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Single ventricular strain measures correlate with peak oxygen consumption in children and adolescents with Fontan
Suma Goudar1, Daniel Forsha2,3, David A White2,3
1Children's National Heart Institute, Department of Pediatrics, Washington, DC, USA.
Insights
Echocardiographic strain analysis in children post-Fontan palliation correlates with peak oxygen consumption. Ventricular mechanics, including global longitudinal strain and dyssynchrony, are linked to exercise capacity, offering insights into Fontan circulation efficiency.
Area of Science:
- Pediatric Cardiology
- Cardiovascular Physiology
- Medical Imaging
Background:
- Children with single ventricle physiology after Fontan palliation face elevated risks of adverse outcomes.
- Peak oxygen consumption (VO2peak) serves as a key surrogate marker for functional capacity in this population.
Purpose of the Study:
- To investigate the association between VO2peak and echocardiographic measures of ventricular function and deformation.
- Specifically, to evaluate global longitudinal strain and ventricular dyssynchrony in pediatric Fontan patients.
Main Methods:
- Prospective recruitment of patients aged 8-21 years with single ventricle post-Fontan palliation.
- Echocardiography with 2D speckle tracking and cardiopulmonary exercise testing to maximal volitional fatigue.
Main Results:
- VO2peak correlated significantly with global longitudinal strain (r = -0.435, p = 0.007) and strain discoordination (r = -0.48, p = 0.003).
- Electromechanical dyssynchrony patterns (p = 0.008) were also associated with VO2peak, independently of age and sex.
- Single right ventricle morphology showed potential diastolic dysfunction (p = 0.001) compared to single left or biventricular morphologies.
Conclusions:
- Echocardiographic strain analysis metrics are significantly correlated with VO2peak in pediatric Fontan survivors.
- Ventricular mechanics, assessed by strain, appear to influence the efficiency of the Fontan circulation.
- These findings highlight the potential of echocardiography for assessing functional status in this high-risk group.
Introduction:
Children with a single ventricle post-Fontan palliation are at increased risk of poor outcomes with peak oxygen consumption acting as a surrogate outcome marker. The purpose of this study is to evaluate the relationship between peak oxygen consumption and echocardiographic measures of ventricular function and deformation, including ventricular global longitudinal strain and dyssynchrony, in children and adolescents following Fontan palliation.
Methods:
Patients (age 8-21 years) with single ventricle post-Fontan palliation were prospectively recruited and participated in an echocardiogram, including views optimised for two-dimensional speckle tracking, and a cardiopulmonary exercise test on a cycle ergometer to maximal volitional fatigue.
Results:
Thirty-eight patients (mean age 13.7 ± 2.3 years) post-Fontan palliation had either a single left ventricular (n = 20), single right ventricular (n = 14), or biventricular (n = 4) morphology. Peak oxygen consumption (24.9 ± 5.6 ml/kg/minute) was correlated with global longitudinal strain (r = -0.435, p = 0.007), a strain discoordination time to peak index (r = -0.48, p = 0.003), and the presence of an electro-mechanical dyssynchrony strain pattern (p = 0.008). On multivariate regression modelling, these three variables were associated with peak oxygen consumption independently of age and sex. The single right ventricular group had evidence of possible diastolic dysfunction by E/e' compared to the single left ventricular and biventricular groups (p = 0.001).
Conclusions:
Strain analysis measures are correlated with peak oxygen consumption in this cohort of children, adolescents, and young adults following Fontan palliation, suggesting that ventricular mechanics may influence the efficiency of the Fontan circulation.
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