Diastolic dysfunction: assessment and implications on the single ventricle circulation.
Journal
Current opinion in pediatrics
ISSN: 1531-698X
Titre abrégé: Curr Opin Pediatr
Pays: United States
ID NLM: 9000850
Informations de publication
Date de publication:
01 Oct 2024
01 Oct 2024
Historique:
medline:
10
9
2024
pubmed:
10
9
2024
entrez:
10
9
2024
Statut:
ppublish
Résumé
Patients with a functionally single ventricle (SV) are palliated with a series of procedures leading to a Fontan circulation. Over the life span, a substantial proportion of SV patients develop heart failure that can arise from circulatory or ventricular failure. Diastolic dysfunction (DD) is an important determinant of adverse outcomes in SV patients. However, assessment and categorization of DD in the SV remains elusive. We review recent literature and developments in assessment of DD in the SV and its relation to clinical outcomes. DD is prevalent in the SV and associated with worse outcomes. Occult DD can be exposed with provocative testing by exercise or preload challenge during catheterization. Likewise, sensitivity to detect DD may be increased via assessment of atrial function and strain imaging. Recent studies revisiting previous concepts such as incoordinate diastolic wall motion show that these are associated with SV end-diastolic pressures and post-Fontan recovery, yielding accessible DD assessment. Emerging technologies such as ultrafast ultrasound (UFUS) can provide noninvasive assessment of myocardial stiffness, inefficient diastolic flow patterns and intraventricular pressure gradients, thereby yielding new tools and insights into diastolic myocardial and hemodynamic properties. Characterizing DD in the SV continues to have substantial limitations, necessitating synthesis of multiple parameters into an overall assessment, accounting for their change over time, and in the context of the patient's clinical status. New and emerging techniques may help advance DD assessment and the ability to track response to treatment of new targets.
Identifiants
pubmed: 39254754
doi: 10.1097/MOP.0000000000001385
pii: 00008480-202410000-00004
doi:
Types de publication
Journal Article
Review
Langues
eng
Sous-ensembles de citation
IM
Pagination
503-511Informations de copyright
Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.
Références
Rychik J, Atz AM, Celermajer DS, et al. Evaluation and management of the child and adult with Fontan circulation: a scientific statement from the American Heart Association. Circulation 2019; 140:e234e284.
Alsaied T, Bokma JP, Engel ME, et al. Factors associated with long-term mortality after Fontan procedures: a systematic review. Heart 2017; 103:104110.
Greenbaum RA, Ho SY, Gibson DG, et al. Left ventricular fibre architecture in man. Br Heart J 1981; 45:248263.
Ghelani SJ, Colan SD, Azcue N, et al. Impact of ventricular morphology on fiber stress and strain in Fontan patients. Circ Cardiovasc Imaging 2018; 11:e006738.
Anthony C, Akintoye E, Wang T, et al. Echo Doppler parameters of diastolic function. Curr Cardiol Rep 2023; 25:235247.
Cheung YF, Penny DJ, Redington AN. Serial assessment of left ventricular diastolic function after Fontan procedure. Heart 2000; 83:420424.
Friedberg MK, Silverman NH. The systolic to diastolic duration ratio in children with hypoplastic left heart syndrome: a novel Doppler index of right ventricular function. J Am Soc Echocardiogr 2007; 20:749755.
Cordina R, von Klemperer K, Kempny A, et al. Echocardiographic predictors of mortality in adults with a fontan circulation. JACC Cardiovasc Imaging 2017; 10:212213.
Cua CL, Moore-Clingenpeel M, Husain N, et al. Systolic/diastolic ratio correlates with end diastolic pressures in pediatric patients with single right ventricles. Congenit Heart Dis 2019; 14:609613.
Margossian R, Sleeper LA, Pearson GD, et al. Assessment of diastolic function in single-ventricle patients after the Fontan procedure. J Am Soc Echocardiogr 2016; 29:10661073.
Dragulescu A, Mertens L, Friedberg MK. Interpretation of left ventricular diastolic dysfunction in children with cardiomyopathy by echocardiography: problems and limitations. Circ Cardiovasc Imaging 2013; 6:254261.
Goudar SP, Zak V, Atz AM, et al. Comparison of echocardiographic measurements to invasive measurements of diastolic function in infants with single ventricle physiology: a report from the Pediatric Heart Network Infant Single Ventricle Trial. Cardiol Young 2019; 29:12481256.
Peck D, Alsaied T, Pradhan S, et al. Atrial reservoir strain is associated with decreased cardiac index and adverse outcomes post Fontan operation. Pediatr Cardiol 2021; 42:307314.
Yu JJ, Grosse-Wortmann L, Slorach C, et al. Diastolic myocardial mechanics and their relation to ventricular filling pressures and postoperative course in functionally single ventricles. J Appl Physiol 19852023; 135:621630.
Chowdhury SM, Butts RJ, Buckley J, et al. Comparison of pressure-volume loop and echocardiographic measures of diastolic function in patients with a single-ventricle physiology. Pediatr Cardiol 2014; 35:9981006.
Averin K, Hirsch R, Seckeler MD, et al. Diagnosis of occult diastolic dysfunction late after the Fontan procedure using a rapid volume expansion technique. Heart 2016; 102:11091114.
Peck D, Averin K, Khoury P, et al. Occult diastolic dysfunction and adverse clinical outcomes in adolescents and young adults with fontan circulation. J Am Heart Assoc 2023; 12:e026508.
