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Comparison of echocardiographic measurements to invasive measurements of diastolic function in infants with single ventricle physiology: a report from the Pediatric Heart Network Infant Single Ventricle Trial

Part of: Pediatric Heart Network

Published online by Cambridge University Press:  03 September 2019

Suma P. Goudar Open the ORCID record for Suma P. Goudar [Opens in a new window] ,
Victor Zak Open the ORCID record for Victor Zak [Opens in a new window] ,
Andrew M. Atz ,
Karen Altmann ,
Steven D. Colan ,
Christine B. Falkensammer ,
Mark K. Friedberg ,
Michele Frommelt ,
Kevin D. Hill  and
Daphne T. Hsu
...Show all authors
Suma P. Goudar*
Affiliation:
Department of Cardiology, Ward Family Heart Center, Children’s Mercy Hospital, Kansas City, MO, USA
Victor Zak
Affiliation:
New England Research Institute, Watertown, MA, USA
Andrew M. Atz
Affiliation:
Division of Pediatric Cardiology, Medical University of South Carolina, Charleston, SC, USA
Karen Altmann
Affiliation:
Division of Pediatric Cardiology, Columbia University Medical Center, New York, NY, USA
Steven D. Colan
Affiliation:
Boston Children’s Hospital, Boston, MA, USA
Christine B. Falkensammer
Affiliation:
Children’s Hospital Philadelphia, Philadelphia, PA, USA
Mark K. Friedberg
Affiliation:
Division of Pediatric Cardiology, The Hospital for Sick Children, Toronto, ON, Canada
Michele Frommelt
Affiliation:
Children’s Hospital of Wisconsin, Milwaukee, WI, USA
Kevin D. Hill
Affiliation:
Duke University, Durham, NC, USA
Daphne T. Hsu
Affiliation:
Children’s Hospital at Montefiore, Bronx, NY, USA
Jami C. Levine
Affiliation:
Boston Children’s Hospital, Boston, MA, USA
Renee Margossian
Affiliation:
Boston Children’s Hospital, Boston, MA, USA
Christopher R. Mart
Affiliation:
Primary Children’s Medical Hospital, Salt Lake City, UT, USA
Joshua Sticka
Affiliation:
Cincinnati Children’s Hospital, Cincinnati, OH, USA
Peter Shrader
Affiliation:
New England Research Institute, Watertown, MA, USA
Girish Shirali
Affiliation:
Department of Cardiology, Ward Family Heart Center, Children’s Mercy Hospital, Kansas City, MO, USA
for the Pediatric Heart Network Investigators
Affiliation:
Department of Cardiology, Ward Family Heart Center, Children’s Mercy Hospital, Kansas City, MO, USA New England Research Institute, Watertown, MA, USA Division of Pediatric Cardiology, Medical University of South Carolina, Charleston, SC, USA Division of Pediatric Cardiology, Columbia University Medical Center, New York, NY, USA Boston Children’s Hospital, Boston, MA, USA Children’s Hospital Philadelphia, Philadelphia, PA, USA Division of Pediatric Cardiology, The Hospital for Sick Children, Toronto, ON, Canada Children’s Hospital of Wisconsin, Milwaukee, WI, USA Duke University, Durham, NC, USA Children’s Hospital at Montefiore, Bronx, NY, USA Primary Children’s Medical Hospital, Salt Lake City, UT, USA Cincinnati Children’s Hospital, Cincinnati, OH, USA
*
Author for correspondence: S. P. Goudar, Ward Family Heart Center, Children’s Mercy Hospital, 2401 Gillham Road, Kansas City, MO 64108, USA. Tel: +1 (816)234-3255; Fax: +1 (816)234-3701; E-mail: [email protected]
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Abstract

Background:

While echocardiographic parameters are used to quantify ventricular function in infants with single ventricle physiology, there are few data comparing these to invasive measurements. This study correlates echocardiographic measures of diastolic function with ventricular end-diastolic pressure in infants with single ventricle physiology prior to superior cavopulmonary anastomosis.

Methods:

Data from 173 patients enrolled in the Pediatric Heart Network Infant Single Ventricle enalapril trial were analysed. Those with mixed ventricular types (n = 17) and one outlier (end-diastolic pressure = 32 mmHg) were excluded from the analysis, leaving a total sample size of 155 patients. Echocardiographic measurements were correlated to end-diastolic pressure using Spearman’s test.

