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Erschienen in: The International Journal of Cardiovascular Imaging 1/2021

04.08.2020 | Original Paper

Cardiac magnetic resonance derived atrial function in patients with a Fontan circulation

verfasst von: Paul J. Critser, Vien Truong, Adam W. Powell, Hassan Almeneisi, Alexander R. Opotowsky, Nicholas J. Ollberding, Janvi Gandhi, Adam M. Lubert, Wojciech Mazur, Sean M. Lang, Justin T. Tretter, Michael D. Taylor, Tarek Alsaied

Erschienen in: The International Journal of Cardiovascular Imaging | Ausgabe 1/2021

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Abstract

To assess atrial function in Fontan patients using cardiac MRI (CMR) and determine the relationships between atrial function, hemodynamics, and clinical outcomes. Two center chart review identified all Fontan patients with technically adequate CMR to assess atrial function within 1 year of cardiac catheterization and age-matched controls with CMR. Atrial reservoir, conduit, and pump global longitudinal strain and strain rate measurements were determined by CMR. Univariate and stepwise multivariable analysis were conducted to detect associations of atrial function measures with ventricular end diastolic pressure (EDP), cardiac index (CI), exercise capacity, liver stiffness and a composite outcome of heart transplantation, ventricular assist device or death. The study cohort was comprised of 33 Fontan patients and 30 age-matched controls. Fontan patients had lower atrial reservoir and conduit strain, and lower reservoir, conduit, and pump strain rate compared to age-matched controls. Atrial conduit strain was negatively associated with EDP and lower atrial pump-to-conduit strain ratio was associated with lower cardiac index in multivariable analysis. Lower atrial pump strain was associated with lower exercise capacity (per 1% increase: β = 2.3 ± 0.9, p = 0.03) and higher liver stiffness (per 1% increase: β =  − 0.12 ± 0.03, p = 0.002). Higher atrial pump strain (HR per 1% increase = 0.53 [95% confidence interval 0.22, 0.83], p = 0.002) and ventricular ejection fraction (HR per 1% increase = 0.90 [95% confidence interval 0.80, 0.98], p = 0.02) were associated with lower risk for the composite adverse outcome. Atrial function is impaired in Fontan patients and is associated with worse CI, EDP, exercise performance, liver stiffness, and a higher risk for adverse outcomes.
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Literatur
1.
Zurück zum Zitat Pundi KN et al (2015) 40-Year Follow-up after the Fontan operation: long-term outcomes of 1,052 patients. J Am Coll Cardiol 66(15):1700–1710CrossRef Pundi KN et al (2015) 40-Year Follow-up after the Fontan operation: long-term outcomes of 1,052 patients. J Am Coll Cardiol 66(15):1700–1710CrossRef
2.
Zurück zum Zitat Alsaied T et al (2017) Factors associated with long-term mortality after Fontan procedures: a systematic review. Heart 103(2):104–110CrossRef Alsaied T et al (2017) Factors associated with long-term mortality after Fontan procedures: a systematic review. Heart 103(2):104–110CrossRef
3.
Zurück zum Zitat Li SJ, Wong SJ, Cheung YF (2014) Atrial and ventricular mechanics in patients after Fontan-type procedures: atriopulmonary connection versus extracardiac conduit. J Am Soc Echocardiogr 27(6):666–674CrossRef Li SJ, Wong SJ, Cheung YF (2014) Atrial and ventricular mechanics in patients after Fontan-type procedures: atriopulmonary connection versus extracardiac conduit. J Am Soc Echocardiogr 27(6):666–674CrossRef
4.
Zurück zum Zitat Truong VT et al (2019) Normal left atrial strain and strain rate using cardiac magnetic resonance feature tracking in healthy volunteers. Eur Heart J Cardiovasc Imaging 21(4):46–453 Truong VT et al (2019) Normal left atrial strain and strain rate using cardiac magnetic resonance feature tracking in healthy volunteers. Eur Heart J Cardiovasc Imaging 21(4):46–453
