1
|
Tikenoğullar i OZ, Peirlinck M, Chubb H, Dubin AM, Kuhl E, Marsden AL. Effects of cardiac growth on electrical dyssynchrony in the single ventricle patient. Comput Methods Biomech Biomed Engin 2024; 27:1011-1027. [PMID: 37314141 PMCID: PMC10719423 DOI: 10.1080/10255842.2023.2222203] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Revised: 04/27/2023] [Accepted: 05/04/2023] [Indexed: 06/15/2023]
Abstract
Single ventricle patients, including those with hypoplastic left heart syndrome (HLHS), typically undergo three palliative heart surgeries culminating in the Fontan procedure. HLHS is associated with high rates of morbidity and mortality, and many patients develop arrhythmias, electrical dyssynchrony, and eventually ventricular failure. However, the correlation between ventricular enlargement and electrical dysfunction in HLHS physiology remains poorly understood. Here we characterize the relationship between growth and electrophysiology in HLHS using computational modeling. We integrate a personalized finite element model, a volumetric growth model, and a personalized electrophysiology model to perform controlled in silico experiments. We show that right ventricle enlargement negatively affects QRS duration and interventricular dyssynchrony. Conversely, left ventricle enlargement can partially compensate for this dyssynchrony. These findings have potential implications on our understanding of the origins of electrical dyssynchrony and, ultimately, the treatment of HLHS patients.
Collapse
Affiliation(s)
- O. Z. Tikenoğullar i
- Department of Mechanical Engineering, Stanford University, Stanford, California, USA
| | - M. Peirlinck
- Department of Biomechanical Engineering, Delft University of Technology, Delft, Netherlands
| | - H. Chubb
- Department of Pediatrics (Cardiology), Stanford University, Stanford, California, USA
| | - A. M. Dubin
- Department of Pediatrics (Cardiology), Stanford University, Stanford, California, USA
| | - E. Kuhl
- Department of Mechanical Engineering, Stanford University, Stanford, California, USA
| | - A. L. Marsden
- Department of Mechanical Engineering, Stanford University, Stanford, California, USA
- Department of Pediatrics (Cardiology), Stanford University, Stanford, California, USA
- Department of Bioengineering, Stanford University, Stanford, California, USA
- Institute for Computational and Mathematical Engineering, Stanford University, Stanford, California, USA
| |
Collapse
|
2
|
Wilson LH, Chowdhury SM, Jackson LB. QRS fragmentation and prolongation as predictors of exercise capacity in patients after Fontan palliation. Pacing Clin Electrophysiol 2022; 45:786-796. [PMID: 35510731 DOI: 10.1111/pace.14514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2021] [Revised: 04/01/2022] [Accepted: 04/29/2022] [Indexed: 12/01/2022]
Abstract
INTRODUCTION Patients with Fontan anatomy are at increased risk for exercise intolerance and early morbidity and mortality. QRS complex fragmentation (fQRS) and prolongation have been studied in multiple heart diseases, but their clinical importance is unknown in the Fontan population. METHODS A retrospective cross-sectional study was performed. ECGs were evaluated for QRS prolongation (>98 %ile for age) and fQRS [ ≥3 R-waves/ notches in the R/S complex (more than 2 in RBBB) in ≥2 contiguous leads]. The primary outcome measures was CPET performance. RESULTS Ninety patients (median age 18 years, 57% male, 59% RV dominant) were included; 13% had fQRS and 31% had prolonged QRS. Demographically, patients with fQRS or prolonged QRS were like those without. Peak VO2 (64% vs 63%, p 0.45), VE/VCO2 slope (85% vs 88%, p = 0.74), and O2 pulse (149% vs 129%, p = 0.83) were similar in the fQRS group versus those without. Upon multi-variable regression, body mass index (β = -0.38, p < 0.01) and QRS duration (β = -0.29, p < 0.01) were independently associated with % predicted VO2; fQRS was not. Lower cardiac index (2.2 vs 2.8 L/min/m2, p = 0.03) and higher ventricular end-diastolic pressure (13 vs 10 mmHg, p = 0.02) was seen with fQRS. CONCLUSIONS QRS fragmentation is present in patients with Fontan physiology. fQRS showed no association with CPET performance but was related to invasive hemodynamic markers of ventricular performance. QRS duration may be a better predictor of exercise function following Fontan. This article is protected by copyright. All rights reserved.
