Skip to main content
SpringerLink
Log in

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

  • Original Paper
  • Published:
The International Journal of Cardiovascular Imaging Aims and scope Submit manuscript

Abstract

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.

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

Availability of data and material

The data is available and permission might be sought per reasonable request.

Abbreviations

APSE:

Atrial plane systolic excursion

AV:

Atrioventricular

CI:

Cardiac index

CO:

Cardiac output

DT:

Deceleration time

ICC:

Intraclass correlation coefficient

PA:

Pulmonary artery

PAOP:

Pulmonary artery occlusion pressure

PVR:

Pulmonary vascular resistance

SVC:

Superior vena cava

SVFP:

Systemic ventricular filling pressure

SVR:

Systemic vascular resistance

TPG:

Transpulmonary gradient

References

  1. Gewillig M, Brown SC, van de Bruaene A, Rychik J (2020) Providing a framework of principles for conceptualising the Fontan circulation. Acta Paediatr 109:651–658

    Article  Google Scholar 

  2. 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 73:1961–1977

    Article  Google Scholar 

  3. Singh A, Addetia K, Maffessanti F, Mor-Avi V, Lang RM (2017) LA strain for categorization of LV diastolic dysfunction. JACC Cardiovasc Imaging 10:735–743

    Article  Google Scholar 

  4. Freed BH, Daruwalla V, Cheng JY et al (2016) Prognostic utility and clinical significance of cardiac mechanics in heart failure with preserved ejection fraction: importance of left atrial strain. Circ Cardiovasc Imaging 9(3):e003754

    Article  Google Scholar 

  5. Wakami K, Ohte N, Asada K et al (2009) Correlation between left ventricular end-diastolic pressure and peak left atrial wall strain during left ventricular systole. J Am Soc Echocardiogr 22:847–851

    Article  Google Scholar 

  6. Miranda WR, Egbe AC, Hagler DJ et al (2018) Filling pressures in Fontan revisited: comparison between pulmonary artery wedge, ventricular end-diastolic, and left atrial pressures in adults. Int J Cardiol 255:32–36

    Article  Google Scholar 

  7. Mitchell C, Rahko PS, Blauwet LA et al (2019) Guidelines for performing a comprehensive transthoracic echocardiographic examination in adults: recommendations from the American Society of Echocardiography. J Am Soc Echocardiogr 32:1–64

    Article  Google Scholar 

  8. Farsalinos KE, Daraban AM, Ünlü S, Thomas JD, Badano LP, Voigt JU (2015) Head-to-head comparison of global longitudinal strain measurements among nine different vendors: the EACVI/ASE inter-vendor comparison study. J Am Soc Echocardiogr 28:1171–1181

    Article  Google Scholar 

  9. 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 27:666–674

    Article  Google Scholar 

  10. 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 26:756–764

    Article  Google Scholar 

  11. Morris DA, Belyavskiy E, Aravind-Kumar R et al (2018) Potential usefulness and clinical relevance of adding left atrial strain to left atrial volume index in the detection of left ventricular diastolic dysfunction. JACC Cardiovasc Imaging 11:1405–1415

    Article  Google Scholar 

  12. Cameli M, Lisi M, Mondillo S et al (2010) Left atrial longitudinal strain by speckle tracking echocardiography correlates well with left ventricular filling pressures in patients with heart failure. Cardiovasc Ultrasound 8:14

    Article  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 13:524–530

    Article  Google Scholar 

  14. van der Ven JPG, Alsaied T, Juggan S et al (2020) Atrial function in Fontan patients assessed by CMR: relation with exercise capacity and long-term outcomes. Int J Cardiol 312:56–61

    Article  Google Scholar 

  15. Howard-Quijano K, Anderson-Dam J, McCabe M, Hall M, Mazor E, Mahajan A (2015) Speckle-tracking strain imaging identifies alterations in left atrial mechanics with general anesthesia and positive-pressure ventilation. J Cardiothorac Vasc Anesth 29:845–851

    Article  Google Scholar 

  16. Hewing B, Theres L, Spethmann S, Stangl K, Dreger H, Knebel F (2017) Left atrial strain predicts hemodynamic parameters in cardiovascular patients. Echocardiography 34:1170–1178

