Increased Global Post-Systolic Contraction During 1st Interstage Predicts Medium-Term Death or Transplantation in Children With Hypoplastic Left Heart Syndrome

IF 1.4 4区医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

Echocardiography-A Journal of Cardiovascular Ultrasound and Allied Techniques Pub Date : 2025-07-11 DOI:10.1111/echo.70244

Danielle Harake, Eva Kapravelou, Luke Eckersley, Edythe Tham, Timothy Colen, Lily Lin, Sachie Shigemitsu, Mirza Beigh, Amol Moray, Nee Scze Khoo

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引用次数: 0

Abstract

Background

Echocardiography parameters of right ventricular (RV) dysfunction, fractional area change (RVFAC), and global longitudinal strain during the first interstage have been shown to be associated with death or transplantation in patients with HLHS. However, both parameters lack adequate discriminatory characteristics. This study sought to examine global post-systolic contraction (PSC), a marker of myocardial inefficiency, as a predictor of death or transplantation (Tx) in patients with classic hypoplastic left heart syndrome (HLHS).

Methods

We performed a post-hoc analysis of 62 prospectively recruited patients with HLHS prior to the bidirectional cavopulmonary anastomosis (BCPA) surgery. We measured RV function parameters: RVFAC, global longitudinal strain, strain rate, mechanical dispersion index (MDI), and PSC. For each parameter, the receiver operating characteristic analysis determined the optimal cut-offs for the primary endpoint of death/Tx, followed by a Kaplan-Meier analysis. Parameters interobserver variability testing was performed.

Results

Median follow-up from pre-BCPA echocardiogram was 7.4 years. HLHS with outcome of death/Tx (n = 14) had lower RVFAC, longitudinal strain and strain rate, and increased PSC when compared with survivors. PSC of >5% performed the best, with the greatest area under the curve 0.75, sensitivity 64% and specificity 83%, hazard ratio 5.54 (95% CI 1.63–18.66), for the primary endpoint of death/Tx. PSC and strain parameters had excellent reproducibility.

Conclusion

Increased global post-systolic contraction during the first interstage is associated with an outcome of death or transplantation in the medium term follow up of patients with HLHS. PSC has a greater specificity and reproducibility than global longitudinal strain and RV FAC. Investigation into its use in clinical practice as a predictor of outcome is warranted.

Abstract Image

查看原文本刊更多论文

左心发育不全综合征患儿第1期间期整体收缩增加预示中期死亡或移植

背景超声心动图参数右心室（RV）功能障碍、局部面积改变（RVFAC）和第一期间期整体纵向应变已被证明与HLHS患者的死亡或移植相关。然而，这两个参数都缺乏足够的区别特征。本研究旨在检测心肌效率低下的标志——整体收缩后收缩（PSC）作为典型左心发育不全综合征（HLHS）患者死亡或移植（Tx）的预测因子。方法：我们对62例前瞻性招募的HLHS患者进行了双向腔隙肺吻合术（BCPA）手术前的事后分析。我们测量了RV功能参数：RVFAC、整体纵向应变、应变率、机械分散指数（MDI）和PSC。对于每个参数，受试者工作特征分析确定了主要终点死亡/Tx的最佳截止值，然后进行Kaplan-Meier分析。进行参数观察者间变异检验。结果bcpa前超声心动图的中位随访时间为7.4年。结果死亡/Tx （n = 14）的HLHS与幸存者相比，RVFAC、纵向应变和应变率较低，PSC升高。PSC为>；5%表现最好，曲线下最大面积为0.75，敏感性64%，特异性83%，风险比5.54 (95% CI 1.63-18.66)，主要终点为死亡/Tx。PSC和应变参数重现性好。结论在HLHS患者中期随访中，第一期间期整体收缩增强与死亡或移植相关。PSC比全局纵向应变和RV FAC具有更高的特异性和重复性。研究其在临床实践中作为预后预测指标的应用是有必要的。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Echocardiography-A Journal of Cardiovascular Ultrasound and Allied Techniques 医学-心血管系统

CiteScore

2.40

自引率

6.70%

发文量

211

审稿时长

3-6 weeks

期刊介绍： Echocardiography: A Journal of Cardiovascular Ultrasound and Allied Techniques is the official publication of the International Society of Cardiovascular Ultrasound. Widely recognized for its comprehensive peer-reviewed articles, case studies, original research, and reviews by international authors. Echocardiography keeps its readership of echocardiographers, ultrasound specialists, and cardiologists well informed of the latest developments in the field.