Evidence of impaired longitudinal strain in pre-Fontan palliation in functional single left ventricle

Background We evaluated two-dimensional speckle-tracking echocardiography longitudinal strain (L2DSE) in functionally single left ventricles (LV).MethodsWe retrospectively analyzed 21 patients with functionally single LV. We divided patients into two groups according to pre-Fontan cardiac catheterization data: group 1, adequate data for Fontan procedure and group 2, inadequate data. Results LV strain correlated with predicted pressure in the Fontan system (r=0.64; P=0.003), pressure in the Glenn system (r=0.57; P=0.010), and transpulmonary gradient (r=0.59; P=0.008), but not with left atrial pressure (r=0.292; P=0.226) or ejection fraction (r=0.254; P=0.294). In multiple regression analysis, four-chamber LV strain was correlated with predicted pressure in the Fontan (β=0.642: P=0.003), whereas no association was found with LV ejection fraction (β=0.254; P=0.294), or time from Glenn palliation (β=0.082; P=0.893). When dividing the population into two groups according to catheterization data, significantly lower four-chamber longitudinal 2DSE (-25.8±3.2 vs.-19.5±5.1; P=0.004) was found to be not suitable for the Fontan procedure, as compared with those who underwent successful Fontan completion. Conclusion Regardless of ejection fraction, four-chamber L2DSE is associated with high predicted pressure in the Fontan system. Patients with hemodynamic data unsuitable for Fontan operation have significantly lower mean longitudinal strain parameters. 2DSE may represent a valuable tool in assessing patients with single LV physiology and might provide useful pre-Fontan information.