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Cardiac magnetic resonance derived atrial function in patients with a Fontan circulation

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Abstract

To assess atrial function in Fontan patients using cardiac MRI (CMR) and determine the relationships between atrial function, hemodynamics, and clinical outcomes. Two center chart review identified all Fontan patients with technically adequate CMR to assess atrial function within 1 year of cardiac catheterization and age-matched controls with CMR. Atrial reservoir, conduit, and pump global longitudinal strain and strain rate measurements were determined by CMR. Univariate and stepwise multivariable analysis were conducted to detect associations of atrial function measures with ventricular end diastolic pressure (EDP), cardiac index (CI), exercise capacity, liver stiffness and a composite outcome of heart transplantation, ventricular assist device or death. The study cohort was comprised of 33 Fontan patients and 30 age-matched controls. Fontan patients had lower atrial reservoir and conduit strain, and lower reservoir, conduit, and pump strain rate compared to age-matched controls. Atrial conduit strain was negatively associated with EDP and lower atrial pump-to-conduit strain ratio was associated with lower cardiac index in multivariable analysis. Lower atrial pump strain was associated with lower exercise capacity (per 1% increase: β = 2.3 ± 0.9, p = 0.03) and higher liver stiffness (per 1% increase: β =  − 0.12 ± 0.03, p = 0.002). Higher atrial pump strain (HR per 1% increase = 0.53 [95% confidence interval 0.22, 0.83], p = 0.002) and ventricular ejection fraction (HR per 1% increase = 0.90 [95% confidence interval 0.80, 0.98], p = 0.02) were associated with lower risk for the composite adverse outcome. Atrial function is impaired in Fontan patients and is associated with worse CI, EDP, exercise performance, liver stiffness, and a higher risk for adverse outcomes.

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Data availability

The datasets used and analyzed during the current study are available from the corresponding author on reasonable request.

Abbreviations

AUC:

Area under the curve

CAO:

Composite adverse outcome

CI:

Cardiac index

CMR:

Cardiac magnetic resonance imaging

EDP:

End diastolic pressure

EDV:

End diastolic volume

ESV:

End systolic volume

GLS:

Global longitudinal strain

iWU:

Woods units indexed of body surface area (WU * m2)

PVR:

Pulmonary vascular resistance

SVR:

Systemic vascular resistance

VAD:

Ventricular assist device

% Predicted VO2 :

Percent of predicted oxygen consumption at peak exercise

% Predicted O2 pulse:

Percent of predicted O2 pulse

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Acknowledgements

We would like to acknowledge Ryan Moore, Mantosh Rattan, Eric Crotty, and Robert Fleck for their assistance with CMR evaluation.

Funding

Cincinnati Children’s Heart Institute Research Core.

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Authors and Affiliations

  1. Heart Institute, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA

    Paul J. Critser, Adam W. Powell, Hassan Almeneisi, Alexander R. Opotowsky, Janvi Gandhi, Adam M. Lubert, Sean M. Lang, Justin T. Tretter, Michael D. Taylor & Tarek Alsaied

  2. Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA

    Adam W. Powell, Alexander R. Opotowsky, Nicholas J. Ollberding, Adam M. Lubert, Sean M. Lang, Justin T. Tretter, Michael D. Taylor & Tarek Alsaied

  3. The Christ Hospital Health Network, Cincinnati, OH, USA

    Vien Truong & Wojciech Mazur

  4. Division of Biostatistics and Epidemiology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA

    Nicholas J. Ollberding

Authors
  1. Paul J. Critser
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  2. Vien Truong
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  3. Adam W. Powell
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  4. Hassan Almeneisi
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  5. Alexander R. Opotowsky
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  6. Nicholas J. Ollberding
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  7. Janvi Gandhi
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  8. Adam M. Lubert
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  9. Wojciech Mazur
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  10. Sean M. Lang
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  11. Justin T. Tretter
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  12. Michael D. Taylor
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  13. Tarek Alsaied
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Contributions

PC, VT, HA, JG, and TA contributed to the experimental design, data analysis, drafting, and revision of the work. AP, AO, NO, AL, WM, SL, JT, and MT contributed to the experimental design, data analysis, and revision of the work.

Corresponding author

Correspondence to Paul J. Critser.

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The authors have no conflicts of interest.

Ethical approval

The Institutional Review Board at Cincinnati Children’s Hospital and The Christ Hospital approved this retrospective study.

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Critser, P.J., Truong, V., Powell, A.W. et al. Cardiac magnetic resonance derived atrial function in patients with a Fontan circulation. Int J Cardiovasc Imaging 37, 275–284 (2021). https://doi.org/10.1007/s10554-020-01959-6

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  • DOI: https://doi.org/10.1007/s10554-020-01959-6

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