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Infants with univentricular physiology are at risk of poor weight gain and reduced ventricular function, both of which have been independently associated with worse outcomes. Since nutritional status has been correlated to ventricular function in other populations, we evaluated the relationship between nutritional status and ventricular function including speckle-tracking strain during this period.
Thirty term infants (median age 55 days, 13 females) with univentricular physiology prior to stage II palliation were included with data obtained at the time of their initial hospital discharge. Ventricular function was quantified using 2D global longitudinal strain (GLS) and strain rate, analyzed from an apical “4-chamber” view (TomtecCPA 2.31). Ventricular myocardium was tracked along the dominant walls producing systolic ejection-- the lateral and septal walls of the dominant ventricle in cases of a single RV or LV and both the lateral LV and RV walls in the presence of an unrestrictive ventricular septal defect and biventricular mass, such as an unbalanced AV septal defect. Statistical analysis using SPSS reported the median with interquartile range (IQR) and utilized Spearman or Pearson correlation testing as appropriate (P < 0.05 significant).
Stage I palliation was performed in 29/30 (14 Norwood, 8 BT shunt, 5 PA bands, and 2 hybrids). GLS correlated with weight for age z-score (WAZ) scores (r= -0.45, p= 0.01) and trended toward correlation with weight for length z-score (r=-0.31, p =0.09) in this small study. Multivariate regression model using GLS as the dependent variable against WAZ score and atrioventricular regurgitation revealed an independent association between GLS and WAZ score (p=0.03) while the association of GLS with atrioventricular valve regurgitation lost significance (p=0.06). On ANOVA analysis of GLS based on ventricular morphology, GLS was diminished in the single RV subgroup [median -13.1% IQR (-15, -10.7)] compared to GLS in single LV [-17.2% (-21, -12.5)] and biventricular [-17.2% (-18.1, -14)] subgroups (p=0.043).
Lower WAZ-scores at the time of neonatal discharge are associated with lower GLS. Systemic right ventricles have lower GLS.
Cardiology | Pediatrics
Buddhavarapu, Amulya; Warren, Mathew; Erickson, Lori; Mathis, Christopher; Haas, Whitney; and Forsha, Daniel, "Correlation between strain and weight status in infants with a univentricular hear" (2021). Posters. 218.