Miranda WR, Borlaug BA, Jain CC, et al. Exercise-induced changes in pulmonary artery wedge pressure in adults post-Fontan versus heart failure with preserved ejection fraction and noncardiac dyspnoea. Eur J Heart Fail 2023; 25:1725.
Thomas L, Marwick TH, Popescu BA, et al. Left atrial structure and function, and left ventricular diastolic dysfunction: JACC State-of-the-Art Review. J Am Coll Cardiol 2019; 73:19611977.
Zuckerberg JC, Matsubara D, Kauffman HL, et al. Left atrial stiffness and strain are novel indices of left ventricular diastolic function in children: validation followed by application in multisystem inflammatory syndrome in children due to COVID-19. Eur Heart J Cardiovasc Imaging 2023; 24:12411251.
Veldtman G, Possner M, Mohty D, et al. Atrial function in the Fontan circulation: comparison with invasively assessed systemic ventricular filling pressure. Int J Cardiovasc Imaging 2021; 37:26512660.
Rathod RH, Prakash A, Powell AJ, et al. Myocardial fibrosis identified by cardiac magnetic resonance late gadolinium enhancement is associated with adverse ventricular mechanics and ventricular tachycardia late after Fontan operation. J Am Coll Cardiol 2010; 55:17211728.
Kato A, Riesenkampff E, Yim D, et al. Pediatric Fontan patients are at risk for myocardial fibrotic remodeling and dysfunction. Int J Cardiol 2017; 240:172177.
Alsaied T, Moore RA, Lang SM, et al. Myocardial fibrosis, diastolic dysfunction and elevated liver stiffness in the Fontan circulation. Open Heart; 2020;7. doi:10.1136/openhrt-2020-001434.
Aly S, Mertens L, Friedberg MK, et al. Longitudinal changes in ventricular mechanics in adolescents after the Fontan operation. J Am Soc Echocardiogr 2023; 36:9981007.
Konduri A, West C, Lowery R, et al. Experience with SGLT2 inhibitors in patients with single ventricle congenital heart disease and Fontan circulatory failure. Pediatr Cardiol. 2023. doi:10.1007/s00246-023-03332-5.
Renaud D, Scholl-Bürgi S, Karall D, Michel M. Comparative metabolomics in single ventricle patients after fontan palliation: a strong case for a targeted metabolic therapy. Metabolites 2023; 13:932.
Stone ML, Schäfer M, DiMaria MV, et al. Diastolic inflow is associated with inefficient ventricular flow dynamics in Fontan patients. J Thorac Cardiovasc Surg 2022; 163:11951207.
Penny DJ, Rigby ML, Redington AN. Abnormal patterns of intraventricular flow and diastolic filling after the Fontan operation: Evidence for incoordinate ventricular wall motion. Br Heart J 1991; 66:375378.
Rösner A, McElhinney DB, Diab SG, et al. Classic-pattern dyssynchrony is associated with outcome in patients with Fontan circulation. J Am Soc Echocardiogr 2022; 35:513522.
Ishizaki U, Nagao M, Shiina Y, et al. Global strain and dyssynchrony of the single ventricle predict adverse cardiac events after the Fontan procedure: analysis using feature-tracking cine magnetic resonance imaging. J Cardiol 2019; 73:163170.
Fogel MA, Weinberg PM, Chin AJ, et al. Late ventricular geometry and performance changes of functional single ventricle throughout staged Fontan reconstruction assessed by magnetic resonance imaging. J Am Coll Cardiol 1996; 28:212221.
Fogel MA, Weinberg PM, Fellows KE, et al. A study in ventricular–ventricular interaction. Circulation 1995; 92:219230.
Rösner A, Bharucha T, James A, et al. Impact of right ventricular geometry and left ventricular hypertrophy on right ventricular mechanics and clinical outcomes in hypoplastic left heart syndrome. J Am Soc Echocardiogr 2019; 32:13501358.
Miwa K, Tsumura S, Kanaya T, et al. Impact of the rudimentary chamber on outcomes in fontan patients. World J Pediatr Congenit Heart Surg. doi:10.1177/21501351241227882.
Chowdhury SM, Graham EM, Taylor CL, et al. Diastolic dysfunction with preserved ejection fraction after the fontan procedure. J Am Heart Assoc 2022; 11:e024095.
Ohuchi H, Mori A, Kurosaki K, et al. Prevalence and clinical correlates and characteristics of “Super Fontan”. Am Heart J 2023; 263:93103.
Rato J, Mendes SC, Sousa A, et al. The influence of atrial strain on functional capacity in patients with the Fontan circulation. Pediatr Cardiol 2020; 41:17301738.
Garofalo CA, Cabreriza SE, Quinn TA, et al. Ventricular diastolic stiffness predicts perioperative morbidity and duration of pleural effusions after the Fontan operation. Circulation; 2006;114. doi:10.1161/CIRCULATIONAHA.105.001396.
Davis EK, Ginde S, Stelter J, et al. Echocardiographic assessment of single-ventricle diastolic function and its correlation to short-term outcomes after the Fontan operation. Congenit Heart Dis 2019; 14:720725.
Sallmon H, Ovroutski S, Schleiger A, et al. Late Fontan failure in adult patients is predominantly associated with deteriorating ventricular function. Int J Cardiol 2021; 344:8794.
Villemain O, Baranger J, Friedberg MK, et al. Ultrafast ultrasound imaging in pediatric and adult cardiology: techniques, applications, and perspectives. JACC Cardiovasc Imaging 2020; 13:17711791.