ArticlePediatric cardiology2021
Atrial Reservoir Strain is Associated with Decreased Cardiac Index and Adverse Outcomes Post Fontan Operation.
Article in Pediatric cardiology, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 13 papers.
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Who cites it
13 citing papers in PubMed, 17 citations in OpenAlex.
- Reduced atrial conduit strain and abnormal diastolic filling are associated with fontan-associated liver disease.The international journal of cardiovascular imaging · 2026Article
- Applications of speckle tracking echocardiography in paediatric and congenital heart disease: an expert consensus paper from AEPC Imaging Working Group.European heart journal. Imaging methods and practice · 2026Article
- Systematic Echocardiographic Assessment of the Univentricular Heart Across the Stages of Fontan Palliation: A Practical Guide with Focus on Emerging 3D and 4D Imaging Modalities and Thromboembolic Complications from AEPC Imaging Working Group.Journal of clinical medicine · 2026Review
- Left Atrial Strain in Pediatric Cardiology: Evidence to Date and Future Directions.Journal of the American Society of Echocardiography : official publication of the American Society of Echocardiography · 2026Review
- Regional Ventricular and Global Atrial Strain Characteristics in Patients with Hypoplastic Left Heart Syndrome and Right Ventricular Dysfunction: An Echocardiography, Cardiac MRI, and Invasive Hemodynamics Study.Pediatric cardiology · 2026Article
- Ejection Fraction-Related Differences in Left Ventricular and Atrial Strain Indices Among Pediatric Fontan Circulation with Systemic Left Ventricle Morphology.Diagnostics (Basel, Switzerland) · 2026Article
- Predictive Role of Atrial Strain, Aortic Stiffness, and Muscle-Related Factors for Maximal and Submaximal Exercise Capacity in Fontan Patients.Pediatric cardiology · 2025Observational
- Myocardial and Atrial Strain Profiles in Pediatric Fontan Patients with Single Left Ventricle Using Two-Dimensional Speckle-Tracking Echocardiography: A Case-Control Study.Journal of clinical medicine · 2025Article
- Addressing Diastolic Dysfunction in the Congenital Heart Population.Current cardiology reports · 2025Review
- Impact of cardiovascular magnetic resonance in single ventricle physiology: a narrative review.Cardiovascular diagnosis and therapy · 2024Review
- The Role of Myocardial Strain Imaging in the Pre- and Post-Operative Assessment of Patients with Single Ventricle.Reviews in cardiovascular medicine · 2023Review
- Relationship of atrial function with cardiac function in the late phase more than 20 years after a Fontan operation.Interactive cardiovascular and thoracic surgery · 2022Article
- Atrial strain: an important addition to the armamentarium of non-invasively assessing Fontan function?The international journal of cardiovascular imaging · 2021Article
Corrections and comments
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Authors and funding
4 authors at 1 institution in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
Fontan patients rely on atrial function for diastolic filling and to augment cardiac output. Emerging data suggests that diminished atrial function is predictive of poor outcomes in adults but studies evaluating the association between atrial mechanics in Fontan patients and outcomes are lacking. We sought to assess atrial function in Fontan patients using speckle tracking echocardiography to determine whether atrial function is associated with invasive hemodynamics and clinical outcomes. Single-center review of Fontan patients receiving both catheterization and echocardiogram from 2012-2017. Atrial reservoir, conduit and pump global longitudinal strain and strain rate were assessed by speckle tracking echocardiography. The primary outcome was a composite of all adverse clinical outcomes including cardiac hospitalizations, transplant and death. Eighty-three Fontan patients at a median age of 14.2 years (IQR 8.6, 21.7) at time of echocardiogram were included. Increased atrial reservoir strain (p = 0.04), atrial emptying fraction (p = 0.04) and atrial fractional area change (p = 0.04), were associated with higher cardiac index at baseline. There were no associations between atrial strain and systemic ventricular end diastolic pressure (EDP) at catheterization. Reservoir strain was inversely associated with the composite clinical outcome on multivariable Cox proportional hazard analysis (HR 0.96, p = 0.03). Reduced atrial function is associated with reduced cardiac index, but is not directly associated with ventricular EDP in Fontan patients. Reservoir strain is associated with an excess of adverse clinical outcomes in Fontan patients.
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