We explored associations of surveillance testing in infants with single right ventricle
(sRV) physiology with clinical outcomes. This prospective, single-center study included
patients with sRV who had initial palliative surgery (September 2019 to December 2020).
Echocardiograms and B-type naturetic peptide (BNP) obtained as a pair within 24 hours
as part of clinical care were included. The primary outcome was death/heart transplant.
Secondary outcomes included interstage duration of milrinone use, hospital length
of stay, and no digoxin use. sRV functional assessment (subjective grade, fractional
area change, tricuspid annular plane systolic excursion, global longitudinal strain,
right atrial strain [RAS]) was performed offline. Associations between echocardiography,
BNP, and clinical outcomes were determined. Of 26 subjects (47 encounters), 20 had
hypoplastic left heart syndrome (77%). Median age at data collection was 50 days (interquartile
range 26 to 90). In most encounters (73%), sRV function was subjectively normal. Median
BNP was 332 pg/ml (interquartile range 160 to 1,085). A total of 5 patients (19%)
met the primary outcome and had lower RAS (14.1 vs 21.3, p = 0.038), but all other
parameters were similar to transplant-free survivors. RAS (16.1%, 0.83) had the highest
area under curve, followed by global longitudinal strain (−14.4%, 0.77). Higher RAS
was associated with fewer days on milrinone (coefficient −1.37, 95% confidence interval
[CI] −2.54 to −0.20, p = 0.02) and higher odds of digoxin use (odds ratio 1.09, 95%
CI 1.01 to 1.18, p = 0.047). Higher BNP was only associated with a lower odds of digoxin
use (odds ratio 0.69, 95% CI 0.5 to 0.96, p = 0.03). In conclusion, RAS is a potentially
important imaging marker in infants with sRV and merits further investigation in larger
studies.
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Article Info
Publication History
Published online: June 13, 2022
Received in revised form:
April 28,
2022
Received:
February 14,
2022
Footnotes
This investigation was supported by the Texas Children’s Heart Center, Houston, Texas, with funding provided by the Texas Children’s Heart Center Innovation Awards’ Grant. This investigation was supported by the University of Utah Study Design and Biostatistics Center, Salt Lake City, Utah, with funding in part from the National Center for Research Resources and the National Center for Advancing Translational Sciences, National Institutes of Health, through Grant UL1TR002538 (formerly 5UL1TR001067-05, 8UL1TR000105 and UL1RR025764).
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