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Myocardial and Atrial Strain Profiles in Pediatric Fontan Patients with Single Left Ventricle Using Two-Dimensional
Carmen Corina Șuteu1,2, Andreea Cerghit-Paler1, Liliana Gozar1,2
1Department of Pediatrics III, "George Emil Palade" University of Medicine, Pharmacy, Science, and Technology of Târgu Mureș, 540139 Târgu-Mureș, Romania.
Insights
Pediatric Fontan patients with single left ventricle anatomy show subclinical myocardial and atrial dysfunction using strain imaging, even with normal ejection fraction. This advanced echocardiography detects early signs of ventricular dysfunction in high-risk children.
Area of Science:
- Cardiology
- Pediatric Cardiology
- Echocardiography
Background:
- Children with single left ventricle (SLV) anatomy post-Fontan palliation face high risks of subclinical ventricular dysfunction.
- Conventional echocardiography may not detect these early cardiac changes.
Purpose of the Study:
- Assess myocardial and atrial strain profiles in pediatric Fontan patients with SLV using 2D-STE.
- Compare these profiles with healthy controls.
- Correlate strain findings with conventional echocardiographic and functional parameters.
Main Methods:
- A single-center study involving 66 pediatric patients who underwent echocardiography and a 6-minute walk test (6 MWT).
- Comparison of conventional, 3D, and strain-based echocardiographic parameters between Fontan patients and controls.
- Correlation analysis using ANCOVA, generalized additive models, and Pearson's correlation coefficient.
Main Results:
- Fontan patients exhibited significantly reduced 6 MWT distances and impaired post-test heart rate and oxygen saturation.
- 3D echocardiography showed lower left ventricular (LV) ejection fraction and higher LV volumes in Fontan patients.
- Global longitudinal strain (LV_GLS) was significantly reduced in Fontan patients, alongside decreased left atrial (LA) reservoir and conduit strain.
Conclusions:
- Myocardial and atrial strain imaging effectively reveals subclinical cardiac dysfunction in pediatric Fontan patients.
- Strain parameters offer a more sensitive assessment of ventricular function than conventional echocardiography in this population.
- These findings highlight the utility of advanced echocardiographic techniques for early detection of dysfunction in high-risk pediatric cardiac patients.
Abstract:
Background/Objectives: Children with single left ventricle (SLV) anatomy following Fontan palliation are at high risk for subclinical ventricular dysfunction, which may not be detected by conventional echocardiographic measures. Our objectives are as follows: (1) to assess myocardial and atrial strain profiles in pediatric Fontan patients with SLV using 2-dimensional speckle-tracking echocardiography (2D-STE), (2) to compare these findings with a healthy control group, (3) to investigate correlations with conventional echocardiographic and functional parameters. Methods: A single-center study of 66 pediatric patients, who underwent echocardiographic evaluation and a 6 min walk test (6 MWT). Conventional, 3D, and strain-based echocardiographic parameters were compared between groups. Correlations with clinical and functional indices were assessed using ANCOVA, analysis, generalized additive models, and Pearson's correlation coefficient. Results: Fontan patients showed significantly reduced 6 MWT distances compared to controls (mean difference: 201.6 m, p < 0.0001). Post-test heart rate (HR) and oxygen saturation were significantly impaired (HR: 104.6 vs. 100.8 bpm, p = 0.0012; SaO2: 90.3% vs. 99.8%, p < 0.0001). Fontan patients showed statistically significant differences in nearly all the 2D parameters. Three-dimensional echocardiography revealed significantly lower left ventricular (LV) ejection fraction (p = 0.0020), higher end-diastolic (p = 0.0275) and end-systolic volumes (p = 0.0125) in the study group. Global longitudinal strain (LV_GLS) was reduced in Fontan patients compared to controls (p < 0.0001), with significant differences across nearly all LV segments. Left atrial (LA) reservoir and conduit strain were markedly decreased, while contractile strain remained similar. LV_GLS was negatively correlated with IVCT (r = -0.50, p = 0.0175). The LA reservoir strain (LASr_AC) significantly correlated with MAPSE (r = 0.43, p = 0.0461). Conclusions: In pediatric Fontan patients, myocardial and atrial strain imaging reveals subclinical dysfunction despite preserved conventional ejection fraction.
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