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The Influence of Atrial Strain on Functional Capacity in Patients with the Fontan Circulation

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Abstract

Speckle-tracking echocardiography has been used to assess atrial function. This analysis is feasible in univentricular hearts. The aim of this study was to characterize the relationship between atrial strain and functional capacity in the Fontan circulation. Apical four-chamber echocardiographic loops of 39 Fontan patients were reviewed. The dominant atrium was assessed for active (εact), conduit (εcon), and reservoir (εres) strain and εact/εres ratio. Cardiopulmonary exercise test was performed on the same day and oxygen uptake (VO2) at ventilatory threshold (VT) and peak VO2 were chosen as the dependent variables. Statistical analysis was performed using SPSS® version 23. Unpaired t test was used for binomial and continuous variable correlation; single and multivariable linear regression were used for continuous variable correlation. Statistical significance was defined as p value < 0.05. VO2 at VT as a percentage of predicted VO2 was 36.8% (SD 10.7). Peak VO2 was 64.7% (SD 18.9) of the predicted value. In univariate analysis, both were associated with age, atrioventricular regurgitation, ejection fraction, εres, εcon, and εact/εres. In multivariate regression, higher VO2 at VT and peak VO2 were associated with younger age (p = 0.003 and p = 0.001, respectively) and higher εcon (p = 0.026 and p = 0.020). Evaluation of heart function is difficult in the Fontan circulation, hindered by complex ventricular morphology and lack of normative data. VO2 provides a good surrogate. Atrial strain parameters are compromised in these patients and associated with VO2. Therefore, whenever possible, atrial strain should be measured as it may provide a new method of risk stratification.

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This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

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  1. Department of Pediatric Cardiology, Hospital de Santa Cruz – Centro Hospitalar Lisboa Ocidental, Av. Prof. Dr. Reinaldo dos Santos, 2790-134, Carnaxide, Portugal

    João Rato, Susana Cordeiro Mendes, Ana Sousa, Mariana Lemos, Duarte Saraiva Martins & Rui Anjos

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  1. João Rato
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  2. Susana Cordeiro Mendes
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Correspondence to João Rato.

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Rato, J., Mendes, S.C., Sousa, A. et al. The Influence of Atrial Strain on Functional Capacity in Patients with the Fontan Circulation. Pediatr Cardiol 41, 1730–1738 (2020). https://doi.org/10.1007/s00246-020-02435-7

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  • DOI: https://doi.org/10.1007/s00246-020-02435-7

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