Journal of the American Society of Echocardiography最新文献

Background: Fontan circulatory failure with impaired systolic function is well documented; however, its mechanisms are not fully understood. We aimed to explore the myocardial functional reserve in adolescent patients with Fontan circulation in response to exercise or acute preload increase.

Methods: Our study comprised 32 patients (median age: 16.7 years, range: 15.4-17.9 years, 12 females) with Fontan circulation. Echocardiographic imaging was performed during exercise using a recumbent cycle ergometer and during heart catheterization with a rapid infusion of 0.9% saline infusion at 5 mL/kg body weight. We measured myocardial peak longitudinal strain (LS) in a 4-chamber view during specific time intervals before, during, and after the exercise (LS_stress) and volume load (LS_cath). During catheterization, central venous pressure (CVP) and ventricular end-diastolic pressures (VEDP) were simultaneously recorded. A control group of 16 healthy individuals participated in the exercise test.

Results: The mean LS_stress was less negative for patients than for controls (P≤0.001 at all stages); however, it significantly improved from -18.4±5.5% at baseline to -22.0±6.5% (P=0.004) at maximal loading. LS_stress at maximal loading did not correlate with changes in heart rate. During catheterization, the mean LS_cath was -19.6±6.0% at baseline and did not improve significantly at 1.00-2.00 min and at 4.00-6.00 min after saline infusion. In more than half of the patients, LS_cath worsened or improved with less than -2% after the saline infusion. Worsening in LS_cath correlated with CVP and VEDP in all conditions (P≤0.017). There was no difference in LS_stress or LS_cath between the morphological right ventricle and the morphological left ventricle.

Conclusion: Patients with Fontan circulation demonstrate systolic myocardial functional reserve that can be recruited with exercise stress but not with an acute increase in preload.

Background: Although the correction of the proximal isovelocity surface area (PISA) method has been shown to improve the accuracy of assessing the severity of secondary tricuspid regurgitation (STR), its clinical impact remains to be investigated.

Objectives: To compare the association of the quantitative parameters of STR severity obtained from the corrected and conventional PISA methods with the outcome.

Methods: We measured both conventional and corrected effective regurgitant orifice area [EROA vs. corrected EROA (EROAc)], regurgitant volume [RegVol vs. corrected RegVol (RegVolc)], and regurgitant fraction [RegFr vs. corrected RegFr (RegFrc)] in 519 consecutive patients (75±12 years, 44% men, 74% ventricular) with moderate and severe STR. The endpoint was a composite of heart failure hospitalization and death.

Results: EROAc, RegVolc, and RegFrc were significantly larger than EROA, RegVol, and RegFr (P < 0.001 for all). After a follow-up of 19±15 months, 210 patients reached the endpoint. Using time-dependent ROC curves, the parameters obtained from the corrected PISA were more closely associated with outcomes at two years than those obtained with the conventional PISA: EROAc vs. EROA (p<0.001), RegVolc vs. RegVol (p=0.001), and RegFrc vs. RegFr (p<0.001) in ventricular STR. Conversely no significant differences were detected in atrial STR. After multivariable adjustment, both uncorrected and corrected EROA, RegVol, and RegFr were independently associated with the endpoint. Using the new 5-grade severity scheme, patients reclassified by corrected PISA method had a significantly higher rate of events compared to those not reclassified in with V-STR (p = 0.0086). Conversely, this relationship was not statistically significant in patients with atrial STR (p = 0.061) CONCLUSIONS: Correcting the PISA method provides larger quantitative parameters of STR severity that are more closely associated with outcomes in patients with ventricular STR.