Ventricular function and cardiac reserve in contemporary Fontan patients
Ventricular function and cardiac reserve in contemporary Fontan patients
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DOI：
10.1016/j.ijcard.2015.05.181
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发表时间：
2015-10-01
影响因子：
3.5
通讯作者：
Helbing, W. A.
中科院分区：
文献类型：
--
作者：
Bossers, S. S. M.;Kapusta, L.;Helbing, W. A.
背景/目的：全腔肺连接术（TCPC）已成为单室心脏患者的首选治疗方法。目前的tcpc技术是心房内外侧隧道（ILT）和心外导管（ECC）。我们的目的是确定休息和应激时的心室功能，并比较两种技术以及左（LV）和右（RV）优势的结果。方法：99例患者，年龄12.5±4.0岁，行超声心动图和磁共振成像（MRI）检查，69例患者行应激MRI检查。结果：超声心动图显示收缩和舒张功能受损。静息时，ILT和ECC的MRI参数具有可比性。在多巴酚丁胺治疗期间，舒张末期容积（EDVi）降低（91 +/- 21 vs 80 +/- 20 ml/m） (2) p < 0.001)。ILT患者在多巴酚丁胺治疗期间的射血分数（EF）和心脏指数（CI）较低(59 +/- 11 (ILT) vs 64 +/- 7% (ECC), p = 0.027; 4.2 +/- 1.0 (ILT) vs 4.9 +/- 1.0 L/min/m(2) (ECC), p = 0.006)，而其他参数具有可比性。il - t患者的tei指数更高(0.72 +/- 0.27 （ILT) vs. 0.56 +/- 0.22 (ECC), p = 0.002）。优势型右室患者的舒张功能经常受损(67% （RV) vs 39% (LV), p = 0.011）。优势型左室患者在休息时收缩末期体积（ESVi）较小(40 +/- 13 (LV) vs. 47 +/- 16 (RV) ml/m(2), p = 0.030)， EF较高(55 +/- 8 (LV) vs. 49 +/- 9 min/m（2) (RV), p = 0.001）和收缩力(2.3 +/- 0.8 (LV) vs. 1.9 +/- 0.7 mmhg /ml/m(2) (RV), p = 0.050)，多巴酚丁胺治疗时EF较高(63 +/- 8 (LV) vs. 58 +/- 10 min/m（2) (RV), p = 0.043）。结论：现代Fontan患者脑室功能保存较好。多巴酚丁胺应激会降低EDVi。应激期ECC患者CI和EF较高。右心室占优的患者收缩功能较低，包括收缩功能受损和舒张功能受损。(C) 2015年由爱思唯尔爱尔兰有限公司出版。
Background/objective: Total cavopulmonary connection (TCPC) has been the preferred treatment for patients with univentricular hearts. Current TCPC-techniques are the intra-atrial lateral tunnel (ILT) and the extracardiac conduit (ECC). We aimed to determine ventricular function during rest and stress, and to compare results for both techniques and for left (LV) versus right ventricular (RV) dominance.Methods: 99 patients, aged 12.5 +/- 4.0 years underwent echocardiography and magnetic resonance imaging (MRI), and 69 patients underwent stress MRI.Results: Echocardiography showed impaired systolic and diastolic function. MRI parameters were comparable between ILT and ECC at rest. During dobutamine there was a decrease in end-diastolic volume (EDVi) (91 +/- 21 vs. 80 +/- 20 ml/m(2) p < 0.001). Ejection fraction (EF) and cardiac index (CI) during dobutamine were lower for ILT patients (59 +/- 11 (ILT) vs. 64 +/- 7% (ECC), p = 0.027 and 4.2 +/- 1.0 (ILT) vs. 4.9 +/- 1.0 L/min/m(2) (ECC), p = 0.006), whereas other parameters were comparable. TEI-index was higher in ILT-patients (0.72 +/- 0.27 (ILT) vs. 0.56 +/- 0.22 (ECC), p = 0.002). Diastolic function was frequently impaired in patients with a dominant RV (67% (RV) vs. 39% (LV), p = 0.011). Patients with dominant LV's had smaller end-systolic volume (ESVi) (40 +/- 13 (LV) vs. 47 +/- 16 (RV) ml/m(2), p = 0.030) and higher EF (55 +/- 8 (LV) vs. 49 +/- 9 min/m(2) (RV), p = 0.001) and contractility (2.3 +/- 0.8 (LV) vs. 1.9 +/- 0.7 mm Hg/ml/m(2) (RV), p = 0.050) during rest and higher EF during dobutamine (63 +/- 8 (LV) vs. 58 +/- 10 min/m(2) (RV), p = 0.043).Conclusion: Ventricular function is relatively well preserved in modern-day Fontan patients. With dobutamine stress there is a decrease in EDVi. ECC patients have higher CI and EF during stress. Patients with a dominant RV have lower systolic, including impaired contractility, and diastolic function. (C) 2015 Published by Elsevier Ireland Ltd.