Pizzuto Alessandra, Ait-Ali Lamia, Marrone Chiara, Salvadori Stefano, Cuman Magdalena, Pak Vitali, Santoro Giuseppe, Festa Pierluigi
Foundation "G. Monasterio", Heart Hospital "G. Pasquinucci", Pediatric Cardiology and GUCH Unit, Massa, Italy.
Institute of Clinical Physiology, National Research Council (NRC), Massa, Italy.
Cardiol Young. 2022 Dec;32(12):1930-1937. doi: 10.1017/S1047951121005175. Epub 2021 Dec 28.
Growing evidence has emphasised the importance of ventricular performance in functionally single-ventricle patients, particularly concerning diastolic function. Cardiac MRI has been proposed as non-invasive alternative to pre-Fontan cardiac catheterisation in selected patients.
To identify clinical and cardiac magnetic resonance predictors of high pre-Fontan end-diastolic ventricular pressure.
In a retrospective single-centre study, 38 patients with functionally univentricular heart candidate for Fontan intervention, who underwent pre-Fontan cardiac catheterisation, beside a comprehensive cardiac MRI, echocardiographic, and clinical assessment were included. Medical and surgical history, cardiac magnetic resonance, cardiac catheterisation, echocardiographic, and clinical data were recorded. We investigated the association between non-invasive parameters and cardiac catheterisation pre-Fontan risk factors, in particular with end-diastolic ventricular pressure. Moreover, the impact of conventional invasive pre-Fontan risk factor on post-operative outcome as also assessed.
Post-operative complications were associated with higher end-diastolic ventricular pressure and Mayo Clinic indexes (p < 0.01 and p = 0.05, respectively). At receiver operating characteristic curve analysis end-diastolic ventricular pressure ≥ 10.5 mmHg predicted post-operative complications with a sensitivity of 75% and specificity of 88% (AUC: 0.795, 95% CI 0.576;1.000, p < 0.05). At multivariate analysis, both systemic right ventricle (OR: 23.312, 95% CI: 2.704-200.979, p < 0.01) and superior caval vein indexed flow (OR: 0.996, 95% CI: 0.993-0.999, p < 0.05) influenced end-diastolic ventricular pressure ≥ 10.5 mmHg.
A reduced superior caval vein flow, evaluated at cardiac magnetic resonance, is associated with higher end-diastolic ventricular pressure a predictor of early adverse outcome in post-Fontan patients.
越来越多的证据强调了心室功能在功能性单心室患者中的重要性，尤其是舒张功能。心脏磁共振成像已被提议作为特定患者Fontan手术前心脏导管检查的非侵入性替代方法。
确定Fontan手术前舒张末期心室压力升高的临床和心脏磁共振预测指标。
在一项回顾性单中心研究中，纳入了38例功能性单心室心脏患者，这些患者计划接受Fontan手术，除了进行全面的心脏磁共振成像、超声心动图和临床评估外，还接受了Fontan手术前的心脏导管检查。记录了患者的病史、手术史、心脏磁共振成像、心脏导管检查、超声心动图和临床数据。我们研究了非侵入性参数与Fontan手术前心脏导管检查危险因素之间的关联，特别是与舒张末期心室压力的关联。此外，还评估了传统的侵入性Fontan手术前危险因素对术后结果的影响。
术后并发症与较高的舒张末期心室压力和梅奥诊所指数相关（分别为p < 0.01和p = 0.05）。在受试者工作特征曲线分析中，舒张末期心室压力≥10.5 mmHg预测术后并发症的敏感性为75%，特异性为88%（AUC：0.795，95% CI 0.576；1.000，p < 0.05）。在多变量分析中，系统性右心室（OR：23.312，95% CI：2.704 - 200.979，p < 0.01）和上腔静脉指数流量（OR：0.996，95% CI：0.993 - 0.999，p < 0.05）均影响舒张末期心室压力≥10.5 mmHg。
心脏磁共振成像评估的上腔静脉血流减少与较高的舒张末期心室压力相关，舒张末期心室压力是Fontan手术后早期不良结局的预测指标。
