Echo-Doppler assessment of ventricular filling pressures in adult Fontan patients

Published on Jun 1, 2019in International Journal of Cardiology3.229
· DOI :10.1016/J.IJCARD.2018.10.077
William R. Miranda14
Estimated H-index: 14
(Mayo Clinic),
Carole A. Warnes70
Estimated H-index: 70
(Mayo Clinic)
+ 4 AuthorsAlexander C. Egbe20
Estimated H-index: 20
(Mayo Clinic)
Sources
Abstract
Abstract Background Diastolic dysfunction is felt to be part of the natural history of patients with prior Fontan operation. Despite that, data on noninvasive assessment of diastolic function and ventricular filling pressures in Fontan patients are limited. Methods We included 45 adult Fontan patients who underwent right heart catheterization with pulmonary artery wedge pressure (PAWP) measurement and transthoracic echo-Doppler assessment within 7 days. Offline measurement of systemic atrioventricular valve pulsed-wave (PW) and medial/lateral atrioventricular annular tissue Doppler velocities was performed and correlated to PAWP. Results Median age was 31.4 years (IQR 24.8–37); 51% of patients were females. Median ventricular ejection fraction was 55% (IQR 50.3–57.5) and median PAWP was 10 mm Hg (IQR 8–11). PW Doppler E velocity (r = 0.64, p ≤ 0.0001), deceleration time (r = −0.40, p = 0.008), and E/A ratio (r = 0.33, p = 0.03) correlated with PAWP. Median medial and lateral E/e′ ratios also correlated to PAWP (r = 0.71, p = 0.002 and r = 0.75, p  75 cm/s had 88% sensitivity and 86% specificity [97% negative predictive value (NPV); 58% positive predictive value (PPV)], E/A ratio >1.7 had 100% sensitivity and 61% specificity (100% NPV; 26% PPV), and deceleration time 12 mm Hg. Conclusion Our data suggest that PW Doppler atrioventricular E velocity, E/A ratio, and deceleration time could be used to identify adult Fontan patients with normal filling pressures. However, PPVs for PAWP >12 mm Hg were poor. Further studies, particularly prospective, simultaneous echo-catheterization correlation, are critically needed.
📖 Papers frequently viewed together
8 Citations
98 Citations
2 Citations
References17
Newest
#1Rachael Cordina (USYD: University of Sydney)H-Index: 17
Last. Wei LiH-Index: 35
view all 8 authors...
Abstract Background Echocardiographic assessment of diastolic function in the setting of Fontan physiology is not well validated. We recently demonstrated that atrioventricular systolic to diastolic duration ratio (AVV S/D ratio) independently predicts mortality in Fontan-adults and that a value >1.1 was associated with poor prognosis. Purpose To correlate echocardiographic measures of diastolic function with direct measurement of ventricular end-diastolic pressure (VEDP). Methods A retrospectiv...
14 CitationsSource
#1William R. Miranda (Mayo Clinic)H-Index: 14
#2Alexander C. Egbe (Mayo Clinic)H-Index: 20
Last. Carole A. Warnes (Mayo Clinic)H-Index: 70
view all 7 authors...
Abstract Background Pulmonary artery wedge pressure (PAWP) has been shown to correlate better with left atrial pressure (LAP) than ventricular end-diastolic pressure (VEDP) in acquired heart disease. The correlation between VEDP and PAWP and their performance as surrogates for LAP in Fontan patients is unknown. Methods Offline single-beat simultaneous measurement of PAWP and VEDP was performed in 50 adult Fontan patients and non-simultaneous hemodynamic data abstracted for calculation of pulmona...
8 CitationsSource
#1O S Andersen (Oslo University Hospital)H-Index: 5
#2Otto A. Smiseth (Oslo University Hospital)H-Index: 70
Last. Sherif F. NaguehH-Index: 84
view all 15 authors...
Abstract Background The diagnosis of heart failure may be challenging because symptoms are rather nonspecific. Elevated left ventricular (LV) filling pressure may be used to confirm the diagnosis, but cardiac catheterization is often not practical. Echocardiographic indexes are therefore used as markers of filling pressure. Objectives This study investigated the feasibility and accuracy of comprehensive echocardiography in identifying patients with elevated LV filling pressure. Methods We conduc...
173 CitationsSource
#1Marc Gewillig (Katholieke Universiteit Leuven)H-Index: 76
#2Stephen C. Brown (University of the Free State)H-Index: 17
The Fontan operation was first performed in 1968. Since then, this operation has been performed on thousands of patients worldwide. Results vary from very good for many decades to very bad with a pleiad of complications and early death. A good understanding of the physiology is necessary to further improve results. The Fontan connection creates a critical bottleneck with obligatory upstream congestion and downstream decreased flow; these two features are the basic cause of the majority of the ph...
189 CitationsSource
#1Sherif F. NaguehH-Index: 84
#2Otto A. Smiseth (University of Oslo)H-Index: 70
Last. Alan D. Waggoner (WashU: Washington University in St. Louis)H-Index: 52
view all 14 authors...