5.
Zurück zum Zitat Hinojar R et al (2019) Prognostic value of left atrial function by cardiovascular magnetic resonance feature tracking in hypertrophic cardiomyopathy. Int J Cardiovasc Imaging 35(6):1055–1065CrossRef Hinojar R et al (2019) Prognostic value of left atrial function by cardiovascular magnetic resonance feature tracking in hypertrophic cardiomyopathy. Int J Cardiovasc Imaging 35(6):1055–1065CrossRef
6.
Zurück zum Zitat Habibi M et al (2014) Association of CMR-measured LA function with heart failure development: results from the MESA study. JACC Cardiovasc Imaging 7(6):570–579CrossRef Habibi M et al (2014) Association of CMR-measured LA function with heart failure development: results from the MESA study. JACC Cardiovasc Imaging 7(6):570–579CrossRef
7.
Zurück zum Zitat Thomas L et al (2019) Left atrial structure and function, and left ventricular diastolic dysfunction: JACC state-of-the-art review. J Am Coll Cardiol 73(15):1961–1977CrossRef Thomas L et al (2019) Left atrial structure and function, and left ventricular diastolic dysfunction: JACC state-of-the-art review. J Am Coll Cardiol 73(15):1961–1977CrossRef
8.
Zurück zum Zitat Khoo NS et al (2013) The assessment of atrial function in single ventricle hearts from birth to Fontan: a speckle-tracking study by using strain and strain rate. J Am Soc Echocardiogr 26(7):756–764CrossRef Khoo NS et al (2013) The assessment of atrial function in single ventricle hearts from birth to Fontan: a speckle-tracking study by using strain and strain rate. J Am Soc Echocardiogr 26(7):756–764CrossRef
9.
Zurück zum Zitat Lunze FI et al (2007) Preserved regional atrial contractile function following extra-atrial rather than intra-atrial type Fontan operation: a tissue Doppler imaging study. Clin Res Cardiol 96(5):264–271CrossRef Lunze FI et al (2007) Preserved regional atrial contractile function following extra-atrial rather than intra-atrial type Fontan operation: a tissue Doppler imaging study. Clin Res Cardiol 96(5):264–271CrossRef
10.
Zurück zum Zitat Stines JR et al (2011) Echocardiographic assessment of atrial properties in single ventricles vs. normal controls. Congenit Heart Dis 6(3):247–252CrossRef Stines JR et al (2011) Echocardiographic assessment of atrial properties in single ventricles vs. normal controls. Congenit Heart Dis 6(3):247–252CrossRef
11.
Zurück zum Zitat van der Ven JPG et al (2020) Atrial function in Fontan patients assessed by CMR: relation with exercise capacity and long-term outcomes. Int J Cardiol 312:56–61CrossRef van der Ven JPG et al (2020) Atrial function in Fontan patients assessed by CMR: relation with exercise capacity and long-term outcomes. Int J Cardiol 312:56–61CrossRef
12.
Zurück zum Zitat Rathod RH et al (2014) Cardiac magnetic resonance parameters predict transplantation-free survival in patients with Fontan circulation. Circ Cardiovasc Imaging 7(3):502–509CrossRef Rathod RH et al (2014) Cardiac magnetic resonance parameters predict transplantation-free survival in patients with Fontan circulation. Circ Cardiovasc Imaging 7(3):502–509CrossRef
13.
Zurück zum Zitat Ghelani SJ et al (2015) Comparison between echocardiography and cardiac magnetic resonance imaging in predicting transplant-free survival after the Fontan operation. Am J Cardiol 116(7):1132–1138CrossRef Ghelani SJ et al (2015) Comparison between echocardiography and cardiac magnetic resonance imaging in predicting transplant-free survival after the Fontan operation. Am J Cardiol 116(7):1132–1138CrossRef
14.
Zurück zum Zitat Alsaied T et al (2018) Maldistribution of pulmonary blood flow in patients after the Fontan operation is associated with worse exercise capacity. J Cardiovasc Magn Reson 20(1):85CrossRef Alsaied T et al (2018) Maldistribution of pulmonary blood flow in patients after the Fontan operation is associated with worse exercise capacity. J Cardiovasc Magn Reson 20(1):85CrossRef
