Edward H Hardison, Christopher C Henderson, Rachel K Duncan, Kristen George-Durrett, James C Slaughter, Ryan D Byrne, Joshua D Chew, Benjamin P Frischhertz, David A Parra, Angela J Weingarten, Jonathan H Soslow, Daniel E Clark
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引用次数: 0
Abstract
Background: Adults with Fontan failure (FF) have variable presentations and are often diagnosed late. Reliable predictors of FF are unknown. Diastolic dysfunction may be associated with adverse outcomes late after Fontan palliation.
Methods: Fontan patients were compared to healthy controls. FF was defined as death, transplant, diagnosis of protein losing enteropathy, peak VO2 < 50% predicted, or new diuretic requirement. All phases in the short axis plane were contoured to calculate filling and ejection curves. The following variables were measured by cardiac magnetic resonance (CMR): peak filling rate (PFR), peak ejection rate (PER), PFR and PER indexed to end diastolic volume (EDV), time to PFR (tPFR), and time to PER (tPER).
Results: Compared to healthy controls (N=96), the Fontan group (N=98) had worse diastolic function as evidenced by decreased PFR and PFR/EDV and increased tPFR. Patients with FF (N=39) had similar ventricular systolic function and volumetrics to the Fontan subjects without failure (NF; N=59). PFR/EDV was significantly reduced and indexed common ventricular mass was significantly higher among FF patients with the most severe adverse outcomes of death or heart transplantation. The prevalence of late gadolinium enhancement was higher in the FF cohort than the NF cohort.
Conclusions: CMR can identify diastolic dysfunction in the Fontan population. Patients with Fontan circulation who died or had a combined outcome of death or transplant had worse diastolic function by CMR compared to Fontan patients without death or transplant.
期刊介绍:
Journal of Cardiovascular Magnetic Resonance (JCMR) publishes high-quality articles on all aspects of basic, translational and clinical research on the design, development, manufacture, and evaluation of cardiovascular magnetic resonance (CMR) methods applied to the cardiovascular system. Topical areas include, but are not limited to:
New applications of magnetic resonance to improve the diagnostic strategies, risk stratification, characterization and management of diseases affecting the cardiovascular system.
New methods to enhance or accelerate image acquisition and data analysis.
Results of multicenter, or larger single-center studies that provide insight into the utility of CMR.
Basic biological perceptions derived by CMR methods.