Collapse
Affiliation(s)
- Lucas H Wilson
- Children's Heart Center, The Medical University of South Carolina, South Carolina, USA
| | - Shahryar M Chowdhury
- Children's Heart Center, The Medical University of South Carolina, South Carolina, USA
| | - Lanier B Jackson
- Children's Heart Center, The Medical University of South Carolina, South Carolina, USA
| |
Collapse
|
3
|
Buendía-Fuentes F, Gordon-Ramírez B, Subirà LD, Merás P, Gallego P, González A, Prieto-Arévalo R, Segura T, Rodríguez-Puras MJ, Montserrat S, Sarnago-Cebada F, Alonso-García A, Oliver JM, Rueda-Soriano J. LONG TERM OUTCOMES OF ADULTS WITH SINGLE VENTRICLE PHYSIOLOGY NOT UNDERGOING FONTAN REPAIR: A MULTICENTRE EXPERIENCE. Can J Cardiol 2021; 38:1111-1120. [PMID: 34118376 DOI: 10.1016/j.cjca.2021.06.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Revised: 05/20/2021] [Accepted: 06/02/2021] [Indexed: 11/02/2022] Open
Abstract
BACKGROUND To describe long-term survival and cardiovascular events in adult patients with single ventricle physiology (SVP) without Fontan palliation, focusing on predictors of mortality and comparing groups according to their cardiovascular physiology. METHODS Multicentre, observational and retrospective study including adult patients with SVP without Fontan palliation since their first adult clinic visit. The cohort was subdivided into three groups. (Eisenmenger - Restricted Pulmonary flow - Aortopulmonary shunt) Death was considered the main endpoint. Other clinical outcomes occurring during follow-up were considered as secondary endpoints. RESULTS 146 patients, mean age 32.5±11.1 years were analysed. Over a mean follow-up of 7.3 ± 4.1 years, 33 patients (22.6%) died. Survival was 86% and 74% at 5 and 10 years, respectively. Right ventricular morphology was not associated with higher mortality. Four variables at baseline were related to a higher mortality (at least moderate AV valve regurgitation, platelet count <150 × 10 3 /mm 3 , GFR <60 ml/min/1.73m 2 and QRS >120ms). 34.2% of patients were admitted to the hospital due to heart failure, and 7.5% received a heart transplant. Other cardiovascular outcomes were also frequent (atrial arrhythmias: 19.2%, stroke: 15.1%, pacemaker/ICD: 6.2%/2.7%). CONCLUSIONS Adult patients with SVP who had not undergone Fontan exhibit a high mortality rate and frequent major cardiovascular events. At least moderate AV valve regurgitation, thrombocytopenia, renal dysfunction and QRS duration >120 ms at baseline visit allow identification of a cohort of patients at higher risk of mortality.
Collapse
Affiliation(s)
- Francisco Buendía-Fuentes
- ACHD Unit, Department of Cardiology, Hospital Universitari i Politecnic La Fe. Instituto de Investigación Sanitaria La Fe. CIBERCV, Valencia, Spain
| | - Blanca Gordon-Ramírez
- Unitat Integrada de Cardiopaties Congènites de l'Adolescent i l'Adult Vall d'Hebron-Sant Pau. Department of Cardiology. Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus. Barcelona, Spain
| | - Laura Dos Subirà
- Unitat Integrada de Cardiopaties Congènites de l'Adolescent i l'Adult Vall d'Hebron-Sant Pau. Department of Cardiology. Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus. Barcelona, Spain; CIBERCV. Barcelona, Spain.
