{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,16]],"date-time":"2026-06-16T21:58:05Z","timestamp":1781647085315,"version":"3.54.5"},"reference-count":27,"publisher":"Springer Science and Business Media LLC","license":[{"start":{"date-parts":[[2026,4,7]],"date-time":"2026-04-07T00:00:00Z","timestamp":1775520000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,4,7]],"date-time":"2026-04-07T00:00:00Z","timestamp":1775520000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/100006942","name":"Medical University of South Carolina","doi-asserted-by":"crossref","id":[{"id":"10.13039\/100006942","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Pediatr Cardiol"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>\n                    While numerous risk factors for poor outcomes in Fontan patients have been investigated, much remains unknown about potential predictors of clinical well-being or long-term morbidity. Additionally, accurate non-invasive assessment of single ventricle (SV) systolic and diastolic function has remained elusive, making it even more difficult to evaluate cardiac performance as a determinant of patient outcome. Our study aimed to evaluate the relationship between SV longitudinal strain (SV-LS) measured via speckle-tracking echocardiography and several markers of clinical status. This was a retrospective study of Fontan patients with an echocardiogram at the Medical University of South Carolina from August 2022 to July 2023. SV-LS and other echocardiographic parameters were obtained and evaluated along with laboratory values, exercise test measures, cardiac catheterization data, and clinical outcomes. Bivariate tests of association were used to determine statistically significant relationships. 105 patients were included. SV-LS was associated with percent predicted VO\n                    <jats:sub>2<\/jats:sub>\n                    max (\n                    <jats:italic>p<\/jats:italic>\n                    \u2009=\u20090.034). ROC analysis identified an SV-LS cutoff of \u201317.5% (AUC\u2009=\u20090.67, sensitivity 75%, specificity 62%) for detecting reduced exercise capacity. Echocardiographic indices of ventricular function including ejection fraction (\n                    <jats:italic>r<\/jats:italic>\n                    = \u20130.49) and fractional area change (\n                    <jats:italic>r<\/jats:italic>\n                    = \u20130.48) (\n                    <jats:italic>p<\/jats:italic>\n                    \u2009&lt;\u20090.0001) correlated with SV-LS. There were no significant associations between SV-LS and laboratory measures of end-organ function, cardiac catheterization data, or adverse clinical events including transplant listing or protein-losing enteropathy. SV-LS is a non-invasive echocardiographic measure that may be associated with exercise capacity and has the potential to be a useful tool for primary cardiologists caring for this growing cohort of patients.\n                  <\/jats:p>","DOI":"10.1007\/s00246-026-04250-y","type":"journal-article","created":{"date-parts":[[2026,4,7]],"date-time":"2026-04-07T08:56:09Z","timestamp":1775552169000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Utility of Single Ventricle Longitudinal Strain and Evaluation of its Clinical Implications in Patients with Fontan Circulation"],"prefix":"10.1007","author":[{"given":"Hiral","family":"Shah","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-7259-3146","authenticated-orcid":false,"given":"Lily","family":"Suh","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jill C.","family":"Newman","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shahryar M.","family":"Chowdhury","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carolyn","family":"Taylor","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,4,7]]},"reference":[{"issue":"5","key":"4250_CR1","doi-asserted-by":"publisher","first-page":"682","DOI":"10.1016\/S0022-5223(19)35174-8","volume":"96","author":"MR de Leval","year":"1988","unstructured":"de Leval MR et al (1988) Total cavopulmonary connection: A logical alternative to