Skip to main content
SpringerLink
Log in

Atrial Reservoir Strain is Associated with Decreased Cardiac Index and Adverse Outcomes Post Fontan Operation

  • Original Article
  • Published:
Pediatric Cardiology Aims and scope Submit manuscript

Abstract

Fontan patients rely on atrial function for diastolic filling and to augment cardiac output. Emerging data suggests that diminished atrial function is predictive of poor outcomes in adults but studies evaluating the association between atrial mechanics in Fontan patients and outcomes are lacking. We sought to assess atrial function in Fontan patients using speckle tracking echocardiography to determine whether atrial function is associated with invasive hemodynamics and clinical outcomes. Single-center review of Fontan patients receiving both catheterization and echocardiogram from 2012–2017. Atrial reservoir, conduit and pump global longitudinal strain and strain rate were assessed by speckle tracking echocardiography. The primary outcome was a composite of all adverse clinical outcomes including cardiac hospitalizations, transplant and death. Eighty-three Fontan patients at a median age of 14.2 years (IQR 8.6, 21.7) at time of echocardiogram were included. Increased atrial reservoir strain (p = 0.04), atrial emptying fraction (p = 0.04) and atrial fractional area change (p = 0.04), were associated with higher cardiac index at baseline. There were no associations between atrial strain and systemic ventricular end diastolic pressure (EDP) at catheterization. Reservoir strain was inversely associated with the composite clinical outcome on multivariable Cox proportional hazard analysis (HR 0.96, p = 0.03). Reduced atrial function is associated with reduced cardiac index, but is not directly associated with ventricular EDP in Fontan patients. Reservoir strain is associated with an excess of adverse clinical outcomes in Fontan patients.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

Data Availability

Available.

References

  1. Pundi KN, Johnson JN, Dearani JA et al (2015) 40-Year follow-up after the fontan operation long-term outcomes of 1052 patients. J Am Coll Cardiol 66(15):1700–1710. https://doi.org/10.1016/j.jacc.2015.07.065

    Article  PubMed  Google Scholar 

  2. Ta H, Alsaied T, Steele J et al (2020) Atrial function and its role in the non-invasive evaluation of diastolic function in congenital heart disease. Pediatr Cardiol. https://doi.org/10.1007/S00246-020-02351-W

    Article  PubMed  Google Scholar 

  3. Benjamin EJ, D’Agostino RB, Belanger AJ, Wolf PA, Levy D (1995) Left atrial size and the risk of stroke and death. Circulation 92(4):835–841. https://doi.org/10.1161/01.CIR.92.4.835

    Article  CAS  PubMed  Google Scholar 

  4. Thomas L, Marwick TH, Popescu BA, Donal E, Badano LP (2019) Left atrial structure and function, and left ventricular diastolic dysfunction: JACC state-of-the-art review. J Am Coll Cardiol 73(15):1961–1977. https://doi.org/10.1016/j.jacc.2019.01.059

    Article  PubMed  Google Scholar 

  5. Otani K, Takeuchi M, Kaku K et al (2010) Impact of diastolic dysfunction grade on left atrial mechanics assessed by two-dimensional speckle tracking echocardiography. J Am Soc Echocardiogr 23(9):961–967. https://doi.org/10.1016/j.echo.2010.06.023

    Article  PubMed  Google Scholar 

  6. Li SJ, Wong SJ, Cheung YF (2014) Atrial and ventricular mechanics in patients after fontan-type procedures: atriopulmonary connection versus extracardiac conduit. J Am Soc Echocardiogr 27(6):666–674. https://doi.org/10.1016/j.echo.2014.01.027

    Article  PubMed  Google Scholar 

  7. Khoo NS, Smallhorn JF, Kaneko S, Kutty S, Altamirano L, Tham EB (2013) The assessment of atrial function in single ventricle hearts from birth to fontan: A speckle-tracking study by using strain and strain rate. J Am Soc Echocardiogr 26(7):756–764. https://doi.org/10.1016/j.echo.2013.04.005

    Article  PubMed  Google Scholar 

  8. Davis EK, Ginde S, Stelter J, Frommelt P, Hill GD (2019) Echocardiographic assessment of single-ventricle diastolic function and its correlation to short-term outcomes after the Fontan operation. Congenit Heart Dis. https://doi.org/10.1111/chd.12814

    Article  PubMed  Google Scholar 

  9. Cordina R, Ministeri M, Babu-Narayan SV et al (2018) Evaluation of the relationship between ventricular end-diastolic pressure and echocardiographic measures of diastolic function in adults with a Fontan circulation. Int J Cardiol 259:71–75. https://doi.org/10.1016/j.ijcard.2018.02.045

