Daniel Forsha1, Ling Li2, Navya Joseph3, Shelby Kutty4, Mark K Friedberg5. 1. Division of Cardiology, Ward Family Heart Center, Children's Mercy Hospital, Kansas City, MO, United States of America. Electronic address: Deforsha@CMH.edu. 2. Division of Pediatric Cardiology, University of Nebraska Medical Center, Children's Hospital and Medical Center, Omaha, NE, United States of America. Electronic address: Ling.li@unmc.edu. 3. Division of Pediatric Cardiology, University of Nebraska Medical Center, Children's Hospital and Medical Center, Omaha, NE, United States of America. Electronic address: Navya.joseph@unmc.edu. 4. Division of Pediatric Cardiology, University of Nebraska Medical Center, Children's Hospital and Medical Center, Omaha, NE, United States of America. Electronic address: Skutty1@jhmi.edu. 5. Department of Cardiology, Labatt Family Heart Centre, Hospital for Sick Children, Toronto, ON, Canada; Department of Pediatrics, University of Toronto, Toronto, ON, Canada. Electronic address: Mark.Friedberg@sickkids.ca.
Abstract
BACKGROUND: In Hypoplastic Left Heart Syndrome (HLHS), RV dysfunction is associated with poor outcomes. However, the effect of varying LV size on regional RV mechanics and outcome has not been studied. METHODS: Twenty newborns (0-7 days) with HLHS had pre-stage 1 and pre-stage 2 echocardiograms prospectively protocoled for strain analysis of the apical 4-chamber view. RV longitudinal strain was analyzed, and LV size was classified as diminutive (no visible LV chamber) or moderate size (visible LV chamber). Clinical outcome was reported as alive vs death or transplant (D-TP) at final clinical follow-up (pre-stage 3). Groups were compared with t-test, Fisher's Exact, and ANOVA tests as appropriate. RESULTS: At pre-stage 1, infants with a diminutive LV (7/20, 35%) vs a moderately hypoplastic LV (13/20, 65%) did not have significantly different global RV strain (-18.4 ± 2.6% vs -18.8 ± 3.2%; p = 0.83). However, basal septal strain was significantly diminished in the moderately hypoplastic LV group vs the diminutive LV group (-4.4 ± 6.0% vs -14.7 ± 3.3%; p < 0.005). There was severely diminished septal strain in nearly all (11/13) of the moderately hypoplastic group. At the pre-stage II echo, global RV strain between groups remained similar (p = 0.76) as did the diminished septal strain in the moderate LV group (p = 0.86). The moderately hypoplastic LV group had worse clinical outcomes (6/13 D-TP vs 0/7 D-TP; p = 0.05). CONCLUSIONS: In this small HLHS cohort, diminished septal strain leading to asymmetric RV mechanics may be associated with poor outcomes in those with larger LV/septal size.
BACKGROUND: In Hypoplastic Left Heart Syndrome (HLHS), RV dysfunction is associated with poor outcomes. However, the effect of varying LV size on regional RV mechanics and outcome has not been studied. METHODS: Twenty newborns (0-7 days) with HLHS had pre-stage 1 and pre-stage 2 echocardiograms prospectively protocoled for strain analysis of the apical 4-chamber view. RV longitudinal strain was analyzed, and LV size was classified as diminutive (no visible LV chamber) or moderate size (visible LV chamber). Clinical outcome was reported as alive vs death or transplant (D-TP) at final clinical follow-up (pre-stage 3). Groups were compared with t-test, Fisher's Exact, and ANOVA tests as appropriate. RESULTS: At pre-stage 1, infants with a diminutive LV (7/20, 35%) vs a moderately hypoplastic LV (13/20, 65%) did not have significantly different global RV strain (-18.4 ± 2.6% vs -18.8 ± 3.2%; p = 0.83). However, basal septal strain was significantly diminished in the moderately hypoplastic LV group vs the diminutive LV group (-4.4 ± 6.0% vs -14.7 ± 3.3%; p < 0.005). There was severely diminished septal strain in nearly all (11/13) of the moderately hypoplastic group. At the pre-stage II echo, global RV strain between groups remained similar (p = 0.76) as did the diminished septal strain in the moderate LV group (p = 0.86). The moderately hypoplastic LV group had worse clinical outcomes (6/13 D-TP vs 0/7 D-TP; p = 0.05). CONCLUSIONS: In this small HLHS cohort, diminished septal strain leading to asymmetric RV mechanics may be associated with poor outcomes in those with larger LV/septal size.
Authors: Alan P Wang; Angela M Kelle; Meredith Hyun; Chelsea L Reece; Phillip M Young; Patrick W O'Leary; M Yasir Qureshi Journal: Pediatr Cardiol Date: 2020-10-26 Impact factor: 1.655
Authors: Katrin Fricke; Mats Mellander; Katarina Hanséus; Phan-Kiet Tran; Mats Synnergren; Jens Johansson Ramgren; Annika Rydberg; Jan Sunnegårdh; Magnus Dalén; Gunnar Sjöberg; Constance G Weismann; Petru Liuba Journal: J Am Heart Assoc Date: 2022-03-29 Impact factor: 6.106