Results:

Median age at echocardiogram was 4.6 (range 2.5–7.4) months. Median ventricular end-diastolic pressure was 7 (range 3–19) mmHg. Median time difference between the echocardiogram and catheterisation was 0 days (range −35 to 59 days). Examining the entire cohort of 155 patients, no echocardiographic diastolic function variable correlated with ventricular end-diastolic pressure. When the analysis was limited to the 86 patients who had similar sedation for both studies, the systolic:diastolic duration ratio had a significant but weak negative correlation with end-diastolic pressure (r = −0.3, p = 0.004). The remaining echocardiographic variables did not correlate with ventricular end-diastolic pressure.

Conclusion:

In this cohort of infants with single ventricle physiology prior to superior cavopulmonary anastomosis, most conventional echocardiographic measures of diastolic function did not correlate with ventricular end-diastolic pressure at cardiac catheterisation. These limitations should be factored into the interpretation of quantitative echo data in this patient population.

Keywords

Diastolic functioninfantssingle ventricle
Type
Original Article
Information
Cardiology in the Young , Volume 29 , Issue 10 , October 2019 , pp. 1248 - 1256
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Copyright
© Cambridge University Press 2019 

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References

Milanesi, O, Stellin, G, Colan, SD, et al. Systolic and diastolic performance late after the Fontan procedure for a single ventricle and comparison of those undergoing operation at <12 months of age and at >12 months of age. Am J Cardiol 2002; 89: 276–280.CrossRefGoogle ScholarPubMed
Ommen, SR, Nishimura, RA, Appleton, CP, et al. Clinical utility of Doppler echocardiography and tissue Doppler imaging in the estimation of left ventricular filling pressures: a comparative simultaneous Doppler-catheterization study. Circulation 2000; 102: 1788–1794.CrossRefGoogle ScholarPubMed
Arteaga, RB, Hreybe, H, Patel, D, Landolfo, C. Derivation and validation of a diagnostic model for the evaluation of left ventricular filling pressures and diastolic function using mitral annulus tissue Doppler imaging. Am Heart J 2008; 155: 924–929.CrossRefGoogle ScholarPubMed
David, C, Almeida, A. Pulmonary transvalvular and venous flows in the estimation of left ventricular diastolic pressures. A comparative Doppler-catheterization study. Rev Port Cardiol 2001; 20: 987–1000.Google ScholarPubMed
Yamamoto, K, Nishimura, RA, Burnett, JC, Redfield, MM. Assessment of left ventricular end-diastolic pressure by Doppler echocardiography: contribution of duration of pulmonary venous versus mitral flow velocity curves at atrial contraction. J Am Soc Echocardiogr 1997; 10: 52–59.CrossRefGoogle ScholarPubMed
Kimura, K, Murata, K, Tanaka, N, et al. The importance of pulmonary venous flow measurement for evaluating left ventricular end-diastolic pressure in patients with coronary artery disease in the early stage of diastolic dysfunction. J Am Soc Echocardiogr 2001; 14: 987–993.CrossRefGoogle ScholarPubMed
Rossvoll, O, Hatle, LK. Pulmonary venous flow velocities recorded by transthoracic Doppler ultrasound: relation to left ventricular diastolic pressures. J Am Coll Cardiol 1993; 21: 1687–1696.CrossRefGoogle ScholarPubMed
Savage, A, Hlavacek, A, Ringewald, J, Shirali, GS. Evaluation of the myocardial performance index and tissue Doppler imaging by comparison to near-simultaneous catheter measurements in pediatric cardiac transplant patients. J Heart Lung Transplant 2010; 29: 853–858.CrossRefGoogle ScholarPubMed
O’Leary, PW, Durongpisitkul, K, Cordes, TM, et al. Diastolic ventricular function in children: a Doppler echocardiographic study establishing normal values and predictors of increased ventricular end-diastolic pressure. Mayo Clin Proc 1998; 73: 616–628.Google ScholarPubMed
Border, WL, Michelfelder, EC, Glascock, BJ, et al. Color M-mode and Doppler tissue evaluation of diastolic function in children: simultaneous correlation with invasive indices. J Am Soc Echocardiogr 2003; 16: 988–994.CrossRefGoogle ScholarPubMed
Colan, SD, Shirali, GS, Margossian, R, et al. The ventricular volume variability study of the Pediatric Heart Network: study design and impact of beat averaging and variable type on the reproducibility of echocardiographic measurements in children with chronic dilated cardiomyopathy. J Am Soc Echocardiogr 2012; 25: 842–854.e6.CrossRefGoogle ScholarPubMed
