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Diastolic dysfunction: assessment and implications on the single ventricle circulation
Ahmed A Hassan1, Alexander Van De Bruaene2, Mark K Friedberg1
1Division of Cardiology, The Labatt Family Heart Center, Hospital for Sick Children and University of Toronto, Toronto, Ontario, Canada.
Insights
Diastolic dysfunction (DD) is common in single ventricle (SV) patients and linked to poor outcomes. New methods are emerging to better assess DD and guide treatment in these complex Fontan patients.
Area of Science:
- Cardiology
- Pediatric Cardiology
- Congenital Heart Disease
Background:
- Single ventricle (SV) physiology requires palliative Fontan circulation.
- Heart failure is a common long-term complication in SV patients.
- Diastolic dysfunction (DD) significantly impacts outcomes but is challenging to assess.
Purpose of the Study:
- To review current literature on assessing DD in SV patients.
- To explore the relationship between DD and clinical outcomes.
- To highlight emerging techniques for DD evaluation.
Main Methods:
- Literature review of recent studies on DD in SV.
- Analysis of diagnostic approaches including provocative testing and advanced imaging.
- Exploration of novel technologies like ultrafast ultrasound (UFUS).
Main Results:
- DD is prevalent in SV patients and associated with adverse outcomes.
- Provocative testing and strain imaging improve DD detection.
- Emerging technologies like UFUS offer new insights into myocardial and hemodynamic properties.
Conclusions:
- Assessing DD in SV patients remains complex, requiring integrated parameter analysis.
- New techniques show promise for improved DD assessment and treatment monitoring.
- Further research is needed to refine DD characterization and management strategies.
Purpose Of Review:
Patients with a functionally single ventricle (SV) are palliated with a series of procedures leading to a Fontan circulation. Over the life span, a substantial proportion of SV patients develop heart failure that can arise from circulatory or ventricular failure. Diastolic dysfunction (DD) is an important determinant of adverse outcomes in SV patients. However, assessment and categorization of DD in the SV remains elusive. We review recent literature and developments in assessment of DD in the SV and its relation to clinical outcomes.
Recent Findings:
DD is prevalent in the SV and associated with worse outcomes. Occult DD can be exposed with provocative testing by exercise or preload challenge during catheterization. Likewise, sensitivity to detect DD may be increased via assessment of atrial function and strain imaging. Recent studies revisiting previous concepts such as incoordinate diastolic wall motion show that these are associated with SV end-diastolic pressures and post-Fontan recovery, yielding accessible DD assessment. Emerging technologies such as ultrafast ultrasound (UFUS) can provide noninvasive assessment of myocardial stiffness, inefficient diastolic flow patterns and intraventricular pressure gradients, thereby yielding new tools and insights into diastolic myocardial and hemodynamic properties.
Summary:
Characterizing DD in the SV continues to have substantial limitations, necessitating synthesis of multiple parameters into an overall assessment, accounting for their change over time, and in the context of the patient's clinical status. New and emerging techniques may help advance DD assessment and the ability to track response to treatment of new targets.
