Volume 14, Issue 6 pp. 1185-1192

ORIGINAL ARTICLE

Trajectory of right ventricular indices is an early predictor of outcomes in hypoplastic left heart syndrome

Andrew S. Kim MD,

Corresponding Author

Andrew S. Kim MD

[email protected]

orcid.org/0000-0002-1253-0506

Division of Cardiology, Department of Pediatrics, University of Virginia, Charlottesville, Virginia

Correspondence

Andrew S. Kim, Division of Cardiology, Department of Pediatrics, University of Virginia, 1215 Lee St. Charlottesville, VA 22903.

Email: [email protected]

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Colleen M. Witzenburg PhD,

Colleen M. Witzenburg PhD

Department of Biomedical Engineering, University of Virginia, Charlottesville, Virginia

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Mark Conaway PhD,

Mark Conaway PhD

Division of Translational Research and Applied Statistics, Department of Public Health Sciences, University of Virginia, Charlottesville, Virginia

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Jeffrey E. Vergales MD,

Jeffrey E. Vergales MD

Division of Cardiology, Department of Pediatrics, University of Virginia, Charlottesville, Virginia

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Jeffrey W. Holmes MD, PhD,

Jeffrey W. Holmes MD, PhD

Department of Biomedical Engineering, University of Virginia, Charlottesville, Virginia

Department of Medicine, University of Virginia, Charlottesville, Virginia

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Thomas J. L’Ecuyer MD,

Thomas J. L’Ecuyer MD

Division of Cardiology, Department of Pediatrics, University of Virginia, Charlottesville, Virginia

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Peter N. Dean MD,

Peter N. Dean MD

Division of Cardiology, Department of Pediatrics, University of Virginia, Charlottesville, Virginia

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Andrew S. Kim MD,

Corresponding Author

Andrew S. Kim MD

[email protected]

orcid.org/0000-0002-1253-0506

Division of Cardiology, Department of Pediatrics, University of Virginia, Charlottesville, Virginia

Correspondence

Andrew S. Kim, Division of Cardiology, Department of Pediatrics, University of Virginia, 1215 Lee St. Charlottesville, VA 22903.

Email: [email protected]

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Colleen M. Witzenburg PhD,

Colleen M. Witzenburg PhD

Department of Biomedical Engineering, University of Virginia, Charlottesville, Virginia

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Mark Conaway PhD,

Mark Conaway PhD

Division of Translational Research and Applied Statistics, Department of Public Health Sciences, University of Virginia, Charlottesville, Virginia

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Jeffrey E. Vergales MD,

Jeffrey E. Vergales MD

Division of Cardiology, Department of Pediatrics, University of Virginia, Charlottesville, Virginia

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Jeffrey W. Holmes MD, PhD,

Jeffrey W. Holmes MD, PhD

Department of Biomedical Engineering, University of Virginia, Charlottesville, Virginia

Department of Medicine, University of Virginia, Charlottesville, Virginia

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Thomas J. L’Ecuyer MD,

Thomas J. L’Ecuyer MD

Division of Cardiology, Department of Pediatrics, University of Virginia, Charlottesville, Virginia

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Peter N. Dean MD,

Peter N. Dean MD

Division of Cardiology, Department of Pediatrics, University of Virginia, Charlottesville, Virginia

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First published: 08 August 2019

https://doi.org/10.1111/chd.12834

Citations: 5

Funding information

CMW was supported by a postdoctoral fellowship from the Hartwell Foundation.

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Abstract

Background

Children with hypoplastic left heart syndrome (HLHS) have risk for mortality and/or transplantation. Previous studies have associated right ventricular (RV) indices in a single echocardiogram with survival, but none have related serial measurements to outcomes. This study sought to determine whether the trajectory of RV indices in the first year of life was associated with transplant-free survival to stage 3 palliation (S3P).

Methods

HLHS patients at a single center who underwent stage 1 palliation (S1P) between 2000 and 2015 were reviewed. Echocardiographic indices of RV size and function were obtained before and following S1P and stage 2 palliation (S2P). The association between these indices and transplant-free survival to S3P was examined.

Results

There were 61 patients enrolled in the study with 51 undergoing S2P, 20 S3P, and 18 awaiting S3P. In the stage 1 perioperative period, indexed RV end-systolic area increased in patients who died or needed transplant following S2P, and changed little in those surviving to S3P (3.37 vs −0.04 cm²/m², P = .017). Increased indexed RV end-systolic area was associated with worse transplant-free survival. (OR = 0.815, P = .042). In the interstage period, indexed RV end-diastolic area increased less in those surviving to S3P (3.6 vs 9.2, P = .03).

Conclusion

Change in indexed RV end-systolic area through the stage 1 perioperative period was associated with transplant-free survival to S3P. Neither the prestage nor poststage 1 indexed RV end-systolic area was associated with transplant-free survival to S3P. Patients with death or transplant before S3P had a greater increase in indexed RV end-diastolic area during the interstage period. This suggests earlier serial changes in RV size which may provide prognostic information beyond RV indices in a single study.

CONFLICT OF INTEREST

The authors declare that they have no conflict of interest with the contents of this article.

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Citing Literature

Volume14, Issue6

November/December 2019

Pages 1185-1192

Trajectory of right ventricular indices is an early predictor of outcomes in hypoplastic left heart syndrome

Abstract

Background

Methods

Results

Conclusion

CONFLICT OF INTEREST

REFERENCES

Citing Literature

References

Information

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Trajectory of right ventricular indices is an early predictor of outcomes in hypoplastic left heart syndrome

Abstract

Background

Methods

Results

Conclusion

CONFLICT OF INTEREST

REFERENCES

Citing Literature

References

Related

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