Two-dimensional speckle strain and dyssynchrony in single right ventricles versus normal right ventricles

Patients with single-right ventricle (RV) physiology are at increased risk for myocardial dysfunction and mechanical dyssynchrony. Newer echocardiographic modalities may be better able to quantitate right ventricular function in this unique population. The aim of this study was to use two-dimensional speckle analysis of strain and strain rate to quantify systolic function and dyssynchrony in single-RV post-Fontan patients and compare them with values for controls.

Patients with single RV who underwent Fontan palliation and patients with normal biventricular anatomy were studied. Two-dimensional speckle echocardiography was used to measure strain, strain rate, time to peak, and longitudinal displacement in a 6-segment model of the RV. Independent t tests were used to compare group means. P values < .05 were considered significant.

Thirteen patients were studied in each group. There was no significant difference in age between single-RV patients and controls (6.60 +/- 2.07 vs 5.75 +/- 1.83 years, respectively). Single-RV strain values were significantly lower in all 6 segments compared with values in controls (basal interventricular septum [IVS], -14.28 +/- 7.78% vs -22.00 +/- 2.36%; mid IVS, -17.70 +/- 4.54% vs -22.99 +/- 2.71%; apical IVS, -19.46 +/- 4.97% vs -25.42 +/- 4.06%; basal RV, -22.40 +/- 5.7% vs -41.42 +/- 5.42%; mid RV, -21.20 +/- 3.21% vs -39.67 +/- 6.04%; apical RV, -20.70 +/- 4.90% vs -33.68 +/- 3.90%). Systolic strain rate and longitudinal displacement were also lower in the free wall and apical IVS in single-RV patients compared with controls. The modified Yu index for strain time to peak was longer in the single-RV patients (43.16 +/- 13.63 vs 21.72 +/- 7.25 ms).

Significant differences in strain analysis between single-RV patients and patients with biventricular physiology exist at a relatively young age. Future studies are needed to determine the clinical significance of these differences.