Non-invasive assessment of ventricular force-frequency relations in the univentricular circulation by tissue Doppler echocardiography: a novel method of assessing myocardial performance in congenital heart disease

Abstract

Objective: To describe the first clinical application of a novel tissue Doppler derived index of contractility, isovolumic acceleration (IVA), in the assessment of the ventricular myocardial force-frequency relation (FFR) in the univentricular heart (UVH).

Design: Prospective study.

Setting: Tertiary referral centre.

Interventions: Non-invasive assessment of the myocardial FFR by tissue Doppler echocardiography during atrial pacing.

Results: IVA was used to measure the FFR of the systemic ventricle in patients with structurally normal hearts and in patients with UVHs. Basal IVA of the normal hearts (mean (SD) 1.9 (0.3) m/s2) was significantly greater than that of UVHs in patients with a dominant right ventricle (RV) (1.0 (0.3) m/s2) or left ventricle (LV) (0.8 (0.7) m/s2; p < 0.05 for both). Neither the absolute nor percentage change from basal to peak values of IVA with pacing differed between the three groups. Peak force developed by the normal LV was significantly greater than that of the UVH, dominant LV group but not different from that of the UVH, dominant RV group.

Conclusion: Contractility at basal heart rate is depressed in patients with UVH compared with the normal LV. Analysis of ventricular FFRs exposes further differences in myocardial contractility. There is no evidence that contractile function of the dominant RV is inferior to that of the dominant LV over a physiological range of heart rates.

Figures

Figure 1

Myocardial force–frequency relations measured in terms of the tissue Doppler derived index isovolumic acceleration (IVA) for functionally univentricular hearts with dominant left (LV) and right (RV) ventricles and structurally normal hearts. Error bars represent SEM.

Figure 2

Percentage change in IVA from basal value for each of the three groups studied. Error bars represent SEM.

Figure 3

Rate related changes in isovolumic velocity (IVV) for the three groups studied. Error bars represent SEM.

Figure 4

Rate related changes in peak ejection phase velocity (S velocity) for the three study groups. Error bars represent SEM.