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Assessing Single Ventricle Function in the Fontan Circulation using Wave Intensity Analysis
John Valdovinos1, Nicolas Eng2, Matthew Russell3
1Electrical and Computer Engineering Department, California State University Northridge, 18111 Nordhoff St., Northridge, CA, 91330, USA. john.valdovinos@csun.edu.
Insights
Wave intensity analysis shows distinct hemodynamic differences in Fontan circulation patients, potentially aiding in early detection of heart failure and predicting outcomes in single ventricle heart disease.
Area of Science:
- Cardiovascular Physiology
- Hemodynamics
- Pediatric Cardiology
Background:
- Single ventricle hearts repaired with the Fontan operation often develop long-term complications due to elevated venous pressures and impaired ventricular function.
- Assessing the hemodynamics in these patients is crucial for predicting clinical outcomes and managing potential heart failure.
Purpose of the Study:
- To evaluate the clinical utility of wave intensity analysis (WIA) in assessing the functional performance of single ventricle hearts in Fontan patients.
- To compare hemodynamic parameters derived from WIA between Fontan patients and controls with biventricular circulation.
Main Methods:
- A retrospective analysis of invasive hemodynamic data from cardiac catheterizations was performed.
- WIA was applied to aortic pressure waveforms and Doppler measurements in 20 Fontan patients and 10 controls.
- Key parameters including peak forward compression wave, early systolic energy flux, and systolic/diastolic ratio were calculated.
Main Results:
- Significant differences were observed in peak forward compression wave, early systolic energy flux, and systolic/diastolic ratio between Fontan patients and controls.
- A positive correlation was found between wave speed and pulmonary vascular resistance within the Fontan group.
- Early systolic energy flux showed potential as an indicator for heart failure classification in Fontan patients (AUC=0.71).
Conclusions:
- Wave intensity analysis is a promising tool for evaluating hemodynamics in Fontan patients.
- WIA may aid in screening, predicting clinical outcomes, and identifying Fontan failure.
- Further prospective studies are warranted to confirm these findings.
Abstract:
Single ventricle hearts palliated with the Fontan operation present complications later in life as a result of increased venous pressures and abnormal ventricle function. Wave intensity analysis uses measurements of blood velocity and pressure to represent arterial hemodynamics as summations of energy waves. This methodology could potentially be a useful tool in assessment of Fontan patients. The clinical value of wave intensity parameters was utilized to evaluate the functional performance of the single ventricle in Fontan patients. A retrospective analysis of invasive hemodynamic data was retrospectively obtained from routine cardiac catheterization of patients with Fontan circulation (n = 20) and comparison to those with biventricular circulation (n = 10) who presented to the catheterization laboratory for closure of small patent ductus arteriosus (PDAs). Wave intensity analysis and wave energy flux was calculated using aortic pressure waveforms and echocardiography aortic Doppler measurements as previously described. Significant differences were seen in the peak forward compression wave (p = 0.013), early systolic energy flux (p = 0.005) and the systolic and diastolic ratio (p = 0.006) in Fontan patients versus controls. Within the Fontan group, there was a positive correlation (0.54, p = 0.02) between the wave speed and pulmonary vascular resistance. Early systolic energy flux was a potential individual indicator of a Fontan patients heart failure classification (AUC = 0.71). Wave intensity analysis could be a useful tool in screening Fontan patients and predicting clinical outcomes and Fontan failure. Future prospective analyses of Fontan hemodynamics and WIA are needed.
