Key result
Single left ventricle patients exhibit reduced GLS of -15.8% and lower LVEF versus healthy controls.
Why the study?
Ventricular dysfunction is a recognized complication in single ventricle patients in Fontan circulation, but studies exclusively examining patients with a single left ventricle are sparse.
Does 2D-CMR-FT detect impaired myocardial deformation in patients with a single left ventricle compared to healthy controls?
Case-Control (n=89)
No
Does 2D-CMR-FT detect impaired myocardial deformation in patients with a single left ventricle compared to healthy controls?
Absolute Event Rate: -15.8% vs -24.1%
p-value: p=<0.0001
In patients with a single left ventricle, 2D-CMR-FT reveals significantly impaired global longitudinal and circumferential strain compared to healthy controls, even when ejection fraction is largely preserved.
Highlights subclinical dysfunction warranting surveillance in single-ventricle patients; leaves open impact on management or outcomes.
Purpose Ventricular dysfunction is a well-known complication in single ventricle patients in Fontan circulation. As studies exclusively examining patients with a single left ventricle (SLV) are sparse, we assessed left ventricular (LV) function in SLV patients by using 2D-cardiovascular magnetic resonance (CMR) feature tracking (2D-CMR-FT) and 2D-speckle tracking echocardiography (2D-STE). Methods 54 SLV patients (11.4, 3.1–38.1 years) and 35 age-matched controls (12.3, 6.3–25.8 years) were included. LV global longitudinal, circumferential and radial strain (GLS, GCS, GRS) and strain rate (GLSR, GCSR, GRSR) were measured using 2D-CMR-FT. LV volumes, ejection fraction (LVEF) and mass were determined from short axis images. 2D-STE was applied in patients to measure peak systolic GLS and GLSR. In a subgroup analysis, we compared double inlet left ventricle (DILV) with tricuspid atresia (TA) patients. Results The population consisted of 19 DILV patients, 24 TA patients and 11 patients with diverse diagnoses. 52 patients were in NYHA class I and 2 patients were in class II. Median LVEF in patients was lower compared to controls (55.6% vs. 61.2%, p = 0.0001). 2D-CMR-FT demonstrated reduced GLS, GCS and GCSR values in patients compared to controls. LVEF correlated with GS values in patients (p < 0.05). There was no significant difference between GLS values from 2D-CMR-FT and 2D-STE in the patient group. LVEF, LV volumes, GS and GSR were not significantly different between DILV and TA patients. Conclusion Although most SLV patients had a preserved EF, our results suggest that, LV deformation and function may behave differently in SLV patients compared to healthy subjects.
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Strodka et al. (2021) conducted a case-control in Single left ventricle (SLV) after Fontan completion (n=89). Single left ventricle (SLV) vs. Healthy controls was evaluated on Global longitudinal strain (GLS) (p=<0.0001). Patients with a single left ventricle exhibited significantly reduced global longitudinal strain (-15.8% vs -24.1%) and left ventricular ejection fraction compared to healthy controls.
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