Impaired Single Right Ventricular Function Compared to Single Left Ventricles during the Early Stages of Palliation: A Longitudinal Study

Somjate Suntratonpipat; Nee S Khoo; Timothy Colen; Mohammed Alhabdan; Dongngan Troung; Norazah Zahari; Shelby Kutty; Jeffrey F Smallhorn; Edythe B Tham

doi:10.1016/j.echo.2017.01.001

Impaired Single Right Ventricular Function Compared to Single Left Ventricles during the Early Stages of Palliation: A Longitudinal Study

J Am Soc Echocardiogr. 2017 May;30(5):468-477. doi: 10.1016/j.echo.2017.01.001. Epub 2017 Mar 3.

Authors

Somjate Suntratonpipat¹, Nee S Khoo¹, Timothy Colen¹, Mohammed Alhabdan¹, Dongngan Troung¹, Norazah Zahari¹, Shelby Kutty², Jeffrey F Smallhorn¹, Edythe B Tham³

Affiliations

¹ Division of Pediatric Cardiology, University of Alberta, Stollery Children's Hospital, Edmonton, Alberta, Canada.
² University of Nebraska College of Medicine/Children's Hospital and Medical Center, Omaha, Nebraska.
³ Division of Pediatric Cardiology, University of Alberta, Stollery Children's Hospital, Edmonton, Alberta, Canada. Electronic address: [email protected].

PMID: 28268110
DOI: 10.1016/j.echo.2017.01.001

Abstract

Background: Single right ventricles (SRV) are postulated to be disadvantaged compared with single left ventricles (SLV). We compared the evolution of SRV versus SLV function during infancy using conventional measures and speckle-tracking echocardiography (STE). We hypothesized that the SRV is mechanically disadvantaged during early infancy.

Methods: SRVs (n = 32) were compared with SLVs (n = 16) at the neonatal (presurgery) and pre-bidirectional cavopulmonary anastomosis (pre-BCPA) stages. Functional measures (fractional area change, indexed ventricular annular plane systolic excursion [iVAPSE], isovolumic acceleration [IVA], myocardial performance index, E and A velocities, tissue Doppler imaging annular velocities and STE-measured global longitudinal and circumferential strain, strain rate [SR], and early diastolic SR [EDSR]) were compared between SRV and SLV at each stage and between presurgery and pre-BCPA.

Results: Compared with SLV, presurgery SRV had lower circumferential strain (-10.6% vs -16.5%; P = .0002) and EDSR (1.41%/sec vs 2.13%/sec; P = .001). Pre-BCPA SRV had decreased IVA (1.2 vs 2.1 m/sec²; P = .006): longitudinal strain (-15.3% vs -19.1%; P = .001), SR (-0.97%/sec vs -1.53%/sec; P = .0001), EDSR (1.5%/sec vs 2.1%/sec; P = .001); circumferential strain (-10.6% vs -14.9%; P = .002), SR (-0.8%/sec vs -1.21%/sec; P = .0001), and EDSR (1.3%/sec vs 1.8%/sec; P = .009). SRV showed reduction of iVAPSE, IVA, s', e', a' velocities, longitudinal strain, SR, EDSR, and circumferential SR (P < .05) from presurgery to pre-BCPA, while circumferential strain was unchanged. SLV showed no significant change in these parameters during this interval.

Conclusions: The progressive reduction in SRV longitudinal and circumferential function suggests that SRV may have a mechanical disadvantage from birth and progressive impairment with age.

Keywords: Echocardiography; Single ventricle; Speckle-tracking imaging; Strain; Ventricular function.

Publication types

Controlled Clinical Trial

MeSH terms

Disease Progression
Echocardiography / methods
Female
Heart Ventricles / abnormalities*
Heart Ventricles / diagnostic imaging
Heart Ventricles / physiopathology*
Humans
Image Interpretation, Computer-Assisted / methods
Infant
Infant, Newborn
Longitudinal Studies
Male
Palliative Care / methods
Reproducibility of Results
Sensitivity and Specificity
Stroke Volume
Treatment Outcome
Ventricular Dysfunction, Left / diagnostic imaging*
Ventricular Dysfunction, Left / physiopathology*
Ventricular Dysfunction, Left / surgery
Ventricular Dysfunction, Right / diagnostic imaging*
Ventricular Dysfunction, Right / physiopathology*
Ventricular Dysfunction, Right / surgery