HYPOPLASTIC LEFT HEART SYNDROME SPECK TRACKING ECHOCARDIOGRAPHY ATRIAL CONDUIT STRAIN AND STRAIN RATE IS RELATED TO VENTRICULAR DIASTOLIC CHANGES: A LONGITUDINAL STUDY

Single ventricle (SV) atrial deformation shows normal maturation changes (increasing conduit and decreasing active atrial strain) with relative impairment of conduit strain and increased reliance on active strain for ventricular filling compared to a normal left atrium. These changes may reflect diastolic abnormalities in SV although its relationship with ventricular filling is unexplored. This study aims to study the relationship between atrial and ventricular function in a survival cohort of children with Hypoplastic Left Heart Syndrome (HLHS). Prospectively recruited HLHS patients underwent a functional echocardiogram prior to staged palliation (Norwood-Sano, Glenn and Fontan) and post-Fontan. Atrial area to derive percent active atrial contribution (% active) and speckle tracking echocardiography for atrial and ventricular deformation parameters were measured (GE, EchoPAC). Spearman correlation coefficients assessed relationships between atrial and ventricular deformation parameters. Data is presented as median [IQR]. Thirty-seven patients completed staged palliation: Norwood at eight days [6 - 14], Glenn at 5.7 months [4.8 - 6.0], Fontan at 3.3 years [2.9 - 3.8] and remain alive at median follow up of 8.1 years [5.8 - 9.0]. Expected maturational progress was noted through staged palliation, including an increase in conduit strain and strain rate (SR), decreasing active strain and SR (Table). This was reflected by progressive decrease in right ventricular late diastolic SR (LDSR). No relationship between atrial function and ventricular function at Pre-Norwood, however, atrial conduit strain and SR, active/reservoir strain ratio and % active showed correlations with ventricular LDSR in all subsequent stages [Figure]. Maturational changes in HLHS atrial deformation are consistent with previous cross-sectional findings and show the expected atrial-ventricular relationship. The use of atrial deformation as a tool to detect diastolic dysfunction warrants exploration.View Large Image Figure ViewerDownload Hi-res image Download (PPT)