    Article  Google Scholar 

  17. 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 33:398–405

    Article  Google Scholar 

  18. Lancellotti P, Galderisi M, Edvardsen T et al (2017) Echo-Doppler estimation of left ventricular filling pressure: results of the multicentre EACVI Euro-Filling study. Eur Heart J Cardiovasc Imaging 18:961–968

    Article  Google Scholar 

  19. Badano LP, Kolias TJ, Muraru D et al (2018) Standardization of left atrial, right ventricular, and right atrial deformation imaging using two-dimensional speckle tracking echocardiography: a consensus document of the EACVI/ASE/Industry Task Force to standardize deformation imaging. Eur Heart J Cardiovasc Imaging 19:591–600

    Article  Google Scholar 

  20. Talreja DR, Nishimura RA, Oh JK (2007) Estimation of left ventricular filling pressure with exercise by Doppler echocardiography in patients with normal systolic function: a simultaneous echocardiographic-cardiac catheterization study. J Am Soc Echocardiogr 20:477–479

    Article  Google Scholar 

Download references

Funding

None.

Author information

Author notes

  1. Gruschen Veldtman and Mathias Possner have contributed equally to this work

Authors and Affiliations

  1. King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia

    Gruschen Veldtman, Dania Mohty, Ziyad Issa, Monerah Alsaleh, AlJuhara Thaar AlMarzoog, Shisamma Emmanual, Mohammed Saleh AlHabdan, Ghassan Siblini & Olga Vriz

  2. Cardiology Department, Kantonsspital St. Gallen, St. Gallen, Switzerland

    Mathias Possner

  3. Cardiology Department, CHU Limoges, Limoges, France

    Dania Mohty

  4. College of Medicine, Al Faisal University, Riyadh, Saudi Arabia

    Dania Mohty, Yezan Salam & Olga Vriz

  5. Department of Pediatrics, Cincinnati Children’s Hospital Medical Center, Heart Institute, University of Cincinnati, Cincinnati, OH, USA

    Tarek Alsaied

  6. Department of Cardiology, Boston Children’s Hospital, Boston, MA, USA

    Rahul H. Rathod

  7. Department of Pediatrics, Harvard Medical School, Boston, MA, USA

    Rahul H. Rathod

  8. King Faisal Specialist Hospital and Research Center, Adult Congenital Heart Disease Service MBC16, PO BOX 3354, Riyadh, 11211, Saudi Arabia

    Gruschen Veldtman

Authors
  1. Gruschen Veldtman
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Mathias Possner
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Dania Mohty
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Ziyad Issa
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Monerah Alsaleh
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. AlJuhara Thaar AlMarzoog
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Shisamma Emmanual
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Yezan Salam
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Mohammed Saleh AlHabdan
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Tarek Alsaied
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Rahul H. Rathod
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. Ghassan Siblini
    View author publications

    You can also search for this author in PubMed Google Scholar

  13. Olga Vriz
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

Conceptualization: GV, MP, GS, OV; Methodology: GV, MP, YS, MSA, GS; Formal analysis and investigation: GV, MP, ZI, MA, ATA, SE, YS, MSA, GS, OV; Writing—original draft preparation: GV, MP; Writing—review and editing: GV, MP, DM, ZI, MA, ATA, SE, YS, MSA, TA, RHR, GS, OV; Funding acquisition: Not applicable; Resources: GV, MP; Supervision: GV, MP, OV.

Corresponding author

Correspondence to Gruschen Veldtman.

Ethics declarations

Conflict of interest

The authors declare that they have no conflicts of interest.

Ethical approval

The study was approved by the local institutional review board (Office of Research Affairs, King Faisal Specialist Hospital and Research Center, RAC 219185). The study was in accordance with the 1975 Declaration of Helsinki and International Conference on Harmonization Good Clinical Practice Guidelines.

Consent to participate

Written informed consent was waived.

Additional information

Publisher's Note

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

Supplementary Information

Below is the link to the electronic supplementary material.

Supplementary file1 (DOCX 29 kb)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Veldtman, G., Possner, M., Mohty, D. et al. Atrial function in the Fontan circulation: comparison with invasively assessed systemic ventricular filling pressure. Int J Cardiovasc Imaging 37, 2651–2660 (2021). https://doi.org/10.1007/s10554-021-02298-w

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10554-021-02298-w

Keywords

Search

Navigation