Negative Impact of the Left Ventricular Remnant Morphology on Systemic Right Ventricular Myocardial Deformation in Hypop
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ORIGINAL ARTICLE
Negative Impact of the Left Ventricular Remnant Morphology on Systemic Right Ventricular Myocardial Deformation in Hypoplastic Left Heart Syndrome Alan P. Wang1 · Angela M. Kelle2,5 · Meredith Hyun3 · Chelsea L. Reece2 · Phillip M. Young4 · Patrick W. O’Leary1,2 · M. Yasir Qureshi1,2 · Wanek Family Program for Hypoplastic Left Heart Syndrome Imaging Pipeline Received: 25 March 2020 / Accepted: 29 September 2020 © Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Left ventricular (LV) morphology may affect right ventricular (RV) function before and after Fontan palliation in patients with hypoplastic left heart syndrome (HLHS). We sought to assess the potential impact of LV morphology on RV function in patients with HLHS using cardiac magnetic resonance (CMR) imaging. A retrospective analysis of available CMR scans from all patients with HLHS was performed. LV morphology was categorized as absent/slit-like or globular/miniaturized. Volumetric analysis was performed using manual disc-summation method on steady-state free precession (SSFP) stack obtained in short-axis orientation of the ventricles. 4-chamber and short-axis SSFP images were used to measure strain on a semiautomated feature-tracking (FT) module. Two sample t-test was used to compare the groups. A total of 48 CMR scans were analyzed. Of those, 12 patients had absent/slit-like and 36 had globular/miniaturized LV morphology. Averaged 4-chamber longitudinal RV strain was significantly higher for absent/slit-like (− 17.6 ± 4.7%) than globular/miniaturized (− 13.4 ± 3.5; P = 0.002). Averaged 4-chamber radial RV strain was also significantly higher for absent/slit-like (33.1 ± 14.9%) than globular/miniaturized (21.6 ± 7.1; P = 0.001). For globular/miniaturized LV morphology, the decreases of 4-chamber longitudinal and radial strains were mainly attributable to the septal basilar and septal mid-ventricular segments. No differences were found in short-axis RV global circumferential strain between the morphologic subtypes (absent/slit-like − 15.0 ± 6.5, globular/miniaturized − 15.7 ± 4.7; P = 0.68). Larger LV remnants, with globular/miniaturized LV morphology, demonstrated diminished strain in the septal base and mid-ventricle segments. Patients with globular/miniaturized LV morphology may benefit with closer monitoring and lower threshold to start heart failure medications. These results exemplify the utility of including both septal and regional deformation in systemic RV strain analysis. Keywords Cardiac magnetic resonance imaging · Strain · Hypoplastic left heart syndrome · Right ventricle · Feature tracking
Background The members of Wanek Family Program for Hypoplastic Left Heart Syndrome Imaging Pipeline are listed in Acknowledgements section. Electronic supplementary material The online version of this article (https://doi.org/10.1007/s00246-020-02480-2) contains supplementary material, which is available to authorized users.
Hypoplastic left heart syndrome (HLHS) is a condition hallmarked by varying de
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