title: Value of speckle-tracking echocardiography and MRI-based feature tracking analysis in adult patients after Fontan-type palliation.
abstract: BACKGROUND
  Patients are commonly affected by ventricular dysfunction and heart failure after Fontan palliation. Reliable quantification of ventricular function is of interest but hampered by complex ventricular anatomy and physiology.
  
  
  OBJECTIVE
  We aimed to assess myocardial function using a novel cardiac magnetic resonance imaging (CMR)-based feature-tracking (FT) technique and to study its clinical utility in Fontan patients.
  
  
  METHODS
  Retrospective study in consecutive patients attending our service.
  
  
  RESULTS
  We included 15 adult Fontan patients (age 27 ± 7 years) who underwent a standardized transthoracic echocardiographic investigation (TTE) with measurement of global strain using speckle tracking. Thirteen patients also underwent CMR, with assessment of myocardial deformation by FT, providing longitudinal and circumferential global strain for the single ventricle. The value of TTE-based strain measurements was limited by the fact that in 63% of patients at least one myocardial segment could not be adequately quantified due to limited acoustic windows. In contrast, CMR allowed for a complete visualization of all wall segments. Not surprisingly, there was poor agreement between the techniques but good or moderate interobserver variability for FT (coefficients of variability 6.6% and 14.3% for circumferential and longitudinal strain). Unlike ejection fraction, FT parameters correlated significantly with age at Fontan completion, New York Heart Association (NYHA) class, and peak oxygen uptake on cardiopulmonary exercise testing.
  
  
  CONCLUSIONS
  Assessment of myocardial function using CMR cine-based feature tracking is feasible in Fontan patients. Unlike echocardiographic techniques, FT is independent of inadequate acoustic windows and FT measurements relate to clinical parameters, suggesting that this approach could have clinical relevance in future.
authors.affiliation: Adult Congenital and Valvular Heart Disease Center, Department of Cardiology and Angiology, University Hospital of Münster, Münster, Germany.
authors.forename: Renate
authors.initials: R
authors.lastname: Schmidt
authors.forename: Stefan
authors.initials: S
authors.lastname: Orwat
authors.forename: Aleksander
authors.initials: A
authors.lastname: Kempny
authors.forename: Pia
authors.initials: P
authors.lastname: Schuler
authors.forename: Robert
authors.initials: R
authors.lastname: Radke
authors.forename: Peter C
authors.initials: PC
authors.lastname: Kahr
authors.forename: Antje
authors.initials: A
authors.lastname: Hellige
authors.forename: Helmut
authors.initials: H
authors.lastname: Baumgartner
authors.forename: Gerhard-Paul
authors.initials: GP
authors.lastname: Diller
mesh_terms: D000328:Adult; D000367:Age Factors; D004452:Echocardiography; D005080:Exercise Test; D005240:Feasibility Studies; D018729:Fontan Procedure / Q000009:adverse effects*; D005858:Germany; D006330:Heart Defects, Congenital / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D006333:Heart Failure / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000209:etiology / Q000503:physiopathology; D006801:Humans; D019028:Magnetic Resonance Imaging, Cine; D009200:Myocardial Contraction; D015588:Observer Variation; D010166:Palliative Care; D011237:Predictive Value of Tests; D015203:Reproducibility of Results; D012189:Retrospective Studies; D013318:Stroke Volume; D013997:Time Factors; D016896:Treatment Outcome; D018754:Ventricular Dysfunction / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000209:etiology / Q000503:physiopathology; D055815:Young Adult
keywords: Cardiac Magnetic Resonance Imaging; Echocardiography; Feature Tracking; Fontan; Speckle Tracking