Recommendations for the Evaluation of Left Ventricular Diastolic Function by Echocardiography : An Update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging
2,593 CitationsSource
#1Oleg F. Sharifov (UAB: University of Alabama at Birmingham)H-Index: 14
#2Chun G. Schiros (UAB: University of Alabama at Birmingham)H-Index: 9
Last. Himanshu Gupta (UAB: University of Alabama at Birmingham)H-Index: 18
view all 5 authors...
Background Tissue Doppler index E/e' is used clinically and in multidisciplinary research for estimation of left ventricular filling pressure (LVFP) and diastolic dysfunction (DD)/heart failure with preserved ejection fraction (HFpEF). Its diagnostic accuracy is not well studied. Methods and Results From the PubMed, Scopus, Embase, and Cochrane databases, we identified 24 studies reporting E/e' and invasive LVFP in preserved EF (≥50%). In random‐effects models, E/e' had poor to mediocre linear c...
100 CitationsSource
#1Kavitha N. Pundi (Mayo Clinic)H-Index: 8
#2Jonathan N. Johnson (Mayo Clinic)H-Index: 30
Last. Frank Cetta (Mayo Clinic)H-Index: 46
view all 11 authors...
Background There are limited long-term, single-cohort, follow-up studies available about patients after the Fontan operation. Objectives This study sought to determine the long-term outcome of all patients who had a Fontan operation at the Mayo Clinic. Methods Records of all patients who had a modified Fontan operation between 1973 and 2012 were reviewed. A follow-up questionnaire was mailed to all patients alive at the time of the study. Results Overall, 10-, 20-, and 30-year survival for 1,052...
293 CitationsSource
#1Nazia Husain (Nationwide Children's Hospital)H-Index: 6
#2Janaki Gokhale (Nationwide Children's Hospital)H-Index: 4
Last. Clifford L. Cua (Nationwide Children's Hospital)H-Index: 21
view all 6 authors...
Background Increased ventricular end-diastolic pressure (VEDP) is a known risk factor for morbidity and mortality in patients with single-ventricle physiology. Spectral Doppler tissue imaging (DTI) has been shown to modestly correlate with direct measurement of VEDP. Strain rate (SR) values, obtained via myocardial deformation, have not yet been compared with VEDP in this patient population. The goal of this study was to evaluate which of these imaging techniques correlates best with VEDP in pat...
23 CitationsSource
#1Dalane W. Kitzman (Wake Forest University)H-Index: 103
#2William C. Little (Wake Forest University)H-Index: 77
To provide for tissue perfusion without pulmonary congestion, the left ventricle (LV) must eject an adequate stroke volume at arterial pressure (systolic function) and fill without requiring an abnormally increased left atrial pressure (diastolic function). Systolic and diastolic function must be adequate to meet the needs of the body both at rest and during stress (reserve capacity). Article see p 782 Normal LV diastolic function requires integration of left ventricular ejection, relaxation, an...
27 CitationsSource
#1Shaji C. Menon (UofU: University of Utah)H-Index: 22
#2Robert G. Gray (UofU: University of Utah)H-Index: 14
Last. Lloyd Y. Tani (UofU: University of Utah)H-Index: 44
view all 3 authors...
Background Elevated ventricular filling pressure is a marker of diastolic dysfunction and a known risk factor for failure of single-ventricle surgical palliation. Doppler echocardiography has been shown valuable in identifying patients with elevated ventricular end-diastolic pressure (VEDP) in other settings, but its utility in evaluating pediatric patients with single ventricle is unclear. The aim of this study was to compare Doppler parameters to simultaneous catheter measurements of VEDP in c...
48 CitationsSource
Cited By4
Newest
#1Marcus Granegger (Charité)H-Index: 15
#2S. Küng (Boston Children's Hospital)
Last. Walter Knirsch (Boston Children's Hospital)H-Index: 28
view all 12 authors...
Abstract Background The palliation of patients with single ventricle (SV) undergoing Fontan procedure led to improved long-term survival but is still limited due to cardiovascular complications. The aim of this study was to describe the somatic and cardiovascular development of Fontan patients until adolescence and to identify determining factors. Methods We retrospectively assessed somatic growth, vascular growth of pulmonary arteries, and cardiac growth of the SV and systemic semilunar valve f...
Source
#1Sumeet S. Vaikunth (Stanford University)H-Index: 5
#2George K. Lui (Stanford University)H-Index: 17
Heart failure with reduced ejection fraction (HFrEF) is common in patients with adult congenital heart disease. Many of the most common congenital defects have a high prevalence of HFrEF, including left-sided obstructive lesions (aortic stenosis, coarctation of the aorta, Shone complex), tetralogy of Fallot, Ebstein anomaly, lesions in which there is a systemic right ventricle, and lesions palliated with a Fontan circulation. However, heart failure with preserved ejection fraction (HFpEF) is als...
5 CitationsSource
Objective . To study the possibilities of using echocardiographic parameters of longitudinal mechanics to assess the diastolic function of the systemic ventricle (SV) in patients after Fontan operation. Material and methods. We examined 29 children aged 8,6 ± 3,16 years with a functionally single ventricle of the heart after performing a total cavopulmonary connection with fenestration of extracardiac conduit. By computed tomography there were evaluated: myocardial mass index (MMI) SV, ejection ...
Source
Source