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Decreased Diastolic Ventricular Kinetic Energy in Young Patients with Fontan Circulation Demonstrated by Four-Dimensional Cardiac Magnetic Resonance Imaging

Sjöberg, Pia LU ; Heiberg, Einar LU ; Wingren, Pär; Ramgren Johansson, Jens; Malm, Torsten LU ; Arheden, Håkan LU ; Liuba, Petru LU and Carlsson, Marcus LU (2017) In Pediatric Cardiology 38(4). p.669-680
Abstract

Four-dimensional (4D) flow magnetic resonance imaging (MRI) enables quantification of kinetic energy (KE) in intraventricular blood flow. This provides a novel way to understand the cardiovascular physiology of the Fontan circulation. In this study, we aimed to quantify the KE in functional single ventricles. 4D flow MRI was acquired in eleven patients with Fontan circulation (median age 12 years, range 3–29) and eight healthy volunteers (median age 26 years, range 23–36). Follow-up MRI after surgical or percutaneous intervention was performed in 3 patients. Intraventricular KE was calculated throughout the cardiac cycle and indexed to stroke volume (SV). The systolic/diastolic ratio of KE in Fontan patients was similar to the ratio of... (More)

Four-dimensional (4D) flow magnetic resonance imaging (MRI) enables quantification of kinetic energy (KE) in intraventricular blood flow. This provides a novel way to understand the cardiovascular physiology of the Fontan circulation. In this study, we aimed to quantify the KE in functional single ventricles. 4D flow MRI was acquired in eleven patients with Fontan circulation (median age 12 years, range 3–29) and eight healthy volunteers (median age 26 years, range 23–36). Follow-up MRI after surgical or percutaneous intervention was performed in 3 patients. Intraventricular KE was calculated throughout the cardiac cycle and indexed to stroke volume (SV). The systolic/diastolic ratio of KE in Fontan patients was similar to the ratio of the controls’ left ventricle (LV) or right ventricle (RV) depending on the patients’ ventricular morphology (Cohen´s κ = 1.0). Peak systolic KE/SV did not differ in patients compared to the LV in controls (0.016 ± 0.006 mJ/ml vs 0.020 ± 0.004 mJ/ml, p = 0.09). Peak diastolic KE/SV in Fontan patients was lower than in the LV of the control group (0.028 ± 0.010 mJ/ml vs 0.057 ± 0.011 mJ/ml, p < 0.0001). The KE during diastole showed a plateau in patients with aortopulmonary collaterals. This is to our knowledge the first study that quantifies the intraventricular KE of Fontan patients. KE is dependent on the morphology of the ventricle, and diastolic KE indexed to SV in patients is decreased compared to controls. The lower KE in Fontan patients may be a result of impaired ventricular filling.

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author
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
CMR, Congenital heart disease, Fontan, Kinetic energy, Magnetic resonance imaging, MRI
in
Pediatric Cardiology
volume
38
issue
4
pages
12 pages
publisher
Springer
external identifiers
  • scopus:85011872817
  • wos:000399219800005
ISSN
0172-0643
DOI
10.1007/s00246-016-1565-6
language
English
LU publication?
yes
id
2596035a-88d8-4bbe-91df-919e2ceef442
date added to LUP
2017-02-27 14:00:26
date last changed
2018-01-07 11:53:00
@article{2596035a-88d8-4bbe-91df-919e2ceef442,
  abstract     = {<p>Four-dimensional (4D) flow magnetic resonance imaging (MRI) enables quantification of kinetic energy (KE) in intraventricular blood flow. This provides a novel way to understand the cardiovascular physiology of the Fontan circulation. In this study, we aimed to quantify the KE in functional single ventricles. 4D flow MRI was acquired in eleven patients with Fontan circulation (median age 12 years, range 3–29) and eight healthy volunteers (median age 26 years, range 23–36). Follow-up MRI after surgical or percutaneous intervention was performed in 3 patients. Intraventricular KE was calculated throughout the cardiac cycle and indexed to stroke volume (SV). The systolic/diastolic ratio of KE in Fontan patients was similar to the ratio of the controls’ left ventricle (LV) or right ventricle (RV) depending on the patients’ ventricular morphology (Cohen´s κ = 1.0). Peak systolic KE/SV did not differ in patients compared to the LV in controls (0.016 ± 0.006 mJ/ml vs 0.020 ± 0.004 mJ/ml, p = 0.09). Peak diastolic KE/SV in Fontan patients was lower than in the LV of the control group (0.028 ± 0.010 mJ/ml vs 0.057 ± 0.011 mJ/ml, p &lt; 0.0001). The KE during diastole showed a plateau in patients with aortopulmonary collaterals. This is to our knowledge the first study that quantifies the intraventricular KE of Fontan patients. KE is dependent on the morphology of the ventricle, and diastolic KE indexed to SV in patients is decreased compared to controls. The lower KE in Fontan patients may be a result of impaired ventricular filling.</p>},
  author       = {Sjöberg, Pia and Heiberg, Einar and Wingren, Pär and Ramgren Johansson, Jens and Malm, Torsten and Arheden, Håkan and Liuba, Petru and Carlsson, Marcus},
  issn         = {0172-0643},
  keyword      = {CMR,Congenital heart disease,Fontan,Kinetic energy,Magnetic resonance imaging,MRI},
  language     = {eng},
  month        = {02},
  number       = {4},
  pages        = {669--680},
  publisher    = {Springer},
  series       = {Pediatric Cardiology},
  title        = {Decreased Diastolic Ventricular Kinetic Energy in Young Patients with Fontan Circulation Demonstrated by Four-Dimensional Cardiac Magnetic Resonance Imaging},
  url          = {http://dx.doi.org/10.1007/s00246-016-1565-6},
  volume       = {38},
  year         = {2017},
}