Schmidt Renate, Orwat Stefan, Kempny Aleksander, Schuler Pia, Radke Robert, Kahr Peter C, Hellige Antje, Baumgartner Helmut, Diller Gerhard-Paul
Adult Congenital and Valvular Heart Disease Center, Department of Cardiology and Angiology, University Hospital of Münster, Münster, Germany.
Congenit Heart Dis. 2014 Sep-Oct;9(5):397-406. doi: 10.1111/chd.12156. Epub 2013 Dec 24.
Patients are commonly affected by ventricular dysfunction and heart failure after Fontan palliation. Reliable quantification of ventricular function is of interest but hampered by complex ventricular anatomy and physiology.
We aimed to assess myocardial function using a novel cardiac magnetic resonance imaging (CMR)-based feature-tracking (FT) technique and to study its clinical utility in Fontan patients.
Retrospective study in consecutive patients attending our service.
We included 15 adult Fontan patients (age 27 ± 7 years) who underwent a standardized transthoracic echocardiographic investigation (TTE) with measurement of global strain using speckle tracking. Thirteen patients also underwent CMR, with assessment of myocardial deformation by FT, providing longitudinal and circumferential global strain for the single ventricle. The value of TTE-based strain measurements was limited by the fact that in 63% of patients at least one myocardial segment could not be adequately quantified due to limited acoustic windows. In contrast, CMR allowed for a complete visualization of all wall segments. Not surprisingly, there was poor agreement between the techniques but good or moderate interobserver variability for FT (coefficients of variability 6.6% and 14.3% for circumferential and longitudinal strain). Unlike ejection fraction, FT parameters correlated significantly with age at Fontan completion, New York Heart Association (NYHA) class, and peak oxygen uptake on cardiopulmonary exercise testing.
Assessment of myocardial function using CMR cine-based feature tracking is feasible in Fontan patients. Unlike echocardiographic techniques, FT is independent of inadequate acoustic windows and FT measurements relate to clinical parameters, suggesting that this approach could have clinical relevance in future.
在Fontan姑息手术后，患者常受心室功能障碍和心力衰竭影响。心室功能的可靠量化备受关注，但复杂的心室解剖结构和生理功能阻碍了这一进程。
我们旨在使用基于新型心脏磁共振成像（CMR）的特征追踪（FT）技术评估心肌功能，并研究其在Fontan患者中的临床应用价值。
对前来我院就诊的连续患者进行回顾性研究。
我们纳入了15例成年Fontan患者（年龄27±7岁），这些患者接受了标准化的经胸超声心动图检查（TTE），并使用斑点追踪技术测量整体应变。13例患者还接受了CMR检查，通过FT评估心肌变形，为单心室提供纵向和周向整体应变。基于TTE的应变测量值受到限制，因为在63%的患者中，由于声学窗口有限，至少一个心肌节段无法得到充分量化。相比之下，CMR能够完整显示所有壁段。不出所料，两种技术之间的一致性较差，但FT的观察者间变异性良好或中等（周向和纵向应变的变异系数分别为6.6%和14.3%）。与射血分数不同，FT参数与Fontan手术完成时的年龄、纽约心脏协会（NYHA）分级以及心肺运动试验中的峰值摄氧量显著相关。
在Fontan患者中，使用基于CMR电影的特征追踪评估心肌功能是可行的。与超声心动图技术不同，FT不受声学窗口不足的影响，且FT测量值与临床参数相关，这表明该方法未来可能具有临床相关性。
