Assessment of Diastolic Function in Single-Ventricle Patients After the Fontan Procedure
| Autor: | Jason T. Su, Michael D. Quartermain, Piers Barker, Lynn A. Sleeper, Gail D. Pearson, Steven D. Colan, Girish S Shirali, Shan Chen, Luc Mertens, Renee Margossian |
|---|---|
| Rok vydání: | 2016 |
| Předmět: |
Heart Defects
Congenital Male medicine.medical_specialty Adolescent medicine.medical_treatment 030204 cardiovascular system & hematology Standard score Fontan Procedure Article Fontan procedure Ventricular Dysfunction Left 03 medical and health sciences Postoperative Complications 0302 clinical medicine Risk Factors Internal medicine medicine Humans Radiology Nuclear Medicine and imaging 030212 general & internal medicine Child End-systolic volume Body surface area Ejection fraction business.industry Incidence Stroke Volume Causality Treatment Outcome medicine.anatomical_structure Echocardiography Ventricle North America Cohort Cardiology End-diastolic volume Female Cardiology and Cardiovascular Medicine business |
| Zdroj: | Journal of the American Society of Echocardiography. 29:1066-1073 |
| ISSN: | 0894-7317 |
| Popis: | Patients with functional single ventricles after the Fontan procedure have abnormal cardiac mechanics. The aims of this study were to determine factors that influence diastolic function and to describe associations of diastolic function with current clinical status.Echocardiograms were obtained as part of the Pediatric Heart Network Fontan Cross-Sectional Study. Diastolic function grade (DFG) was assessed as normal (grade 0), impaired relaxation (grade 1), pseudonymization (grade 2), or restrictive (grade 3). Studies were also classified dichotomously (restrictive pattern present or absent). Relationships between DFG and pre-Fontan variables (e.g., ventricular morphology, age at Fontan, history of volume-unloading surgery) and current status (e.g., systolic function, valvar regurgitation, exercise performance) were explored.DFG was calculable in 326 of 546 subjects (60%) (mean age, 11.7 ± 3.3 years). Overall, 32% of patients had grade 0, 9% grade 1, 37% grade 2, and 22% grade 3 diastolic function. Although there was no association between ventricular morphology and DFG, there was an association between ventricular morphology and E', which was lowest in those with right ventricular morphology (P .001); this association remained significant when using Z scores adjusted for age (P .001). DFG was associated with achieving maximal effort on exercise testing (P = .004); the majority (64%) of those not achieving maximal effort had DFG 2 or 3. No additional significant associations of DFG with laboratory or clinical measures were identified.Assessment of diastolic function by current algorithms results in a high percentage of patients with abnormal DFG, but few clinically or statistically significant associations were found. This may imply a lack of impact of abnormal diastolic function on clinical outcomes in this cohort, or it may indicate that the methodology may not be applicable to pediatric patients with functional single ventricles. |
| Databáze: | OpenAIRE |
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