Ventricular dyssynchrony late after the Fontan operation is associated with decreased survival
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12968_2023_Article_984.pdf
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Author(s)
Gearhart, Addison
Bassi, Sunakshi
Rathod, Rahul H.
Beroukhim, Rebecca S.
Lipsitz, Stuart
Gold, Maxwell P.
Harrild, David M.
Dionne, Audrey
Ghelani, Sunil J.
Date Issued
November 20, 2023
Publisher
BioMed Central
Citation
Journal of Cardiovascular Magnetic Resonance. 2023 Nov 20;25(1):66
Version
Final published version
Abstract
Abstract
Background
Ventricular dyssynchrony and its relationship to clinical outcomes is not well characterized in patients following Fontan palliation.
Methods
Single-center retrospective analysis of cardiac magnetic resonance (CMR) imaging of patients with a Fontan circulation and an age-matched healthy comparison cohort as controls. Feature tracking was performed on all slices of a ventricular short-axis cine stack. Circumferential and radial strain, strain rate, and displacement were measured; and multiple dyssynchrony metrics were calculated based on timing of these measurements (including standard deviation of time-to-peak, maximum opposing wall delay, and maximum base-to-apex delay). Primary endpoint was a composite measure including time to death, heart transplant or heart transplant listing (D/HTx).
Results
A total of 503 cases (15 y; IQR 10, 21) and 42 controls (16 y; IQR 11, 20) were analyzed. Compared to controls, Fontan patients had increased dyssynchrony metrics, longer QRS duration, larger ventricular volumes, and worse systolic function. Dyssynchrony metrics were higher in patients with right ventricular (RV) or mixed morphology compared to those with LV morphology. At median follow-up of 4.3 years, 11% had D/HTx. Multiple risk factors for D/HTx were identified, including RV morphology, ventricular dilation, dysfunction, QRS prolongation, and dyssynchrony. Ventricular dilation and RV morphology were independently associated with D/HTx.
Conclusions
Compared to control LVs, single right and mixed morphology ventricles in the Fontan circulation exhibit a higher degree of mechanical dyssynchrony as evaluated by CMR-FT. Dyssynchrony indices correlate with ventricular size and function and are associated with death or need for heart transplantation. These data add to the growing understanding regarding factors that can be used to risk-stratify patients with the Fontan circulation.
MIT Department
Massachusetts Institute of Technology. Computational and Systems Biology Program
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DOI of Published Version
https://doi.org/10.1186/s12968-023-00984-3