| | - Pablo Merás
- ACHD Unit, Department of Cardiology, Hospital Universitario La Paz, Madrid, Spain
| | - Pastora Gallego
- ACHD Unit, Department of Cardiology, Hospital Universitario Virgen del Rocio. Instituto de BioMedicina de Sevilla. CIBERCV, Sevilla, Spain
| | - Ana González
- ACHD Unit, Department of Cardiology, Hospital Universitario La Paz, Madrid, Spain
| | - Raquel Prieto-Arévalo
- ACHD Unit, Department of Cardiology, Hospital General Universitario Gregorio Marañon. CIBERCV, Madrid, Spain
| | - Teresa Segura
- ACHD Unit, Department of Cardiology, Hospital Universitario 12 Octubre, Madrid, Spain
| | - María J Rodríguez-Puras
- ACHD Unit, Department of Cardiology, Hospital Universitario Virgen del Rocio. Instituto de BioMedicina de Sevilla. CIBERCV, Sevilla, Spain
| | - Silvia Montserrat
- ACHD Unit, Department of Cardiology, Hospital Clinic Barcelona. Institut clinic Cardiovascular. IDIBAPS. CIBERCV. Barcelona, Spain
| | | | - Andrés Alonso-García
- ACHD Unit, Department of Cardiology, Hospital General Universitario Gregorio Marañon. CIBERCV, Madrid, Spain
| | - José M Oliver
- ACHD Unit, Department of Cardiology, Hospital General Universitario Gregorio Marañon. CIBERCV, Madrid, Spain
| | - Joaquín Rueda-Soriano
- ACHD Unit, Department of Cardiology, Hospital Universitari i Politecnic La Fe. Instituto de Investigación Sanitaria La Fe. CIBERCV, Valencia, Spain
| |
Collapse
|
4
|
Karikari Y, Abdulkarim M, Li Y, Loomba RS, Zimmerman F, Husayni T. The Progress and Significance of QRS Duration by Electrocardiography in Hypoplastic Left Heart Syndrome. Pediatr Cardiol 2020; 41:141-148. [PMID: 31722042 DOI: 10.1007/s00246-019-02237-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2019] [Accepted: 10/30/2019] [Indexed: 01/06/2023]
Abstract
Patients with hypoplastic left heart syndrome (HLHS) are now surviving through to Fontan palliation and beyond, however, with increased morbidity and mortality. Prolonged QRSd has become one of the predictors of morbidity and mortality in certain congenital heart diseases. There is limited data characterizing the QRSd in patients with HLHS. We aimed to describe the changes in QRSd at various times during the lifetime and to evaluate whether QRSd correlates with a higher risk of developing a composite endpoint of heart failure, heart transplant, or death. We conducted a retrospective chart review of patients with HLHS who survived Fontan palliation. QRSd was measured on ECGs at various stages pre- and postsurgical palliations and subsequently at 5 year intervals. Patients with a composite endpoint were compared to those without. A total of 89 patients were included in the final analysis. The QRSd increased significantly with time from 68.7 ± 9.0 ms prior to Norwood to 91.0 ± 14.0 ms immediately following Fontan and 104.7 ± 13.6 ms 15 years after Fontan (p < 0.001). The composite endpoint was observed in 28 patients (31.4%). The time trends of QRSd differ so that the patients having the composite endpoint experienced a greater increase in QRSd over time (p = 0.009). Ever having a QRSd of 120 ms or more predicted the composite endpoint with 93% specificity. The area under the curve of the receiver operator curve analysis was 0.596. A Cox regression analysis demonstrated that QRS duration > 120 ms was independently related to a greater frequency of composite endpoint and this was confirmed by a Kaplan-Meier analysis (p = 0.011). This study unveils a novel relationship between QRSd of 120 ms or more with the composite endpoint. Despite the low sensitivity, this finding on a routine surveillance ECG could help identify HLHS Fontan patients at risk for heart failure, heart transplant, or death.
Collapse
Affiliation(s)
- Yaa Karikari
- Division of Cardiology, Advocate Children's Hospital, 4440 95th street, Chicago, IL, 60453, USA
| | - Mubeena Abdulkarim
- Division of Cardiology, Advocate Children's Hospital, 4440 95th street, Chicago, IL, 60453, USA
| | - Yi Li
- Division of Cardiology, Advocate Children's Hospital, 4440 95th street, Chicago, IL, 60453, USA
| | - Rohit S Loomba
- Division of Cardiology, Advocate Children's Hospital, 4440 95th street, Chicago, IL, 60453, USA.
| | - Frank Zimmerman
- Division of Cardiology, Advocate Children's Hospital, 4440 95th street, Chicago, IL, 60453, USA
| | - Tarek Husayni
- Division of Cardiology, Advocate Children's Hospital, 4440 95th street, Chicago, IL, 60453, USA
| |
Collapse
|