Myocardial Deformation in Fontan Patients Assessed by Cardiac Magnetic Resonance Feature Tracking: Correlation with Function, Clinical Course, and Biomarkers

AbstractCardiac MR (CMR) is a standard modality for assessing ventricular function of single ventricles. CMR feature-tracking (CMR-FT) is a novel application enabling strain measurement on cine MR images and is used in patients with congenital heart diseases. We sought to assess the feasibility of CMR-FT in Fontan patients and analyze the correlation between CMR-FT strain values and conventional CMR volumetric parameters, clinical findings, and biomarkers. Global circumferential (GCS) and longitudinal (GLS) strain were retrospectively measured by CMR-FT on Steady-State Free Precession cine images. Data regarding post-operative course at Fontan operation, and medication, exercise capacity, invasive hemodynamics, and blood biomarkers at a time interval ± 6 months from CMR were collected. Forty-seven patients underwent CMR 11 ± 6 years after the Fontan operation; age at CMR was 15 ± 7 years. End-diastolic volume (EDV) of the SV was 93 ± 37 ml/m2, end-systolic volume (ESV) was 46 ± 23 ml/m2, and ejection fraction (EF) was 51 ± 11%. Twenty (42%) patients had a single right ventricle (SRV). In single left ventricle (SLV), GCS was higher (p < 0.001), but GLS was lower (p = 0.04) than in SRV. GCS correlated positively with EDV (p = 0.005), ESV (p < 0.001), and EF (p ≤ 0.0001). GLS correlated positively with EF (p = 0.002), but not with ventricular volumes. Impaired GCS correlated with decreased ventricular function (p = 0.03) and atrioventricular valve regurgitation (p = 0.04) at echocardiography, direct atriopulmonary connection (p = 0.02), post-operative complications (p = 0.05), and presence of a rudimentary ventricle (p = 0.01). A reduced GCS was associated with increased NT-pro-BNP (p = 0.05). Myocardial deformation can be measured by CMR-FT in Fontan patients. SLVs have higher GCS, but lower GLS than SRVs. GCS correlates with ventricular volumes and EF, whereas GLS correlates with EF only. Myocardial deformation shows a relationship with several clinical parameters and NT-pro-BNP.

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Comparison of cardiac MR feature tracking and myocardial MR tagging for assessment of regional ventricular function

European Heart Journal ◽

10.1093/ehjci/ehaa946.0242 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

I Del Canto Serrano ◽

P Tejero ◽

M.P Lopez-Lereu ◽

J.V Monmeneu ◽

V Bodi ◽

...

Keyword(s):

Ventricular Function ◽

Feature Tracking ◽

Intraclass Correlation ◽

Myocardial Strain ◽

Funding Source ◽

Post Processing ◽

National Budget ◽

Cine Mr ◽

Cmr Tagging ◽

Regional Ventricular Function

Abstract Background Quantification of regional myocardial function allows risk stratification in heart disease. CMR tagging (TAG) enables the evaluation of segmental cardiac deformation, but it has not reached clinical routine due to the long acquisition and post-processing times. Conversely, CMR feature-tracking (FT) is a post-processing method based on standard cine-MR imaging. Purpose To compare myocardial strain and torsion obtained with CMR-TAG and CMR-FT in healthy volunteers and myocardial infarction (MI). Methods 42 subjects (18 healthy; 24 MI) underwent CMR (1.5T, cine/TAG sequences). Global and segmental (16-segment) circumferential strain (CS), and torsion were measured using FT (CVI42, Canada) and tagging (InTag, France). Inter-method agreement was assessed using 2-way-mixed intraclass correlation coefficient (ICC). Results The agreement for segmental and global CS measurements was good to excellent in both groups (Table). Torsion angle showed excellent (0.763) and good (0.697) agreement for healthy and MI. Conclusion CMR-FT strain and torsion measurements showed high agreement with CMR-tagging. Thus, CMR-FT provides a potential clinical alternative in the assessment of regional ventricular function. Funding Acknowledgement Type of funding source: Public grant(s) – National budget only. Main funding source(s): Carlos III Health Institute, Spanish Ministry of Economy and Competiveness; Agencia Valenciana de la Innovaciόn, Generalitat Valenciana

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N-terminal pro-brain natriuretic peptide serum levels reflect attrition of the Fontan circulation

Cardiology in the Young ◽

10.1017/s1047951120000657 ◽

2020 ◽

Vol 30 (6) ◽

pp. 753-760

Author(s):

Djoeke Wolff ◽

Joost P. van Melle ◽

Tineke P. Willems ◽

Beatrijs Bartelds ◽

Mark-Jan Ploegstra ◽

...

