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Published on: December 13, 2019
Echocardiographic assessment of atrial properties in single ventricles vs. normal controls
Jack R Stines1, Jared A Hershenson, John Hayes
1The Heart Center, Nationwide Children's Hospital, The Ohio State University, Columbus, Ohio 43205, USA. jack.stines@nationwidechildrens.org
Insights
Patients with single ventricle physiology after Fontan completion show altered atrial properties, including higher atrial fraction and lower diastolic function, compared to controls. These changes may impact long-term cardiac health.
Area of Science:
- Pediatric Cardiology
- Cardiac Physiology
- Congenital Heart Disease
Background:
- Atrial function is crucial for overall cardiac performance in adults.
- Limited research exists on atrial properties in pediatric congenital heart disease patients.
- The Fontan procedure is a common surgical intervention for single ventricle physiology.
Purpose of the Study:
- To evaluate atrial properties in pediatric patients with single ventricle physiology post-Fontan completion.
- To compare these atrial properties with those of healthy control subjects.
- To identify potential implications for long-term outcomes in this patient population.
Main Methods:
- Echocardiography was utilized to assess atrial properties in both single ventricle and control groups.
- Tissue Doppler imaging and blood flow measurements were performed.
- Key metrics including atrial fraction, E/A ratio, and electromechanical values were calculated and analyzed using ANOVA.
Main Results:
- Single ventricle patients exhibited a significantly higher tricuspid valve A wave and atrial fraction compared to controls.
- Lower E/A ratios and late diastolic annular velocities were observed in single ventricle patients.
- While atrial electromechanical measurements showed no significant difference, increased atrial dyssynchrony was noted in single ventricle patients.
Conclusions:
- Patients with single ventricle physiology post-Fontan completion demonstrate distinct atrial property profiles.
- These identified differences in atrial function may influence long-term clinical outcomes.
- Further research is warranted to elucidate the clinical significance of these findings.
Introduction:
Atrial function is increasingly being recognized as a significant factor in overall cardiac function in adults. Limited studies evaluating atrial properties exist in the pediatric congenital heart disease population. The goal of this study was to evaluate atrial properties in patients with single ventricle physiology after Fontan completion and compare these values with normal control patients.
Methods:
Echocardiograms were performed in patients with single ventricular physiology and in control patients. Tissue Doppler and blood flow measurements were obtained. Atrial fraction and atrial electromechanical values were calculated. Differences were assessed with one-way analysis of variance. Post hoc comparisons were performed with Tukey adjustment. P < .05 was considered significant.
Results:
No significant difference was present in age or heart rate between single ventricle and control patients. The single right ventricle tricuspid valve A wave (52.6 ± 14.5 vs. 36.7 ± 10.4 cm/s) and atrial fraction (39.2 ± 6.2 vs. 32.7 ± 7.7%) were significantly higher, and the E/A ratio (1.4 + 0.3 vs. 1.8 + 0.4), tricuspid valve E/A velocity-time integral (1.6 + 0.4 vs. 2.2 + 0.7 cm), and late diastolic annular value (5.3 + 1.5 vs. 8.7 + 1.4 cm/s) were significantly lower compared with the controls. The single left ventricle late diastolic annular velocity (4.2 + 1.0 vs. 6.7 + 1.3 cm/s) was significantly lower and atrial fraction was significantly higher compared with the controls (37.7 ± 12.5 vs. 29.8 ± 4.3%). There were no significant differences in atrial electromechanical measurements between groups, but the single right ventricle patients tended to have increased atrial dyssynchrony compared with controls.
Conclusions:
Patients with single ventricle physiology after Fontan completion have differences in atrial properties when compared with normal controls. These differences may have important implications in their long-term outcomes. Further studies are necessary to determine the clinical significance of these findings.
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