    Article  PubMed  Google Scholar 

  10. Gan GCH, Ferkh A, Boyd A, Thomas L (2018) Left atrial function: evaluation by strain analysis. Cardiovasc Diagn Ther 8(1):29–46. https://doi.org/10.21037/cdt.2017.06.08

    Article  PubMed  PubMed Central  Google Scholar 

  11. Deferm S, Martens P, Verbrugge FH et al (2020) LA mechanics in decompensated heart failure: insights from strain echocardiography with invasive hemodynamics. JACC Cardiovasc Imaging 13(5):1107–1115. https://doi.org/10.1016/j.jcmg.2019.12.008

    Article  PubMed  Google Scholar 

  12. Alsaied T, Niss O, Tretter JT et al (2020) Left atrial dysfunction in sickle cell anemia is associated with diffuse myocardial fibrosis, increased right ventricular pressure and reduced exercise capacity. Sci Rep 10:1767. https://doi.org/10.1038/S41598-020-58662-8

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  13. Kurt M, Tanboga IH, Aksakal E et al (2012) Relation of left ventricular end-diastolic pressure and N-terminal pro-brain natriuretic peptide level with left atrial deformation parameters. Eur Heart J Cardiovasc Imaging 13(6):524–530. https://doi.org/10.1093/ejechocard/jer283

    Article  PubMed  Google Scholar 

  14. Cameli M, Sparla S, Losito M et al (2016) Correlation of left atrial strain and doppler measurements with invasive measurement of left ventricular end-diastolic pressure in patients stratified for different values of ejection fraction. Echocardiography 33(3):398–405. https://doi.org/10.1111/echo.13094

    Article  PubMed  Google Scholar 

  15. Moustafa S, Zuhairy H, Youssef MA et al (2015) Right and left atrial dissimilarities in normal subjects explored by speckle tracking echocardiography. Echocardiography 32(9):1392–1399. https://doi.org/10.1111/echo.12880

    Article  PubMed  Google Scholar 

  16. Hui W, Rahman M, Dsebissowa F et al (2004) Quantitative analysis of right atrial performance after surgical repair of tetralogy of fallot. Cardiol Young 14:520–526. https://doi.org/10.1016/s0022-5223(19)38815-4

    Article  PubMed  Google Scholar 

  17. Meng X, Li Y, Li H, Wang Y, Zhu W, Lu X (2018) Right atrial function in patients with pulmonary hypertension: A study with two-dimensional speckle-tracking echocardiography. Int J Cardiol 255:200–205. https://doi.org/10.1016/j.ijcard.2017.11.093

    Article  PubMed  Google Scholar 

  18. Ojaghi Haghighi Z, Naderi N, Amin A et al (2011) Quantitative assessment of right atrial function by strain and strain rate imaging in patients with heart failure. Acta Cardiol 66(6):737–742. https://doi.org/10.1080/ac.66.6.2136957

    Article  PubMed  Google Scholar 

  19. Santos A, Kraigher-Krainer E, Gupta D et al (2014) Impaired left atrial function in heart failure with preserved ejection fraction. Eur J Heart Fail 16(10):1096–1103. https://doi.org/10.1002/ejhf.147

    Article  CAS  PubMed  PubMed Central  Google Scholar 

Download references

Funding

No additional sources of funding were used for this study.

Author information

Authors and Affiliations

  1. The Heart Institute, Cincinnati Children’s Hospital Medical Center, 3333 Burnet Avenue, MLC 2003, Cincinnati, OH, 45229, USA

    Daniel Peck, Tarek Alsaied, Sarah Pradhan & Garick Hill

Authors
  1. Daniel Peck
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Tarek Alsaied
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Sarah Pradhan
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Garick Hill
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

All authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by DP, TA, and GH. The first draft of the manuscript was written by Daniel Peck and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Daniel Peck.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical Approval

This retrospective chart review study involving human participants was in accordance with the ethical standards of the institutional and national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. The Human Investigation Committee (IRB) of Cincinnati Children’s Hospital approved this study.

Informed Consent

Informed consent was waived for this study due to the following considerations: a) participants were selected for inclusion by reviewing existing medical records and no direct interaction with the patient was required outside of the normal course of care; b) the study involves no more than minimal risk; and c) no data beyond that collected in the course of routine standard care was collected.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Peck, D., Alsaied, T., Pradhan, S. et al. Atrial Reservoir Strain is Associated with Decreased Cardiac Index and Adverse Outcomes Post Fontan Operation. Pediatr Cardiol 42, 307–314 (2021). https://doi.org/10.1007/s00246-020-02484-y

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00246-020-02484-y

Keywords

Search

Navigation