Ventricular dyssynchrony and its relationship to clinical outcomes is not well characterized in patients following Fontan palliation. Single-center retrospective analysis of cardiac magnetic resonance (CMR) imaging of patients with a Fontan circulation and an age-matched healthy comparison cohort as controls. Feature tracking was performed on all slices of a ventricular short-axis cine stack. Circumferential and radial strain, strain rate, and displacement were measured; and multiple dyssynchrony metrics were calculated based on timing of these measurements (including standard deviation of time-to-peak, maximum opposing wall delay, and maximum base-to-apex delay). Primary endpoint was a composite measure including time to death, heart transplant or heart transplant listing (D/HTx). A total of 503 cases (15 y; IQR 10, 21) and 42 controls (16 y; IQR 11, 20) were analyzed. Compared to controls, Fontan patients had increased dyssynchrony metrics, longer QRS duration, larger ventricular volumes, and worse systolic function. Dyssynchrony metrics were higher in patients with right ventricular (RV) or mixed morphology compared to those with LV morphology. At median follow-up of 4.3 years, 11% had D/HTx. Multiple risk factors for D/HTx were identified, including RV morphology, ventricular dilation, dysfunction, QRS prolongation, and dyssynchrony. Ventricular dilation and RV morphology were independently associated with D/HTx. Compared to control LVs, single right and mixed morphology ventricles in the Fontan circulation exhibit a higher degree of mechanical dyssynchrony as evaluated by CMR-FT. Dyssynchrony indices correlate with ventricular size and function and are associated with death or need for heart transplantation. These data add to the growing understanding regarding factors that can be used to risk-stratify patients with the Fontan circulation.

中文翻译：

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Fontan 手术后心室不同步与生存率降低相关

Fontan 姑息治疗后患者的心室不同步及其与临床结果的关系尚未得到很好的表征。对具有 Fontan 循环的患者和作为对照的年龄匹配的健康对照队列进行心脏磁共振 (CMR) 成像的单中心回顾性分析。对心室短轴电影堆栈的所有切片进行特征跟踪。测量周向和径向应变、应变率和位移；并根据这些测量的时间计算多个不同步指标（包括峰值时间的标准偏差、最大对墙延迟和最大基部到顶点延迟）。主要终点是综合衡量指标，包括死亡时间、心脏移植或心脏移植列表 (D/HTx)。总共分析了 503 名病例（15 岁；IQR 10、21）和 42 名对照者（16 岁；IQR 11、20）。与对照组相比，Fontan 患者的不同步指标增加、QRS 持续时间更长、心室容积更大、收缩功能更差。与左心室形态患者相比，右心室 (RV) 或混合形态患者的不同步指标更高。中位随访时间为 4.3 年，11% 的患者患有 D/HTx。确定了 D/HTx 的多种危险因素，包括 RV 形态、心室扩张、功能障碍、QRS 延长和不同步。心室扩张和右心室形态与 D/HTx 独立相关。与对照左心室相比，通过 CMR-FT 评估，Fontan 循环中的单右心室和混合形态心室表现出更高程度的机械不同步。不同步指数与心室大小和功能相关，并与死亡或心脏移植的需要相关。这些数据加深了人们对可用于对 Fontan 循环患者进行风险分层的因素的了解。