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Assessment of Diastolic Function in Single-Ventricle Patients After the Fontan Procedure.

Publication ,  Journal Article
Margossian, R; Sleeper, LA; Pearson, GD; Barker, PC; Mertens, L; Quartermain, MD; Su, JT; Shirali, G; Chen, S; Colan, SD ...
Published in: J Am Soc Echocardiogr
November 2016

BACKGROUND: Patients with functional single ventricles after the Fontan procedure have abnormal cardiac mechanics. The aims of this study were to determine factors that influence diastolic function and to describe associations of diastolic function with current clinical status. METHODS: Echocardiograms were obtained as part of the Pediatric Heart Network Fontan Cross-Sectional Study. Diastolic function grade (DFG) was assessed as normal (grade 0), impaired relaxation (grade 1), pseudonymization (grade 2), or restrictive (grade 3). Studies were also classified dichotomously (restrictive pattern present or absent). Relationships between DFG and pre-Fontan variables (e.g., ventricular morphology, age at Fontan, history of volume-unloading surgery) and current status (e.g., systolic function, valvar regurgitation, exercise performance) were explored. RESULTS: DFG was calculable in 326 of 546 subjects (60%) (mean age, 11.7 ± 3.3 years). Overall, 32% of patients had grade 0, 9% grade 1, 37% grade 2, and 22% grade 3 diastolic function. Although there was no association between ventricular morphology and DFG, there was an association between ventricular morphology and E', which was lowest in those with right ventricular morphology (P < .001); this association remained significant when using Z scores adjusted for age (P < .001). DFG was associated with achieving maximal effort on exercise testing (P = .004); the majority (64%) of those not achieving maximal effort had DFG 2 or 3. No additional significant associations of DFG with laboratory or clinical measures were identified. CONCLUSIONS: Assessment of diastolic function by current algorithms results in a high percentage of patients with abnormal DFG, but few clinically or statistically significant associations were found. This may imply a lack of impact of abnormal diastolic function on clinical outcomes in this cohort, or it may indicate that the methodology may not be applicable to pediatric patients with functional single ventricles.

Duke Scholars

Published In

J Am Soc Echocardiogr

DOI

EISSN

1097-6795

Publication Date

November 2016

Volume

29

Issue

11

Start / End Page

1066 / 1073

Location

United States

Related Subject Headings

  • Ventricular Dysfunction, Left
  • Treatment Outcome
  • Stroke Volume
  • Risk Factors
  • Postoperative Complications
  • North America
  • Male
  • Incidence
  • Humans
  • Heart Defects, Congenital
 

Citation

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Margossian, R., Sleeper, L. A., Pearson, G. D., Barker, P. C., Mertens, L., Quartermain, M. D., … Pediatric Heart Network Investigators, . (2016). Assessment of Diastolic Function in Single-Ventricle Patients After the Fontan Procedure. J Am Soc Echocardiogr, 29(11), 1066–1073. https://doi.org/10.1016/j.echo.2016.07.016
Margossian, Renee, Lynn A. Sleeper, Gail D. Pearson, Piers C. Barker, Luc Mertens, Michael D. Quartermain, Jason T. Su, et al. “Assessment of Diastolic Function in Single-Ventricle Patients After the Fontan Procedure.J Am Soc Echocardiogr 29, no. 11 (November 2016): 1066–73. https://doi.org/10.1016/j.echo.2016.07.016.
Margossian R, Sleeper LA, Pearson GD, Barker PC, Mertens L, Quartermain MD, et al. Assessment of Diastolic Function in Single-Ventricle Patients After the Fontan Procedure. J Am Soc Echocardiogr. 2016 Nov;29(11):1066–73.
Margossian, Renee, et al. “Assessment of Diastolic Function in Single-Ventricle Patients After the Fontan Procedure.J Am Soc Echocardiogr, vol. 29, no. 11, Nov. 2016, pp. 1066–73. Pubmed, doi:10.1016/j.echo.2016.07.016.
Margossian R, Sleeper LA, Pearson GD, Barker PC, Mertens L, Quartermain MD, Su JT, Shirali G, Chen S, Colan SD, Pediatric Heart Network Investigators. Assessment of Diastolic Function in Single-Ventricle Patients After the Fontan Procedure. J Am Soc Echocardiogr. 2016 Nov;29(11):1066–1073.
Journal cover image

Published In

J Am Soc Echocardiogr

DOI

EISSN

1097-6795

Publication Date

November 2016

Volume

29

Issue

11

Start / End Page

1066 / 1073

Location

United States

Related Subject Headings

  • Ventricular Dysfunction, Left
  • Treatment Outcome
  • Stroke Volume
  • Risk Factors
  • Postoperative Complications
  • North America
  • Male
  • Incidence
  • Humans
  • Heart Defects, Congenital