Atrial function in Fontan patients assessed by CMR: Relation with exercise capacity and long-term outcomes

International Journal of Cardiology, vol. 312, pp. 56–61

Abstract

Objective To assess the role of atrial function on exercise capacity and clinical events in Fontan patients. Design We included 96 Fontan patients from 6 tertiary centers, aged 12.8 (IQR 10.1–15.6) years, who underwent cardiac magnetic resonance imaging and cardiopulmonary exercise testing within 12 months of each other from 2004 to 2017. Intra-atrial lateral tunnel (ILT) and extracardiac conduit (ECC) patients were matched 1:1 with regard to age, gender and dominant ventricle. The pulmonary venous atrium was manually segmented in all phases and slices. Atrial function was assessed by volume-time curves. Furthermore, atrial longitudinal and circumferential feature tracking strain was assessed. We determined the relation between atrial function and exercise capacity, assessed by peak oxygen uptake and VE/VCO 2 slope, and events (mortality, listing for transplant, re-intervention, arrhythmia) during follow-up. Results Atrial maximal and minimal volumes did not differ between ILT and ECC patients. ECC patients had higher reservoir function (21.1 [16.4–28.0]% vs 18.2 [10.9–22.2]%, p = .03), lower conduit function and lower total circumferential strain (13.8 ± 5.1% vs 18.0 ± 8.7%, p = .01), compared to ILT patients. Only for ECC patients, a better late peak circumferential strain rate predicted better VE/VCO 2 slope. No other parameter of atrial function predicted peak oxygen uptake or VE/VCO 2 slope. During a median follow-up of 6.2 years, 42 patients reached the composite end-point. No atrial function parameters predicted events during follow-up. Conclusions ECC patients have higher atrial reservoir function and lower conduit function. Atrial function did not predict exercise capacity or events during follow-up.

Authors 12

1. Jelle P. G. van der Ven

   Erasmus MC · Netherlands Heart Institute · Erasmus MC - Sophia Children’s Hospital

   Affiliation as printed

   Department of Pediatrics, Division of Cardiology, Erasmus Medical Centre - Sophia Children's Hospital, Rotterdam, the Netherlands; Netherlands Heart Institute, Utrecht, the Netherlands

   Department of Pediatrics, Division of Cardiology, Erasmus Medical Centre — Sophia Children's Hospital, Rotterdam, the Netherlands

   Netherlands Heart Institute, Utrecht, the Netherlands

2. Tarek Alsaied

   Cincinnati Children's Hospital Medical Center · Boston Children's Hospital · Harvard University · University of Cincinnati

   Affiliation as printed

   Department of Cardiology, Boston Children's Hospital and Department of Pediatrics, Harvard Medical School, Boston, MA, USA; Department of Cardiology, Cincinnati Children's Hospital, University of Cincinnati College of Medicine, Cincinnati, OH, USA

   Department of Cardiology, Boston Children's Hospital and Department of Pediatrics, Harvard Medical School, Boston, MA, USA

   Department of Cardiology, Cincinnati Children's Hospital, University of Cincinnati College of Medicine, Cincinnati, OH, USA

3. Saeed Juggan

   Boston Children's Hospital · Harvard University

   Affiliation as printed

   Department of Cardiology, Boston Children's Hospital and Department of Pediatrics, Harvard Medical School, Boston, MA, USA

4. Sjoerd S.M. Bossers

   Erasmus MC · Erasmus MC - Sophia Children’s Hospital

   Affiliation as printed

   Department of Pediatrics, Division of Cardiology, Erasmus Medical Centre - Sophia Children's Hospital, Rotterdam, the Netherlands

   Department of Pediatrics, Division of Cardiology, Erasmus Medical Centre — Sophia Children's Hospital, Rotterdam, the Netherlands

5. Eva van den Bosch

   Erasmus MC · Netherlands Heart Institute · Erasmus MC - Sophia Children’s Hospital

   Affiliation as printed

   Department of Pediatrics, Division of Cardiology, Erasmus Medical Centre - Sophia Children's Hospital, Rotterdam, the Netherlands; Netherlands Heart Institute, Utrecht, the Netherlands

   Department of Pediatrics, Division of Cardiology, Erasmus Medical Centre — Sophia Children's Hospital, Rotterdam, the Netherlands

   Netherlands Heart Institute, Utrecht, the Netherlands

6. Livia Kapusta

   Radboud University Nijmegen · Tel Aviv University · Tel Aviv Sourasky Medical Center · Radboud University Medical Center

   Affiliation as printed

   Department of Pediatrics, Division of Cardiology, Radboud University Nijmegen Medical Centre, Nijmegen, the Netherlands; Pediatric Cardiology Unit, Tel-Aviv Sourasky Medical Center, Tel Aviv University Sackler School of Medicine, Tel Aviv, Israel

   Department of Pediatrics, Division of Cardiology, Radboud University Nijmegen Medical Centre, Nijmegen, the Netherlands

   Pediatric Cardiology Unit, Tel-Aviv Sourasky Medical Center, Tel Aviv University Sackler School of Medicine, Tel Aviv, Israel

7. Irene Mariette Kuipers

   Amsterdam UMC Location University of Amsterdam

   Affiliation as printed

   Department of Pediatrics, Division of Cardiology, Academic Medical Centre, Amsterdam, the Netherlands

8. Lucia J. M. Kroft Aachen Department of Radiology, Leiden University Medical Center

   Leiden University · Leiden University Medical Center

   Affiliation as printed

   Department of Radiology, Leiden University Medical Centre, Leiden, the Netherlands

9. Arend D.J. ten Harkel Aachen Department of Pediatrics Division of Cardiology, Leiden University Medical Centre

   Leiden University · Leiden University Medical Center

   Affiliation as printed

   Department of Pediatrics, Division of Cardiology, Leiden University Medical Centre, Leiden, the Netherlands

10. Gabriëlle G. van Iperen

    Utrecht University · University Medical Center Utrecht · Wilhelmina Children's Hospital

    Affiliation as printed

    Department of Pediatrics, Division of Cardiology, University Medical Centre Utrecht - Wilhelmina Children's Hospital, Utrecht, the Netherlands

    Department of Pediatrics, Division of Cardiology, University Medical Centre Utrecht — Wilhelmina Children's Hospital, Utrecht, the Netherlands

11. Rahul Hardas Rathod

    Boston Children's Hospital · Harvard University

    Affiliation as printed

    Department of Cardiology, Boston Children's Hospital and Department of Pediatrics, Harvard Medical School, Boston, MA, USA

12. Willem A. Helbing corresponding

    Radboud University Nijmegen · Erasmus MC · Radboud University Medical Center · Erasmus MC - Sophia Children’s Hospital

    Affiliation as printed

    Department of Pediatrics, Division of Cardiology, Erasmus Medical Centre - Sophia Children's Hospital, Rotterdam, the Netherlands; Department of Radiology, Erasmus Medical Centre, Rotterdam, the Netherlands; Department of Pediatrics, Division of Cardiology, Radboud University Nijmegen Medical Centre, Nijmegen, the Netherlands. Electronic address: w.a.helbing@erasmusmc.nl

    Department of Pediatrics, Division of Cardiology, Erasmus Medical Centre — Sophia Children's Hospital, Rotterdam, the Netherlands

    Department of Pediatrics, Division of Cardiology, Radboud University Nijmegen Medical Centre, Nijmegen, the Netherlands

    Department of Radiology, Erasmus Medical Centre, Rotterdam, the Netherlands