Clinical Investigation
Congenital Heart Disease
Evaluation of Ventricular Filling Pressures and Ventricular Function by Doppler Echocardiography in Patients with Functional Single Ventricle: Correlation with Simultaneous Cardiac Catheterization

https://doi.org/10.1016/j.echo.2011.08.011Get rights and content

Background

Elevated ventricular filling pressure is a marker of diastolic dysfunction and a known risk factor for failure of single-ventricle surgical palliation. Doppler echocardiography has been shown valuable in identifying patients with elevated ventricular end-diastolic pressure (VEDP) in other settings, but its utility in evaluating pediatric patients with single ventricle is unclear. The aim of this study was to compare Doppler parameters to simultaneous catheter measurements of VEDP in children with single ventricle.

Methods

All consecutive patients (age < 18 years) with single ventricle who underwent simultaneous echocardiography and catheterization in 2009 and 2010 were included in this prospective study. Data regarding diagnosis, morphology of the “single” ventricle, prior surgeries, Doppler tissue imaging (DTI), atrioventricular valve inflow and pulmonary vein Doppler, and myocardial performance index (MPI) were collected. Ventricular Doppler echocardiography was performed from the dominant ventricle. Simultaneous Doppler and catheter measurements of systolic and diastolic function and VEDP were obtained. Correlation of continuous variables was examined using linear regression analysis. Receiver operating characteristic curves, two-sample Student's t tests, χ2 analyses, and Fisher's exact tests were used as appropriate.

Results

A total of 32 patients (15 male; mean age, 30.2 ± 22 months) were studied (nine post-Fontan, 15 post-Glenn, and eight pre-Glenn). Mean systemic arterial saturation was 81 ± 10%, mean VEDP was 11 ± 3 mm Hg, and mean echocardiographically estimated ejection fraction was 55 ± 7%. VEDP was correlated positively with E/E′ ratio (r = 0.44, P < .01), pulmonary vein atrial reversal duration (r = 0.77, P < .001), and E′ (r = 0.49, P < .01). Receiver operating characteristic curve analysis using an E/E′ cutoff of 12 showed sensitivity of 90% (95% confidence interval, 54.1%–99.5%) and specificity of 75.0% (95% confidence interval, 47.4%–91.7%) for identifying VEDP > 10 mm Hg. Single left ventricles had higher DTI S′ and E′ velocities and lower E/E′ ratios and MPIs compared with single right ventricles. S′ velocity correlated positively with ejection fraction (r = 0.77, P < .001) and negatively with single left ventricular MPI (r = −0.46, P < .01).

Conclusions

In patients with single-ventricle physiology, DTI and pulmonary vein Doppler echocardiographic parameters correlated modestly with direct measurement of VEDP and may be helpful in identifying patients with elevated filling pressures. In addition, single left ventricles had better systolic and diastolic performance than single right ventricles. DTI systolic velocities and left ventricular MPI correlated well with ventricular ejection fraction.

Section snippets

Patients

In this prospective study, we included all consecutive patients (age < 18 years) with functional single ventricle who underwent simultaneous echocardiography and cardiac catheterization as part of their routine preoperative cardiac evaluation at our institution between 2009 and 2010. Cardiac catheterization for hemodynamic measurements and evaluation of vascular structures was routinely performed before Glenn and Fontan palliation at our center. In all patients, echocardiographic measurements

Results

A total of 32 patients (15 male; mean age, 30.2 ± 22 months) were studied. Characteristics of the study population are shown in Table 1. There were no significant differences in age, gender, and oxygen saturation between the single right ventricle and single left ventricle cohorts (Table 1). The Doppler values obtained are shown in Table 2. Two patients with fused E and A waves and one patient with a significant outflow tract obstruction were excluded from the study. None of the patients in the

Discussion

Echocardiographically obtained pulsed-wave and tissue Doppler has emerged as a very practical tool in the noninvasive estimation of ventricular filling pressures and diastolic function in both adult and pediatric practices.10, 12, 13 In adults with biventricular physiology, an E/E′ ratio < 8 identified patients with normal filling pressures, and a ratio > 15 predicted elevated left ventricular filling pressures (>12 mm Hg).9, 11 Prior studies in pediatric patients with single-ventricle

Conclusions

To the best of our knowledge, this is the first study to simultaneously evaluate the relationship between noninvasive echocardiographically derived Doppler parameters of VEDP and directly measured VEDP in children with functional single ventricle. In functional single ventricles, Doppler echocardiographic parameters correlate modestly with direct measurement of VEDP and may be helpful in identifying patients with elevated filling pressures but not for precise characterization of ventricular

References (34)

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    Citation Excerpt :

    In our cohort, the correlation between medial and lateral e′ velocities was only modest. Menon et al. [4] also observed free wall (lateral) e′ velocities to be lower in single ventricle patients with morphologic right ventricles compared to left ventricular morphology. The lack of tissue Doppler data for some of the patients can be explained by our current inability to interpret these findings when acquired.

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