Abstract 8889: Isovolumic Acceleration Correlates with Single Ventricle Pre or Post Fontan Ventricular End Diastolic Pressure, Not E/e′
Background: Estimation of diastolic function in single ventricle (SV) hearts with varied ventricular loading from staged palliative surgery is particularly challenging. To define the best non-invasive correlate of diastolic function in SV, we studied the relationship between echocardiography function parameters, and invasively measured end diastolic pressure (EDP) of the dominant ventricle in SV patients.
Methods and Results: Thirty SV patients, mean age 41±11 months, with cardiac catheterization pre (n=20) or post Fontan (n=10), had their most closely associated echocardiogram (median 3.5, 0.6 to 9.9 months), assessed using conventional and color tissue Doppler imaging (TDI) parameters for systolic and diastolic function. Echocardiogram parameters and catheter-derived data were explored for linear correlations with p<0.05 being significant. The EDP and mean pulmonary artery (PAP) pressures were 6.5±3.5 and 9.6±3.4 mmHg respectively. No significant correlation was found between echocardiography diastolic parameters, early and late peak inflow velocities (E, A and E/A), TDI annular velocities (e′, a′ and E/e′), pulmonary venous Doppler spectra, isovolumic relaxation time, atrial size and function, and invasively measured EDP or PAP. Systolic parameters, ventricular annular excursion, TDI (s′ and Tei index), ventricular size and function, had no significant correlation with EDP or PAP. Only isovolumic acceleration (IVA), a mostly load independent non-invasive measure of myocardial contractility, held a highly significant negative correlation with EDP (Figure).
Conclusions: Decreased IVA, a marker of reduced myocardial contractility, has the best non-invasive correlate with invasively measured EDP in SV. In contrast E/e′ and other parameters of diastolic function do not. Current echocardiographic diastolic parameters established in adults with heart failure may not be useful in SV.
- © 2011 by American Heart Association, Inc.