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Optimal Heart Rate May Improve Systolic and Diastolic Function in Patients with Fontan Circulation

Keiichi Hirono1, Teruhiko Imamura2, Kaori Tsuboi1

  • 1Department of Pediatrics, Faculty of Medicine, University of Toyama, Toyama 930-0194, Japan.

Journal of Clinical Medicine
|April 28, 2023
PubMed

Insights

In Fontan circulation patients, echocardiographic overlap length, reflecting ventricular dysfunction, decreased over one year. Lower heart rates may improve cardiac remodeling.

Area of Science:

  • Pediatric Cardiology
  • Cardiovascular Physiology
  • Echocardiography

Background:

  • Optimal heart rate in systolic heart failure maximizes cardiac output by preventing transmitral flow Doppler E-wave and A-wave overlap.
  • The clinical significance of echocardiographic overlap length in Fontan circulation remains unclear.
  • This study explores heart rate and hemodynamics in Fontan patients, with and without beta-blockers.

Purpose of the Study:

  • To investigate the relationship between heart rate (HR) and hemodynamics in patients with Fontan circulation.
  • To assess the clinical implication of echocardiographic overlap length in this population.
  • To compare hemodynamic parameters in Fontan patients with and without beta-blocker therapy.

Main Methods:

  • Enrolled 26 Fontan patients (median age 1.8 years).
  • Measured baseline plasma N-terminal pro-B-type natriuretic peptide, fraction area change, cardiac index, and transmitral flow Doppler overlap length.
  • Followed patients for one year, reassessing hemodynamic parameters.

Main Results:

  • Baseline overlap length was 45.2 ± 59.0 msec, significantly decreasing to 7.60 ± 78.57 msec at one-year follow-up (p=0.0069).
  • Positive correlations observed between overlap length and A-wave, and E/A ratio (p=0.0021, p=0.0046).
  • Ventricular end-diastolic pressure correlated with overlap length in non-beta-blocker patients (p=0.0483).

Conclusions:

  • Echocardiographic overlap length may serve as an indicator of ventricular dysfunction in Fontan circulation.
  • Maintaining hemodynamic stability at lower heart rates appears crucial for cardiac reverse remodeling in these patients.

Keywords:
Fontanheart failureheart rateoverlap length

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