15.
Zurück zum Zitat Badano LP et al (2018) Standardization of left atrial, right ventricular, and right atrial deformation imaging using two-dimensional speckle tracking echocardiography: a consensus document of the EACVI/ASE/Industry Task Force to standardize deformation imaging. Eur Heart J Cardiovasc Imaging 19(6):591–600CrossRef Badano LP et al (2018) Standardization of left atrial, right ventricular, and right atrial deformation imaging using two-dimensional speckle tracking echocardiography: a consensus document of the EACVI/ASE/Industry Task Force to standardize deformation imaging. Eur Heart J Cardiovasc Imaging 19(6):591–600CrossRef
16.
Zurück zum Zitat Jarasunas J, Aidietis A, Aidietiene S (2018) Left atrial strain—an early marker of left ventricular diastolic dysfunction in patients with hypertension and paroxysmal atrial fibrillation. Cardiovasc Ultrasound 16(1):29CrossRef Jarasunas J, Aidietis A, Aidietiene S (2018) Left atrial strain—an early marker of left ventricular diastolic dysfunction in patients with hypertension and paroxysmal atrial fibrillation. Cardiovasc Ultrasound 16(1):29CrossRef
17.
Zurück zum Zitat Alsaied T et al (2020) Author Correction: left atrial dysfunction in sickle cell anemia is associated with diffuse myocardial fibrosis, increased right ventricular pressure and reduced exercise capacity. Sci Rep 10(1):4880CrossRef Alsaied T et al (2020) Author Correction: left atrial dysfunction in sickle cell anemia is associated with diffuse myocardial fibrosis, increased right ventricular pressure and reduced exercise capacity. Sci Rep 10(1):4880CrossRef
18.
Zurück zum Zitat Powell AW et al (2019) Abnormal submaximal cardiopulmonary exercise parameters predict impaired peak exercise performance in sickle cell anemia patients. Pediatr Blood Cancer 66(6):e27703CrossRef Powell AW et al (2019) Abnormal submaximal cardiopulmonary exercise parameters predict impaired peak exercise performance in sickle cell anemia patients. Pediatr Blood Cancer 66(6):e27703CrossRef
19.
Zurück zum Zitat Wasserman K (1999) Principles of exercise testing and interpretation: including pathophysiology and clinical applications, 3rd edn. Lippincott Williams and Wilkins, Philadelphia Wasserman K (1999) Principles of exercise testing and interpretation: including pathophysiology and clinical applications, 3rd edn. Lippincott Williams and Wilkins, Philadelphia
20.
Zurück zum Zitat Xanthakos SA et al (2014) Use of magnetic resonance elastography to assess hepatic fibrosis in children with chronic liver disease. J Pediatr 164(1):186–188CrossRef Xanthakos SA et al (2014) Use of magnetic resonance elastography to assess hepatic fibrosis in children with chronic liver disease. J Pediatr 164(1):186–188CrossRef
21.
Zurück zum Zitat Manning WJ et al (1993) Atrial ejection force: a noninvasive assessment of atrial systolic function. J Am Coll Cardiol 22(1):221–225CrossRef Manning WJ et al (1993) Atrial ejection force: a noninvasive assessment of atrial systolic function. J Am Coll Cardiol 22(1):221–225CrossRef
Metadaten
Titel
Cardiac magnetic resonance derived atrial function in patients with a Fontan circulation
verfasst von
Paul J. Critser
Vien Truong
Adam W. Powell
Hassan Almeneisi
Alexander R. Opotowsky
Nicholas J. Ollberding
Janvi Gandhi
Adam M. Lubert
Wojciech Mazur
Sean M. Lang
Justin T. Tretter
Michael D. Taylor
Tarek Alsaied
Publikationsdatum
04.08.2020
Verlag
Springer Netherlands
Erschienen in
The International Journal of Cardiovascular Imaging / Ausgabe 1/2021
Print ISSN: 1569-5794
Elektronische ISSN: 1875-8312
DOI
https://doi.org/10.1007/s10554-020-01959-6

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