Abstract 14453: Atrial Function and Single Ventricular Hearts Diastolic Function Across Staged Surgical Palliation Using Speckle Tracking Imaging
Background: Our recent study of single ventricular (SV) hearts across staged palliation using speckle tracking imaging (STI) echocardiography showed a reduction in ventricular function. A percentage of patients had to be excluded due to poor image quality, especially with increasing age. Imaging of the atrium is potentially easier to achieve and has been shown to be an important prognosticator of morbidity and death in adults with heart failure. Using STI, we assessed atrial strain (ε) parameters in SV to identify potential measures of function across the stages of surgical palliation.
Methods: Cross-sectional study of 80 SV patients with STI performed for atrial ε parameters with reference set at P wave. The peak negative ε, peak positive ε and total ε, corresponded to atrial active (εact), passive (εpas) and reservoir (εres - a measure of total atrial expansion) respectively. Similarly peak strain rate (SR) for each atrial phase corresponded to atrial contractility (SRact), passive emptying (SRpas) and reservoir filling (SRres). Correlations of ε and SR with ventricular color tissue Doppler imaging (TDI) were explored, as well as the changes through staged palliation.
Results: Changes in atrial ε parameters across staged palliation included, a reduction in SRact (p < 0.001), SRres (p = 0.02), εact (p < 0.01) and an increased in εpas (p < 0.01). Although these parameters had various relations with atrial (a′) and ventricular (E/e′, s′) function, the changes across stages were associated with a reduction in heart rate (HR) (p<0.0001). However εres and SRpas were HR independent and did not change significantly across surgical stages. Decreased εres and SRpas correlated with increased E/e′ (r = 0.42, p = 0.002, r = 0.27, p = 0.04 respectively). TDI s′ decreased (p = 0.01) while E/e′ and a′ did not significantly change across the stages.
Conclusion: The gradual change from greater atrial active to greater passive emptying with age and reducing HR, parallels known normal early life maturational changes. In contrast, reservoir function and passive emptying were HR independent and did not alter across staged surgeries. Both measures had an inverse correlation with E/e′ suggesting their potential complementary role for serial monitoring of ventricular function in SV hearts.
- © 2010 by American Heart Association, Inc.