Optimal Heart Rate May Improve Systolic and Diastolic Function in Patients with Fontan Circulation

(1) Background: The optimal heart rate, at which the E-wave and A-wave stand adjacent without any overlaps in the Doppler transmitral flow echocardiography, is associated with maximum cardiac output and favorable clinical outcomes in adult patients with systolic heart failure. However, the clinical implication of the echocardiographic overlap length in patients with Fontan circulation remains unknown. We investigated the relationship between heart rate (HR) and hemodynamics in Fontan surgery patients with and without beta-blockers. (2) Methods and Results: A total of 26 patients (median age 1.8 years, 13 males) were enrolled. At baseline, the plasma N-terminal pro-B-type natriuretic peptide was 2439 +/- 3483 pg/mL, the fraction area change was 33.5 +/- 11.4%, the cardiac index was 3.55 +/- 0.90 L/min/m(2), and the overlap length was 45.2 +/- 59.0 msec. Overlap length was importantly decreased after the one-year follow-up (7.60 +/- 78.57 msec, p = 0.0069). Positive correlations were noted between the overlap length and A-wave and E/A ratio (p = 0.0021 and p = 0.0046, respectively). Ventricular end-diastolic pressure was significantly correlated with the overlap length in non-beta-blocker patients (p = 0.0483). (3) Conclusion: Overlap length may reflect the status of ventricular dysfunction. Hemodynamic preservation at lower HR could be critical for cardiac reverse remodeling.

Automated summary

In Fontan surgery patients, the overlap length in Doppler transmitral flow echocardiography is associated with ventricular dysfunction and can reflect the status of cardiac reverse remodeling. Hemodynamic preservation at lower heart rate may be critical for these patients.