title: Speckle-Tracking Echocardiography Improves Pre-operative Risk Stratification Before the Total Cavopulmonary Connection.
abstract: BACKGROUND
  Single-ventricle patients with elevated pulmonary vascular resistance (PVR) or end-diastolic pressure (EDP) are excluded from undergoing total cavopulmonary connection (TCPC). However, a subset of patients deemed to be at acceptable risk experience prolonged length of stay (LOS) after TCPC. Routine assessment of ventricular function has been inadequate in identifying these high-risk patients. Speckle-tracking echocardiography (STE) is a novel method for assessment of myocardial deformation that may be useful in single-ventricle patients. The aim of this study was to perform a contemporary preoperative risk assessment for prolonged LOS to determine whether STE improves risk stratification before TCPC.
  
  
  METHODS
  Our single institution's perioperative data were retrospectively collected. The primary outcome was postoperative LOS >14 days. Longitudinal and circumferential STE deformation measures were analyzed on echocardiograms obtained during preoperative catheterization. Patient-specific, echocardiographic, and catheterization data were included in multivariable logistic regression. Receiver operating characteristic area under the curves (AUC) were analyzed.
  
  
  RESULTS
  From 2007 to 2014, 135 patients who underwent TCPC were included in the analysis. The median LOS was 11 (IQR 9-14) days. The PVR (P < .01) and circumferential strain rate (CSR) (P < .01) were the only variables independently associated with LOS >14 days. For every 0.1 s-1CSR increased, there was a 20% increased odds of prolonged LOS. The AUC for CSR was 0.70. The AUC for PVR and EDP combined was 0.68. The AUC for PVR, EDP, and CSR combined was 0.73.
  
  
  CONCLUSIONS
  Preoperative CSR is independently associated with LOS >14 days and improves preoperative risk stratification in patients undergoing TCPC.
authors.affiliation: Department of Pediatrics, Division of Cardiology, Medical University of South Carolina, Charleston, South Carolina.
authors.forename: Patsy W
authors.initials: PW
authors.lastname: Park
authors.affiliation: Department of Pediatrics, Division of Cardiology, Medical University of South Carolina, Charleston, South Carolina.
authors.forename: Andrew M
authors.initials: AM
authors.lastname: Atz
authors.affiliation: Department of Pediatrics, Division of Cardiology, Medical University of South Carolina, Charleston, South Carolina.
authors.forename: Carolyn L
authors.initials: CL
authors.lastname: Taylor
authors.affiliation: Department of Pediatrics, Division of Cardiology, Medical University of South Carolina, Charleston, South Carolina. Electronic address: chowdhur@musc.edu.
authors.forename: Shahryar M
authors.initials: SM
authors.lastname: Chowdhury
mesh_terms: D002675:Child, Preschool; D004452:Echocardiography / Q000379:methods*; D054459:Elasticity Imaging Techniques / Q000379:methods; D005260:Female; D018610:Heart Bypass, Right; D006330:Heart Defects, Congenital / Q000000981:diagnostic imaging* / Q000401:mortality* / Q000601:surgery; D006352:Heart Ventricles / Q000002:abnormalities* / Q000000981:diagnostic imaging / Q000601:surgery*; D006801:Humans; D015994:Incidence; D008297:Male; D011300:Preoperative Care / Q000379:methods* / Q000401:mortality; D015203:Reproducibility of Results; D012189:Retrospective Studies; D018570:Risk Assessment / Q000379:methods; D012680:Sensitivity and Specificity; D013022:South Carolina / Q000453:epidemiology; D015996:Survival Rate; D016896:Treatment Outcome
keywords: Single ventricle; Speckle-tracking echocardiography