Comparison of echocardiographic and pressure-volume loop indices of systolic function in patients with single ventricle physiology: a preliminary report

Congenit Heart Dis. 2015 Jan-Feb;10(1):E17-24. doi: 10.1111/chd.12191. Epub 2014 May 28.

Abstract

Background: Differences in ventricular geometry and physiology of patients with single ventricle anatomy complicate the application of traditional, noninvasive measurements of systolic function. We compared noninvasive measures of ventricular systolic function in single ventricle patients with invasive measures to evaluate their validity in this population.

Methods: A secondary analysis of patients with single ventricle physiology enrolled in the multi-institutional research project, "multi-scale modeling of single ventricle hearts," was performed. Pressure-volume loops (PVLs) were recorded using microconductance catheters. Transthoracic echocardiogram and cardiac magnetic resonance imaging were performed on the same day. PVL indices of systolic function including end-systolic elastance (Ees), maximal rate of pressure increase (dP/dTmax), and stroke work indexed to end-diastolic volume (SW/EDV) were compared with noninvasive measures, including echocardiographic myocardial performance index (MPI), rate of pressure rise (AV valve dP/dT), isovolumic acceleration, longitudinal shortening fraction (longSF), and fractional area change (FAC).

Results: Fifteen patients had PVLs available for analysis. Eleven had a dominant right ventricle, three were status poststage 1 repair, five had superior cavopulmonary anastomosis, and seven had a total cavopulmonary anastomosis. FAC correlated with Ees (r = 0.69, P < .01), SW/EDV (r = 0.64, P = .01), and dP/dTmax (r = 0.59, P = .03). LongSF correlated with dP/dTmax (r = 0.61, P = .02) MPI, AV valve dP/dT, and isovolumic acceleration did not correlate with pressure-volume loop indices of systolic function.

Conclusions: Obtaining PVLs via microconductance catheters can reliably be performed in the single ventricle population and serve as a method to validate echocardiographic indices in this high-risk population. Of the echocardiographic variables, FAC showed the best correlation with PVL indices. Future studies controlling for stage of palliation should be performed to further validate echocardiographic measures of systolic function in this patient population.

Keywords: Echocardiography; Pressure-volume Loop; Single Ventricle; Systolic Function; Ventricular Mechanics.

Publication types

  • Comparative Study
  • Multicenter Study
  • Research Support, Non-U.S. Gov't
  • Validation Study

MeSH terms

  • Adolescent
  • Cardiac Catheterization* / instrumentation
  • Cardiac Catheters
  • Cardiac Surgical Procedures
  • Child
  • Child, Preschool
  • Echocardiography, Doppler*
  • Equipment Design
  • Heart Defects, Congenital / diagnosis*
  • Heart Defects, Congenital / diagnostic imaging
  • Heart Defects, Congenital / physiopathology
  • Heart Defects, Congenital / surgery
  • Heart Ventricles / abnormalities
  • Heart Ventricles / diagnostic imaging*
  • Heart Ventricles / physiopathology*
  • Heart Ventricles / surgery
  • Humans
  • Infant
  • Magnetic Resonance Imaging, Cine
  • Male
  • Miniaturization
  • Palliative Care
  • Predictive Value of Tests
  • Reproducibility of Results
  • Stroke Volume
  • Ventricular Function, Left*
  • Ventricular Function, Right*
  • Ventricular Pressure