• Renate Schmidt, Stefan Orwat, Aleksander Kempny, Pia Schuler, Robert Radke, Peter C Kahr, Antje Hellige, Helmut Baumgartner, and Gerhard-Paul Diller.
• Adult Congenital and Valvular Heart Disease Center, Department of Cardiology and Angiology, University Hospital of Münster, Münster, Germany.
• Congenit Heart Dis. 2014 Sep 1;9(5):397-406.

BackgroundPatients are commonly affected by ventricular dysfunction and heart failure after Fontan palliation. Reliable quantification of ventricular function is of interest but hampered by complex ventricular anatomy and physiology.ObjectivesWe aimed to assess myocardial function using a novel cardiac magnetic resonance imaging (CMR)-based feature-tracking (FT) technique and to study its clinical utility in Fontan patients.MethodsRetrospective study in consecutive patients attending our service.ResultsWe included 15 adult Fontan patients (age 27 ± 7 years) who underwent a standardized transthoracic echocardiographic investigation (TTE) with measurement of global strain using speckle tracking. Thirteen patients also underwent CMR, with assessment of myocardial deformation by FT, providing longitudinal and circumferential global strain for the single ventricle. The value of TTE-based strain measurements was limited by the fact that in 63% of patients at least one myocardial segment could not be adequately quantified due to limited acoustic windows. In contrast, CMR allowed for a complete visualization of all wall segments. Not surprisingly, there was poor agreement between the techniques but good or moderate interobserver variability for FT (coefficients of variability 6.6% and 14.3% for circumferential and longitudinal strain). Unlike ejection fraction, FT parameters correlated significantly with age at Fontan completion, New York Heart Association (NYHA) class, and peak oxygen uptake on cardiopulmonary exercise testing.ConclusionsAssessment of myocardial function using CMR cine-based feature tracking is feasible in Fontan patients. Unlike echocardiographic techniques, FT is independent of inadequate acoustic windows and FT measurements relate to clinical parameters, suggesting that this approach could have clinical relevance in future.© 2013 Wiley Periodicals, Inc.

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