Background

Previous studies have suggested the presence of dyssynchrony in the functionally single ventricle. The aim of this study was to investigate the presence of classic-pattern dyssynchrony (CPD), characterized by typical early and late deformation of opposite walls, and its relation to QRS duration and myocardial function in patients with single-ventricle physiology after Fontan palliation.

Methods

In a retrospective cross-sectional study, 101 adolescent and adult patients with single-ventricle physiology after the Fontan procedure were investigated. Strain curves were visually assessed for the presence of CPD. Systolic and diastolic function were assessed using echocardiography.

Results

One hundred one patients were included, with varying anatomic morphology: two sizable ventricular components (n = 21), right dominant (n = 21), left dominant (n = 49), and undefined anatomy (n = 10). Fifteen of 101 Fontan patients had CPD. Forty-three percent of patients with two sizable ventricular masses displayed CPD, mostly with prolonged QRS, while the number of patients with CPD with right-dominant (9%) and left-dominant (6%) morphology was significantly lower (P = .016). Those with CPD displayed significantly (P < .05) larger QRS widths (142 ± 22 vs 112 ± 24 msec), lower ejection fractions (31 ± 14% vs 45 ± 14%), lower global early diastolic strain rates (0.7 ± 0.5 vs 1.2 ± 0.8 sec⁻¹), and global systolic circumferential (−10 ± 5% vs −16 ± 7%) and longitudinal (−9 ± 5% vs −14 ± 5%) strain, respectively.

Conclusions

CPD is present in a proportion of adolescent and adult patients after Fontan palliation. The presence of CPD is associated with reduced systolic and diastolic function compared with Fontan patients without CPD. Because the presence of CPD appears to be a promising predictor for response to cardiac resynchronization therapy in patients with biventricular circulation, these findings may have important potential for prospective evaluation of cardiac resynchronization therapy in patients with univentricular circulation.

中文翻译：

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患有Fontan循环的青少年和成人的经典模式不同步

背景

先前的研究表明功能单一心室中存在不同步。这项研究的目的是研究典型模式不同步性（CPD）的存在，其特征为典型的对立壁早期和晚期变形，及其与Fontan缓解后单室生理患者的QRS持续时间和心肌功能的关系。

方法

在一项回顾性横断面研究中，对101名接受Fontan手术后的单室生理机能的青少年和成人患者进行了调查。视觉评估应变曲线是否存在CPD。使用超声心动图评估收缩和舒张功能。

结果

包括一百零一例患者，它们具有不同的解剖形态：两个相当大的心室组件（n  = 21），右显性（n  = 21），左显性（n  = 49）和不确定的解剖结构（n  = 10）。101名Fontan患者中有15名患有CPD。患有两个较大心室包块的患者中有43％表现出CPD，大多数伴有QRS延长，而形态为右占优势（9％）和左占优势（6％）的CPD患者数量则显着降低（P  =。 016）。CPD者显示明显（P <.05）较大的QRS宽度（142±22 vs 112±24毫秒），较低的射血分数（31±14％与45±14％），较低的总体舒张早期应变率（0.7±0.5与1.2±0.8秒^-1），总收缩期周向应变（−10±5％vs −16±7％）和纵向应变（−9±5％vs −14±5％）。

结论

枫丹镇定后，青少年和成人患者中存在一定比例的CPD。与没有CPD的Fontan患者相比，CPD的存在与收缩和舒张功能降低有关。因为CPD的存在似乎是双心室循环患者对心脏再同步治疗反应的有希望的预测因素，所以这些发现可能对单心室循环患者的心脏再同步治疗具有重要的潜在潜力。