Author + information
- Shahryar Chowdhury,
- Ryan Butts,
- Jason Buckley,
- Anthony Hlavacek,
- Sachin Khambadkone,
- Tain-Yen Hsia and
- G. Hamilton Baker
Non-invasive measurements of systolic function in the single ventricle population are performed using measures whose accuracy and reliability have not been fully assessed. We sought to validate non-invasive measures of systolic function with invasive measures of systolic function derived from pressure-volume loop (PVL) analysis. We hypothesized that non-invasive measures of systolic function would correlate with PVL indices of systolic function in patients with single ventricle physiology.
During routine cardiac catheterization, PVLs were recorded using conductance catheters (CD Leycom, Netherlands). PVL indices were calculated using single beat methods to avoid instability from load alterations. PVLs were volume calibrated using cardiac magnetic resonance obtained the same day. Echocardiograms were obtained at the time of catheterization. The relationship between PVL and non-invasive measures of systolic function was determined using a Spearman's correlation analysis.
Ten patients (7 right ventricular dominant, 3 left ventricular dominant) were enrolled. Median age was 3yr (range 3mo to 19yr). Three were enrolled at stage 1, six at stage 2, and two at stage 3 of surgical palliation. MRI ejection fraction (EF) correlated well with end systolic elastance (Ees) (r = 0.73) and dP/dt max (r = 0.71). The single atrioventricular valve annular plane systolic excursion (SAPSE) correlated well with Ees (r = 0.69). Fractional area change (FAC) correlated well with dP/dt max (r = 0.93) and stroke work/end-diastolic volume (r = 0.65). Myocardial performance index, isovolumic acceleration, and 3D-echo derived EF did not correlate with PVL measures.
This study represents the first-ever validation of systolic echocardiographic indices to invasive PVL indices in a single ventricle population. We demonstrated MRI derived EF and echocardiographic derived FAC and SAPSE showed the best correlation with PVL indices. Our results support the use of these non-invasive measures as accurate indices of systolic function in single ventricle patients. Further validation of noninvasive indices with PVL analysis is warranted in this population.
Poster Sessions, Expo North
Sunday, March 10, 2013, 9:45 a.m.-10:30 a.m.
Session Title: Congenital Cardiology Solutions: Single Ventricles
Abstract Category: 13. Congenital Cardiology Solutions: Pediatric
Presentation Number: 1203-124
- 2013 American College of Cardiology Foundation