Keyword(s):

Brain Natriuretic Peptide ◽

Ventricular Function ◽

Natriuretic Peptide ◽

Heart Diseases ◽

Nyha Class ◽

Fontan Circulation ◽

Peak Exercise ◽

Class Iii ◽

Z Scores ◽

Fontan Patients

AbstractObjective:N-terminal pro-brain natriuretic peptide has an established role in the diagnosis and prognosis of heart failure. In Fontan patients, this peptide is often increased, but its diagnostic value in this particular non-physiologic, univentricular circulation is unclear. We investigated whether N-terminal pro-brain natriuretic peptide represents ventricular function or other key variables in Fontan patients.Methods and results:Ninety-five consecutive Fontan patients ≥10 years old who attended the outpatient clinic of the Center for Congenital Heart Diseases in 2012–2013 were included. Time since Fontan completion was 16 ± 9 years. Median N-terminal pro-brain natriuretic peptide was 114 (61–264) ng/l and was higher than gender-and age-dependent normal values in 54% of the patients. Peptide Z-scores were higher in patients in NYHA class III/IV compared to those in class I/II, but did not correlate with ventricular function assessed by MRI and echocardiography, nor with peak exercise capacity. Instead, peptide Z-scores significantly correlated with follow-up duration after Fontan completion (p < 0.001), right ventricular morphology (p = 0.004), indexed ventricular mass (p = 0.001), and inferior caval vein diameter (p < 0.001) (adjusted R2 = 0.615).Conclusions:N-terminal pro-brain natriuretic peptide levels in Fontan patients correlate with functional class, but do not necessarily indicate ventricular dysfunction. Increased peptide levels were associated with a longer existence of the Fontan circulation, morphologic ventricular characteristics, and signs of increased systemic venous congestion. Since the latter are known to be key determinants of the performance of the Fontan circulation, these findings suggest increase in N-terminal pro-brain natriuretic peptide levels to indicate attrition of the Fontan circulation, independent of ventricular function.

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Success in a Fontan pregnancy: how important is ventricular function?

Cardiology in the Young ◽

10.1017/s1047951118001865 ◽

2018 ◽

Vol 29 (2) ◽

pp. 225-227

Author(s):

M. Victoria Ordonez ◽

Johanna Trinder ◽

Stephanie L. Curtis

Keyword(s):

High Risk ◽

Ventricular Function ◽

Surgical Procedure ◽

Fontan Operation ◽

Fetal Outcome ◽

Haemodynamic Changes ◽

Fontan Patients ◽

In Pregnancy

AbstractThe Fontan operation is a palliative surgical procedure for patients whose hearts cannot support a biventricular circulation. The haemodynamic changes that occur in pregnancy are particularly challenging for Fontan patients and the outcomes are variable. We present a case where fetal outcome was particularly poor despite a lack of high risk features pre-pregnancy.

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Faculty Opinions recommendation of Biventricular dyssynchrony on cardiac magnetic resonance imaging and its correlation with myocardial deformation, ventricular function and objective exercise capacity in patients with repaired tetralogy of Fallot.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.733082758.793564203 ◽

2019 ◽

Author(s):

Willem Helbing

Keyword(s):

Magnetic Resonance Imaging ◽

Cardiac Magnetic Resonance ◽

Magnetic Resonance ◽

Cardiac Magnetic Resonance Imaging ◽

Ventricular Function ◽

Tetralogy Of Fallot ◽

Exercise Capacity ◽

Myocardial Deformation ◽

Resonance Imaging ◽

Repaired Tetralogy Of Fallot

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Impact of the Fontan Operation on Organ Systems

Cardiovascular & Haematological Disorders - Drug Targets ◽

10.2174/1871529x19666190211165124 ◽

2019 ◽

Vol 19 (3) ◽

pp. 205-214

Author(s):

Miriam Michel ◽

Manuela Zlamy ◽

Andreas Entenmann ◽

Karin Pichler ◽

Sabine Scholl-Bürgi ◽

...

Keyword(s):

Systematic Study ◽

Fontan Operation ◽

Gastrointestinal System ◽

Adjunct Treatment ◽

Organ Systems ◽

Fontan Surgery ◽

Fontan Patients

: In patients having undergone the Fontan operation, besides the well discussed changes in the cardiac, pulmonary and gastrointestinal system, alterations of further organ systems including the hematologic, immunologic, endocrinological and metabolic are reported. As a medical adjunct to Fontan surgery, the systematic study of the central role of the liver as a metabolizing and synthesizing organ should allow for a better understanding of the pathomechanism underlying the typical problems in Fontan patients, and in this context, the profiling of endocrinological and metabolic patterns might offer a tool for the optimization of Fontan follow-up, targeted monitoring and specific adjunct treatment.

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