Atrial function in the Fontan circulation: comparison with invasively assessed systemic ventricular filling pressure

Atrial function in the Fontan circulation: comparison with invasively assessed systemic ventricular filling pressure

Abnormal atrial mechanics in biventricular circulations have been associated with elevated left heart filling pressures. Similar associations in the Fontan circulation are unknown. The aim of this study was to examine the relationship between atrial mechanics and invasively assessed hemodynamic para...

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Published in:The International Journal of Cardiovascular Imaging Vol. 37; no. 9; pp. 2651 - 2660
Main Authors: Veldtman, Gruschen, Possner, Mathias, Mohty, Dania, Issa, Ziyad, Alsaleh, Monerah, AlMarzoog, AlJuhara Thaar, Emmanual, Shisamma, Salam, Yezan, AlHabdan, Mohammed Saleh, Alsaied, Tarek, Rathod, Rahul H., Siblini, Ghassan, Vriz, Olga
Format: Journal Article
Language:English
Published: Dordrecht Springer Netherlands 01-09-2021
Springer Nature B.V
Subjects:
Atria
Blood pressure
Cardiac Imaging
Cardiology
Diastolic pressure
Heart surgery
Hemodynamics
Imaging
Mechanics
Mechanics (physics)
Medicine
Medicine & Public Health
Occlusion
Original Paper
Pulmonary arteries
Pulmonary artery
Radiology
Ventricle
Ventricular strain
Atrial strain
Adult congenital heart disease
Fontan pressure
Fontan
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Summary:Abnormal atrial mechanics in biventricular circulations have been associated with elevated left heart filling pressures. Similar associations in the Fontan circulation are unknown. The aim of this study was to examine the relationship between atrial mechanics and invasively assessed hemodynamic parameters late after the Fontan operation. Thirty-nine Fontan patients with echocardiographic and invasive hemodynamic studies done within 48 h were included and were compared to 40 age-matched healthy controls. Atrial and ventricular strain measurements were measured offline using 2-dimensional speckle-tracking. Mean age was 10.2 ± 6.7 years and 24 (62%) were male. Atrial strain measures were lower in Fontan patients compared to healthy controls. There was no significant association between atrial strain measurements and Fontan systemic ventricular filling pressures (SVFP) as indicated by pulmonary artery occlusion pressures, direct left atrial pressure or systemic ventricular end-diastolic pressure. Global atrial strain was not correlated with segmental atrial strain in the pulmonary venous atrium. Global atrial reservoir strain was positively correlated with pulmonary vascular resistance (r = 0.508, p = 0.045). Global atrial conduit strain was positively correlated with E/A ratio of the AV valve inflow (r = 0.555, p = 0.002). Atrial and ventricular strain measurements were not significantly correlated. In patients with a Fontan, global atrial function is significantly depressed, and is uncoupled from segmental left lateral atrial function. Global as well as segmental atrial mechanics are not significantly associated with SVFPs in Fontan patients. Instead, global atrial reservoir function appears to parallel pulmonary vascular resistance.
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ISSN:1569-5794
1573-0743
1875-8312
DOI:10.1007/s10554-021-02298-w