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LONGITUDINAL CARDIAC MRI-DERIVED MARKERS OF VENTRICULAR PERFORMANCE FOLLOWING FONTAN PALLIATION ARE PREDICTIVE OF OUTCOMES AS A FUNCTION OF VENTRICULAR MORPHOLOGY
Nicolas Drysdale, MD1, Jason Breithaupt, MD1, Benjamin Borg, MD1, Joanna Shad, MD1, Brian Fonseca, MD2, Melanie Everitt2, James Jaggers, MD2, Charles Fraser, III, MD2, Matthew Stone, MD, PhD2.
1University of Colorado, Aurora, CO, USA, 2Childrens Hospital Colorado, Aurora, CO, USA.
Objective(s): Improved survival for single ventricle congenital heart disease (SVCHD) has increased the number of patients with Fontan physiology. This study aimed to longitudinally evaluate cardiac MRI (CMR)-derived markers of ventricular performance in SVCHD patients and their predictive association with Fontan failure.
Methods: A longitudinal retrospective single-center study (2004-2025) analyzed SVCHD patients with CMR post-Fontan. Systolic and diastolic performance markers, including ventricular strain, wall stress, torsion, end-systolic elastance (ESE), and ventriculoarterial coupling ratio (VAC), were evaluated. Patients were grouped by ventricular morphology: hypoplastic left heart (HLHS), non-HLHS RV dominant (RVD), and left ventricular dominant (LVD). Longitudinal CMR changes and their associations with outcomes were assessed.
Results: Among 73 patients with longitudinal CMR data post-Fontan, LVD patients showed improved mechanics with higher EF, lower ventricular volumes, reduced wall stress, improved strain and VAC. 11 (15.1%) patients identified as early clinical Fontan failures demonstrated annualized decline in CMR-derived mechanics with associated decreased exercise capacity and increased need for transplantation
Conclusions:
CMR is a non-invasive technique for the longitudinal measurement of systolic and diastolic ventricular performance post-Fontan. CMR-derived variables of ventricular performance demonstrate significant associations with clinical outcomes as a function of ventricular morphology. These findings provide a foundation on which to build further prospective study to optimize and individualize management strategies post-Fontan, seeking to increase the quantity and improve the quality of life for patients with palliated SVCHD.
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