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The Evolution of Longitudinal Strain Across Various Univentricular Morphologies Prior to Superior Cavopulmonary

Amulya Buddhavarapu¹, Dhaval Chauhan¹, Lori A Erickson²

¹Department of Pediatric Cardiology, Ward Family Heart Center, Children's Mercy Hospital, University of Missouri at Kansas City, Kansas City, Missouri.

Journal of the American Society of Echocardiography : Official Publication of the American Society of Echocardiography

|May 4, 2023

Insights

Longitudinal strain (LS) in infants with single-ventricle physiology improved overall before superior cavopulmonary anastomosis (SCPA) surgery, but not in the single right ventricle group. Lower LS correlated with unplanned reinterventions.

Area of Science:

Pediatric Cardiology
Echocardiography
Congenital Heart Disease

Background:

Infants with single-ventricle physiology face high risks before superior cavopulmonary anastomosis (SCPA).
Echocardiography-derived longitudinal strain (LS) is a key metric for assessing single-ventricle function.
Understanding LS evolution in different univentricular morphologies is crucial.

Purpose of the Study:

To analyze the changes in longitudinal strain (LS) during the pre-SCPA period in infants with various univentricular morphologies.
To identify factors associated with LS, including modifiable and nonmodifiable variables.
To explore the relationship between LS and clinical outcomes like unplanned reinterventions.

Main Methods:

Serial echocardiographic analysis of LS in 94 infants with univentricular physiology before SCPA.
Tracking ventricular myocardium strain in single right ventricle (RV), single left ventricle (LV), and biventricular (BiV) morphology groups.
Correlating LS with clinical data, including arrhythmias and reinterventions.

Main Results:

Overall LS improved significantly (P=.003) from 16.48% to 17.57% during the pre-SCPA period.
LS improved in single LV and BiV groups but not in the single RV group (P=.7).
The single RV group, often hypoplastic left heart syndrome, showed lower LS and higher rates of arrhythmias (57%) and unplanned reinterventions (60%). Lower LS was independently linked to unplanned reinterventions (P=.008 and .02).

Conclusions:

Longitudinal strain (LS) dynamics vary across different univentricular morphologies before SCPA.
Lower LS in the single RV group, predominantly hypoplastic left heart syndrome, highlights a vulnerable population.
LS is a significant predictor of the need for unplanned cardiac reinterventions in this cohort.

Read full analysis

Abstract

Background:

Infants with single-ventricle physiology have increased morbidity, mortality, and ventricular dysfunction in the pre-superior cavopulmonary anastomosis (pre-SCPA) period. Echocardiography-derived longitudinal strain (LS) is emerging as a reliable marker of single-ventricle performance. We aim to assess evolution of LS during the pre-SCPA period across univentricular morphologies and explore associations of LS with modifiable and nonmodifiable factors.

Methods:

Ninety-four term infants (36 females) with univentricular physiology who were discharged home prior to stage 2 palliation were serially analyzed for LS (single apical view) and other echo measures at initial hospital discharge and the last pre-SCPA encounter. Ventricular myocardium was tracked for strain along the septum and respective lateral wall for single right ventricular (RV) and left ventricular (LV) groups, and along both right and left lateral walls in functionally univentricular hearts with biventricular (BiV) morphology. Clinical data were obtained from the medical record.

Results:

Longitudinal strain improved in the total cohort during the pre-SCPA period (16.48% ± 3.31% to 17.57% ± 3.81%, P = .003). Longitudinal strain improved between encounters in the single LV (P = .04) and BiV groups (P = .02). However, LS failed to improve in the RV group (P = .7) with lower LS at both visits compared with the other groups. The RV group, mostly composed of hypoplastic left heart syndrome patients-87% of cases-had a higher incidence of arrhythmias (57%) and unplanned reinterventions (60%), most of which were arch reinterventions. A subanalysis based on arch reintervention showed that LS improves between encounters in the single LV group needing arch reintervention (P = .05) compared with the single RV group needing arch reintervention (P = .89). Lower LS was independently associated with unplanned reinterventions at both encounters (P = .008 and .02).

Conclusions:

Single-ventricle LS evolves differently across ventricular morphologies during the pre-SCPA period and is related to the need for unplanned cardiac reinterventions. Lower LS is noted in the single RV group, who mostly have hypoplastic left heart syndrome.

Keywords:

Global longitudinal strain Infant Interstage Single ventricle Ventricular function

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