Tissue Motion Annular Displacement Predicts Mortality/Transplant After the Bidirectional Glenn

Area of Science:

• Pediatric Cardiology
• Echocardiography
• Congenital Heart Disease

Background:

• Assessing right ventricular (RV) function in patients with a systemic RV is crucial for prognosis but challenging.
• Tissue motion annular displacement (TMD) tracks tricuspid annulus movement towards the apex.
• Fractional area change (FAC) is another common RV function metric.

Purpose of the Study:

• To evaluate TMD and FAC as predictors of outcomes in patients with a single RV before the bidirectional Glenn procedure.
• To compare the prognostic utility of TMD and FAC in this specific pediatric population.

Main Methods:

• Retrospective analysis of echocardiographic clips for TMD and FAC measurements.
• Chart review for postoperative outcomes and midterm mortality/transplant data.
• Bivariate correlations and Cox proportional hazards models were employed for statistical analysis.

Main Results:

• Neither TMD nor FAC correlated with short-term postoperative outcomes in 51 patients (median age 4 months).
• TMD was independently predictive of midterm mortality/transplant (P=.03), with lower mean values in non-survivors/transplant recipients (10.0% vs 12.4%).
• TMD demonstrated good intra-observer (2.8%) and inter-observer (6.1%) variability, while FAC was not predictive.

Conclusions:

• TMD is an independent predictor of midterm mortality/transplant post-bidirectional Glenn procedure in single RV patients.
• TMD may outperform FAC in predicting outcomes and exhibits good reproducibility.
• TMD can be a valuable tool for identifying high-risk children with a single RV.