Key result
In adult Fontan patients, a short duration of significant atrioventricular valve regurgitation did not increase the incidence of Fontan failure compared to matched controls.
Why the study?
Significant atrioventricular valve regurgitation is prevalent in adult Fontan patients, but its association with 2D speckle-tracking echocardiographic parameters and adverse clinical outcomes required evaluation.
Does significant atrioventricular valve regurgitation worsen echocardiographic parameters or increase the incidence of Fontan failure in adult Fontan patients?
Case-Control (n=32)
Single-blind
No
Does significant atrioventricular valve regurgitation worsen echocardiographic parameters or increase the incidence of Fontan failure in adult Fontan patients?
In adult Fontan patients, a short duration of significant AVVR was not associated with reduced ejection fraction, worse global longitudinal strain, or increased incidence of Fontan failure compared to matched controls.
Answers are grounded in this paper and cite their sources.
AVVR links to larger atria and worse GLS in Fontan adults; leaves open whether strain refines risk stratification or guides intervention.
Background: Significant atrioventricular valve regurgitation (AVVR) is prevalent in Fontan adults. Two-dimensional speckle-tracking echocardiography allows for evaluation of subclinical myocardial dysfunction and offers technical benefits. We aimed to evaluate the association of AVVR with echocardiographic parameters and adverse outcomes. Materials and Methods: Fontan adults (≥18 years) with lateral tunnel or extracardiac connection actively followed at our institution were retrospectively reviewed. Patients with AVVR on most recent transthoracic echocardiogram (≥grade 2 as per American Society of Echocardiography guidelines) were matched with Fontan controls. Echocardiographic parameters, including global longitudinal strain (GLS), were measured. The composite outcome of Fontan failure included Fontan conversion, protein losing enteropathy, plastic bronchitis, and New York Heart Association Class III/IV. Results: Sixteen patients (14%, mean age 28.4 ± 7.0 years) with predominantly moderate AVVR (81%) were identified. The mean duration of AVVR was 8.1 ± 5.8 months. There was no significant reduction in ejection fraction (EF) (51.2% ± 11.7% vs. 54.7% ± 10.9%, P = 0.39) or GLS (−16.0% ± 5.2% vs. −16.0% ± 3.5%, P = 0.98) associated with AVVR. Larger atrial volumes and longer deceleration time (DT) were observed in the AVVR group. Patients with AVVR and a worse GLS (≥−16%) had higher E velocity, DT, and medial E/E’ ratio. The incidence of Fontan failure did not differ from controls (38% vs. 25%, P = 0.45). Patients with worse GLS (≥−16%) demonstrated a marked trend toward a higher incidence of Fontan failure (67% vs. 20%, P = 0.09). Conclusions: In Fontan adults, a short duration of AVVR did not influence EF or GLS but was associated with larger atrial volumes and those with worse GLS demonstrated some differences in diastolic parameters. Larger multicenter studies throughout its disease course are warranted.
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Chen et al. (2022) conducted a case-control in Significant atrioventricular valve regurgitation in adult Fontan patients (n=32). Significant atrioventricular valve regurgitation (AVVR) vs. Fontan controls without significant AVVR was evaluated on Composite outcome of Fontan failure (Fontan conversion, protein-losing enteropathy, plastic bronchitis, and NYHA Class III/IV) (p=0.45). In adult Fontan patients, a short duration of significant atrioventricular valve regurgitation did not increase the incidence of Fontan failure compared to matched controls.
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