atriopulmonary connection for complex Fontan operations: Experimental studies and early clinical experience. J Thorac Cardiovasc Surg 96(5):682\u2013695","journal-title":"J Thorac Cardiovasc Surg"},{"issue":"2","key":"4250_CR2","doi-asserted-by":"publisher","first-page":"207","DOI":"10.1161\/hc0202.102237","volume":"105","author":"MS Lemler","year":"2002","unstructured":"Lemler MS et al (2002) Fenestration improves clinical outcome of the fontan procedure: a prospective, randomized study. Circulation 105(2):207\u2013212","journal-title":"Circulation"},{"issue":"1","key":"4250_CR3","doi-asserted-by":"publisher","first-page":"4","DOI":"10.1053\/j.pcsu.2011.01.019","volume":"14","author":"CL Backer","year":"2011","unstructured":"Backer CL et al (2011) Extracardiac versus intra-atrial lateral tunnel fontan: extracardiac is better. Seminars Thorac Cardiovasc Surgery: Pediatr Cardiac Surg Annual 14(1):4\u201310","journal-title":"Seminars Thorac Cardiovasc Surgery: Pediatr Cardiac Surg Annual"},{"issue":"11 Suppl","key":"4250_CR4","first-page":"I157","volume":"116","author":"Y d\u2019Udekem","year":"2007","unstructured":"d\u2019Udekem Y et al (2007) The Fontan procedure: contemporary techniques have improved long-term outcomes. Circulation 116(11 Suppl):I157\u2013I164","journal-title":"Circulation"},{"issue":"1","key":"4250_CR5","doi-asserted-by":"publisher","first-page":"85","DOI":"10.1161\/CIRCULATIONAHA.107.738559","volume":"117","author":"P Khairy","year":"2008","unstructured":"Khairy P et al (2008) Long-term survival, modes of death, and predictors of mortality in patients with Fontan surgery. Circulation 117(1):85\u201392","journal-title":"Circulation"},{"issue":"4","key":"4250_CR6","doi-asserted-by":"publisher","first-page":"1291","DOI":"10.1016\/j.athoracsur.2009.05.076","volume":"88","author":"JS Tweddell","year":"2009","unstructured":"Tweddell JS et al (2009) Fontan palliation in the modern era: factors impacting mortality and morbidity. Ann Thorac Surg 88(4):1291\u20131299","journal-title":"Ann Thorac Surg"},{"issue":"6","key":"4250_CR7","doi-asserted-by":"publisher","first-page":"e234","DOI":"10.1161\/CIR.0000000000000696","volume":"140","author":"J Rychik","year":"2019","unstructured":"Rychik J et al (2019) Evaluation and management of the child and adult with fontan circulation: a scientific statement from the american heart association. Circulation 140(6):e234\u2013e284","journal-title":"Circulation"},{"issue":"11","key":"4250_CR8","doi-asserted-by":"publisher","first-page":"1222","DOI":"10.1016\/j.echo.2012.08.005","volume":"25","author":"S Kaneko","year":"2012","unstructured":"Kaneko S et al (2012) Single right ventricles have impaired systolic and diastolic function compared to those of left ventricular morphology. J Am Soc Echocardiogr 25(11):1222\u20131230","journal-title":"J Am Soc Echocardiogr"},{"issue":"4","key":"4250_CR9","doi-asserted-by":"publisher","first-page":"399","DOI":"10.1017\/S1047951101000518","volume":"11","author":"WT Mahle","year":"2001","unstructured":"Mahle WT et al (2001) Quantitative echocardiographic assessment of the performance of the functionally single right ventricle after the Fontan operation. Cardiol Young 11(4):399\u2013406","journal-title":"Cardiol Young"},{"issue":"25","key":"4250_CR10","doi-asserted-by":"publisher","first-page":"2450","DOI":"10.1016\/j.jacc.2007.02.062","volume":"49","author":"E Pettersen","year":"2007","unstructured":"Pettersen E et al (2007) Contraction pattern of the systemic right ventricle shift from longitudinal to circumferential shortening and absent global ventricular torsion. J Am Coll Cardiol 49(25):2450\u20132456","journal-title":"J Am Coll Cardiol"},{"issue":"13","key":"4250_CR11","doi-asserted-by":"publisher","first-page":"1178","DOI":"10.1016\/j.jacc.2011.11.049","volume":"59","author":"Y d\u2019Udekem","year":"2012","unstructured":"d\u2019Udekem Y et al (2012) Predictors of survival after single-ventricle palliation: the impact of right ventricular dominance. J Am Coll Cardiol 59(13):1178\u20131185","journal-title":"J Am Coll Cardiol"},{"key":"4250_CR12","doi-asserted-by":"publisher","DOI":"10.1093\/ejcts\/ezac535","author":"M