Key result
Reduced superior caval vein indexed flow evaluated by cardiac MRI was associated with end-diastolic ventricular pressure ≥ 10.5 mmHg (OR 0.996; 95% CI 0.993-0.999; p<0.05).
Why the study?
Ventricular performance, especially diastolic function, is critical in functionally single-ventricle patients, prompting the search for non-invasive clinical and cardiac MRI predictors of high pre-Fontan end-diastolic ventricular pressure.
Can cardiac MRI parameters predict high pre-Fontan end-diastolic ventricular pressure and post-operative complications in patients with functionally univentricular hearts?
Cohort (n=38)
No
Can cardiac MRI parameters predict high pre-Fontan end-diastolic ventricular pressure and post-operative complications in patients with functionally univentricular hearts?
Odds Ratio: 0.996 (95% CI 0.993–0.999)
p-value: p=< 0.05
Reduced superior caval vein flow on cardiac MRI is associated with higher end-diastolic ventricular pressure, serving as a non-invasive predictor of early adverse outcomes in post-Fontan patients.
Should not yet alter pre-Fontan catheterization; leaves open whether CMR can noninvasively identify high-EDP patients.
BACKGROUND: Growing evidence has emphasised the importance of ventricular performance in functionally single-ventricle patients, particularly concerning diastolic function. Cardiac MRI has been proposed as non-invasive alternative to pre-Fontan cardiac catheterisation in selected patients. AIM OF THE STUDY: To identify clinical and cardiac magnetic resonance predictors of high pre-Fontan end-diastolic ventricular pressure. METHOD: In a retrospective single-centre study, 38 patients with functionally univentricular heart candidate for Fontan intervention, who underwent pre-Fontan cardiac catheterisation, beside a comprehensive cardiac MRI, echocardiographic, and clinical assessment were included. Medical and surgical history, cardiac magnetic resonance, cardiac catheterisation, echocardiographic, and clinical data were recorded. We investigated the association between non-invasive parameters and cardiac catheterisation pre-Fontan risk factors, in particular with end-diastolic ventricular pressure. Moreover, the impact of conventional invasive pre-Fontan risk factor on post-operative outcome as also assessed. RESULTS: Post-operative complications were associated with higher end-diastolic ventricular pressure and Mayo Clinic indexes (p < 0.01 and p = 0.05, respectively). At receiver operating characteristic curve analysis end-diastolic ventricular pressure ≥ 10.5 mmHg predicted post-operative complications with a sensitivity of 75% and specificity of 88% (AUC: 0.795, 95% CI 0.576;1.000, p < 0.05). At multivariate analysis, both systemic right ventricle (OR: 23.312, 95% CI: 2.704-200.979, p < 0.01) and superior caval vein indexed flow (OR: 0.996, 95% CI: 0.993-0.999, p < 0.05) influenced end-diastolic ventricular pressure ≥ 10.5 mmHg. CONCLUSIONS: A reduced superior caval vein flow, evaluated at cardiac magnetic resonance, is associated with higher end-diastolic ventricular pressure a predictor of early adverse outcome in post-Fontan patients.
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A 2021 study conducted a cohort in Functionally univentricular heart (n=38). Superior caval vein indexed flow was evaluated on End-diastolic ventricular pressure ≥ 10.5 mmHg (OR 0.996, 95% CI 0.993-0.999, p=< 0.05). Reduced superior caval vein indexed flow evaluated by cardiac MRI was associated with end-diastolic ventricular pressure ≥ 10.5 mmHg (OR 0.996; 95% CI 0.993-0.999; p<0.05).
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