Serial cardiovascular magnetic resonance feature tracking indicates early worsening of cardiac function in Fontan patients

• Published in: International journal of cardiology Vol. 303; pp. 23 - 29
• Main Authors: Meyer, Sophie L., Ridderbos, Floris-Jan S., Wolff, Djoeke, Eshuis, Graziella, van Melle, Joost P., Ebels, Tjark, Berger, Rolf M.F., Willems, Tineke P.
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier B.V 15.03.2020
• Subjects: Adolescent; Child; Feature tracking; Female; Follow-Up Studies; Fontan circulation; Fontan Procedure; Functionally univentricular heart; Global circumferential strain; Global longitudinal strain; Heart Defects, Congenital - diagnosis; Heart Defects, Congenital - surgery; Heart Ventricles - diagnostic imaging; Heart Ventricles - physiopathology; Humans; Magnetic Resonance Imaging, Cine - methods; Male; Predictive Value of Tests; Prospective Studies; Stroke Volume - physiology; Ventricular Function, Left - physiology; Young Adult; Global circumferential strain; Global longitudinal strain; Feature tracking; Fontan circulation; Functionally univentricular heart
• ISSN: 0167-5273; 1874-1754
• DOI: 10.1016/j.ijcard.2019.12.041

In Fontan patients, attrition of ventricular function is well recognized, but early detection of ventricular dysfunction is difficult. The aim of this study is to longitudinally assess ventricular strain in Fontan patients using a new method for cardiac magnetic resonance (CMR) feature tracking, and to investigate the relationship between ventricular strain and cardiac systolic function. In this prospective, standardized follow-up study in 51 Fontan patients, age ≥ 10 years, CMR and concomitant clinical assessment was done at the start of the study and after 2 years. CMR feature tracking was done combining the dominant and hypoplastic ventricles. Global longitudinal strain (GLS) (−17.3% versus −15.9%, P = 0.041) and global circumferential strain (GCS) (−17.7 versus −16.1, P = 0.047) decreased over 2 years' time. Ejection fraction (EF) (57%), cardiac index (CI) (2.7 l/min/m2) and NYHA functional class (97% in class I/II) were preserved. The strain values of the combined dominant and hypoplastic ventricles were significantly worse compared to those of the dominant ventricle only (GLS −16.8 (−19.5 to −14.0) versus −18.8 (−21.3 to −15.3) respectively, P = 0.001, GCS −18.3 (−22.1 to −14.8) versus −22.5 (−26.3 to −19.4) respectively, P < 0.001). This study showed a decrease in cardiac strain over 2 years in Fontan patients without clinical signs of Fontan failure, where EF, CI and clinical status were still preserved. Cardiac strain might be a sensitive early indicator of systolic ventricular decline. Furthermore, combined strain of the hypoplastic and dominant ventricles seems a more accurate representation of cardiac strain in functionally univentricular hearts. •This study showed a decrease in cardiac strain over 2 years in Fontan patients.•Cardiac strain might be a sensitive early indicator of systolic ventricular decline.•combined strain of the hypoplastic and dominant ventricles is an accurate representation of cardiac strain.