cardiac function; Dyssynchrony; Fontan procedure.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Adolescent
Adult
Cross-Sectional Studies
Echocardiography / methods*
Female
Fontan Procedure / methods*
Heart Defects, Congenital / diagnosis*
Heart Defects, Congenital / physiopathology
Heart Defects, Congenital / surgery
Heart Ventricles / diagnostic imaging*
Heart Ventricles / physiopathology
Heart Ventricles / surgery
Humans
Male
Retrospective Studies
Systole
Ventricular Function, Left / physiology*
Young Adult