Author + information
- Angela Kelle,
- Govinda Paudel,
- Muhammad Qureshi,
- Megan O'Byrne and
- Patrick O'Leary
Background: Increased left atrial volume predicts mortality in adults with heart failure (HF). Implications of increased atrial volume in complex congenital heart disease are less well understood. We sought to determine if increased atrial volume is associated with clinical HF in hypoplastic left heart syndrome (HLHS).
Methods: Subjects in a prospective HLHS research program were classified as having no HF or clinical HF [NYHA class ≥3, growth failure, cardiomegaly (cardiothoracic ratio >0.6 on X-ray), or hepatomegaly (edge >2.5 cm below costal margin)]. Atrial volumes were measured by transthoracic echocardiogram (TTE) at end systole by area-length method and indexed to body surface area.
Results: Criteria for HF were met in 16/75 clinic visits [(21%); 6/18 post stage 2 palliation (pre-Fontan) and 10/57 post Fontan completion]. In the entire cohort, those with HF had ∼50% greater RA volume (p = 0.04). Pre-Fontan subgroup analysis showed association between all atrial volumes and HF; total atrial volume index (RAV + LAV) >43 ml/m2 predicted clinical HF with 86% sensitivity and 80% specificity. Post-Fontan, no association was seen between total atrial volume and HF status.
Conclusions: Total atrial volume by TTE in pre-Fontan HLHS patients is a marker of clinical HF, with volume index >43/m2 predicting HF status with good sensitivity and specificity. Atrial volumes are less closely associated with HF post Fontan, likely secondary to multiple factors (sample heterogeneity, altered RA compliance/geometry).
Poster Hall, Hall C
Saturday, March 18, 2017, 9:45 a.m.-10:30 a.m.
Session Title: Congenital Heart Disease: Innovations in Single Ventricle Heart Disease
Abstract Category: 10. Congenital Heart Disease: Pediatric
Presentation Number: 1182-014
- 2017 American College of Cardiology Foundation