Menon, SC, Gray, R, Tani, LY. Evaluation of ventricular filling pressures and ventricular function by Doppler echocardiography in patients with functional single ventricle: correlation with simultaneous cardiac catheterization. J Am Soc Echocardiogr 2011; 24: 1220–1225.CrossRefGoogle ScholarPubMed
Chowdhury, SM, Butts, RJ, Buckley, J, et al. Comparison of pressure-volume loop and echocardiographic measures of diastolic function in patients with a single-ventricle physiology. Pediatr Cardiol 2014; 35: 998–1006.CrossRefGoogle ScholarPubMed
Husain, N, Gokhale, J, Nicholson, L, Cheatham, JP, Holzer, RJ, Cua, CL. Noninvasive estimation of ventricular filling pressures in patients with single right ventricles. J Am Soc Echocardiogr 2013; 26: 1330–1336.CrossRefGoogle ScholarPubMed
Hsu, DT, Mital, S, Ravishankar, C, et al. Rationale and design of a trial of angiotensin-converting enzyme inhibition in infants with single ventricle. Am Heart J 2009; 157: 37–45.CrossRefGoogle ScholarPubMed
Hsu, DT, Zak, V, Mahony, L, et al. Enalapril in infants with single ventricle: results of a multicenter randomized trial. Circulation 2010; 122: 333–340.CrossRefGoogle ScholarPubMed
Margossian, R, Schwartz, ML, Prakash, A, et al. Comparison of echocardiographic and cardiac magnetic resonance imaging measurements of functional single ventricular volumes, mass, and ejection fraction (from the Pediatric Heart Network Multicenter Fontan Cross-Sectional Study). Am J Cardiol 2009; 104: 419–428.CrossRefGoogle Scholar
Tei, C, Dujardin, KS, Hodge, DO, Kyle, RA, Tajik, J, Seward, JB. New non-invasive index for combined systolic and diastolic ventricular function. J Cardiol 1995; 26: 135–136.Google ScholarPubMed
Cui, W, Roberson, DA, Chen, Z, Madronero, LF, Cuneo, BF. Systolic and diastolic time intervals measured from Doppler tissue imaging: normal values and Z-score tables, and effects of age, heart rate, and body surface area. J Am Soc Echocardiogr 2008; 21: 361–370.CrossRefGoogle ScholarPubMed
Friedberg, MK, Silverman, NH. The systolic to diastolic duration ratio in children with hypoplastic left heart syndrome: a novel Doppler index of right ventricular function. J Am Soc Echocardiogr 2007; 20: 749–755.CrossRefGoogle ScholarPubMed
Okumura, K, Slorach, C, Mroczek, D, et al. Right ventricular diastolic performance in children with pulmonary arterial hypertension associated with congenital heart disease: correlation of echocardiographic parameters with invasive reference standards by high-fidelity micromanometer catheter. Circ Cardiovasc Imaging 2014; 7: 491–501.CrossRefGoogle ScholarPubMed
Friedberg, MK, Silverman, NH. The systolic to diastolic duration ratio in children with heart failure secondary to restrictive cardiomyopathy. J Am Soc Echocardiogr 2006; 19: 1326–1331.CrossRefGoogle ScholarPubMed
Moiduddin, N, Texter, KM, Zaidi, AN, et al. Two-dimensional speckle strain and dyssynchrony in single left ventricles vs. normal left ventricles. Congenit Heart Dis 2010; 5: 579–586.CrossRefGoogle ScholarPubMed
Stiver, C, Gokhale, J, Husain, N, et al. Catheterization diastolic pressures correlate with diastolic dyssynchrony in patients with single right ventricles. Echocardiography 2014; 31: 370–374.CrossRefGoogle ScholarPubMed
Williams, IA, Sleeper, LA, Colan, SD, et al. Functional state following the Fontan procedure. Cardiol Young 2009; 19: 320–330.CrossRefGoogle ScholarPubMed
Border, W, Syed, AU, Michelfelder, EC, et al. Impaired systemic ventricular relaxation affects postoperative short-term outcome in Fontan patients. J Thorac Cardiovasc Surg 2003; 126: 1760–1764.CrossRefGoogle ScholarPubMed
Dragulescu, A, Mertens, L, Friedberg, MK. Interpretation of left ventricular diastolic dysfunction in children with cardiomyopathy by echocardiography: problems and limitations. Circ Cardiovasc Imaging 2013; 6: 254–261.CrossRefGoogle ScholarPubMed
Janicki, JS, Brower, GL. The role of myocardial fibrillar collagen in ventricular remodeling and function. J Card Fail 2002; 8: S319–S325.CrossRefGoogle ScholarPubMed
Learn, CP, Yates, AR, Nicholson, L, Milton, K, Lloyd, E, Cua, CL. Tissue Doppler measurements correlate with central venous pressure in pediatric patients after cardiac surgery. ASAIO J 2010; 56: 377–382.CrossRefGoogle ScholarPubMed