Ponzoni","year":"2022","unstructured":"Ponzoni M et al (2022) Ventricular morphology of single-ventricle hearts has a significant impact on outcomes after Fontan palliation: a meta-analysis. Eur J Cardiothorac Surg. https:\/\/doi.org\/10.1093\/ejcts\/ezac535","journal-title":"Eur J Cardiothorac Surg"},{"issue":"2","key":"4250_CR13","doi-asserted-by":"publisher","first-page":"614","DOI":"10.1016\/j.athoracsur.2011.10.012","volume":"93","author":"TM Lee","year":"2012","unstructured":"Lee TM et al (2012) Risk factor analysis for second-stage palliation of single ventricle anatomy. Ann Thorac Surg 93(2):614\u20138","journal-title":"Ann Thorac Surg"},{"issue":"3","key":"4250_CR14","doi-asserted-by":"publisher","first-page":"376","DOI":"10.1016\/S0022-5223(97)70183-1","volume":"114","author":"TL Gentles","year":"1997","unstructured":"Gentles TL et al (1997) Fontan operation in five hundred consecutive patients: factors influencing early and late outcome. J Thorac Cardiovasc Surg 114(3):376\u2013391","journal-title":"J Thorac Cardiovasc Surg"},{"issue":"11","key":"4250_CR15","doi-asserted-by":"publisher","first-page":"1143","DOI":"10.1016\/j.echo.2010.08.010","volume":"23","author":"GK Singh","year":"2010","unstructured":"Singh GK et al (2010) Accuracy and reproducibility of strain by speckle tracking in pediatric subjects with normal heart and single ventricular physiology: a two-dimensional speckle-tracking echocardiography and magnetic resonance imaging correlative study. J Am Soc Echocardiogr 23(11):1143\u20131152","journal-title":"J Am Soc Echocardiogr"},{"issue":"1","key":"4250_CR16","doi-asserted-by":"publisher","first-page":"108","DOI":"10.1111\/echo.13408","volume":"34","author":"R Rios","year":"2017","unstructured":"Rios R et al (2017) Quantitative echocardiographic measures in the assessment of single ventricle function post-Fontan: Incorporation into routine clinical practice. Echocardiography 34(1):108\u2013115","journal-title":"Echocardiography"},{"issue":"2","key":"4250_CR17","doi-asserted-by":"publisher","first-page":"216","DOI":"10.1016\/j.echo.2023.11.003","volume":"37","author":"DM Dorobantu","year":"2024","unstructured":"Dorobantu DM et al (2024) The role of speckle-tracking echocardiography in predicting mortality and morbidity in patients with congenital heart disease: a systematic review and meta-analysis. J Am Soc Echocardiogr 37(2):216\u2013225","journal-title":"J Am Soc Echocardiogr"},{"issue":"5","key":"4250_CR18","doi-asserted-by":"publisher","first-page":"643","DOI":"10.1016\/j.echo.2019.01.006","volume":"32","author":"JL Colquitt","year":"2019","unstructured":"Colquitt JL et al (2019) Serial strain analysis identifies hypoplastic left heart syndrome infants at risk for cardiac morbidity and mortality: a pilot study. J Am Soc Echocardiogr 32(5):643\u2013650","journal-title":"J Am Soc Echocardiogr"},{"issue":"7","key":"4250_CR19","doi-asserted-by":"publisher","first-page":"1136","DOI":"10.1017\/S1047951122002323","volume":"33","author":"S Goudar","year":"2023","unstructured":"Goudar S et al (2023) Single ventricular strain measures correlate with peak oxygen consumption in children and adolescents with Fontan circulation. Cardiol Young 33(7):1136\u20131142","journal-title":"Cardiol Young"},{"issue":"6","key":"4250_CR20","first-page":"357","volume":"26","author":"C Tei","year":"1995","unstructured":"Tei C et al (1995) New index of combined systolic and diastolic myocardial performance: a simple and reproducible measure of cardiac function\u2013a study in normals and dilated cardiomyopathy. J Cardiol 26(6):357\u2013366","journal-title":"J Cardiol"},{"issue":"2","key":"4250_CR21","doi-asserted-by":"publisher","first-page":"133","DOI":"10.2174\/157340309788166642","volume":"5","author":"M Dandel","year":"2009","unstructured":"Dandel M et al (2009) Strain and strain rate imaging by echocardiography - basic concepts and clinical applicability. Curr Cardiol Rev 5(2):133\u2013148","journal-title":"Curr Cardiol Rev"},{"issue":"3","key":"4250_CR22","doi-asserted-by":"publisher","first-page":"112","DOI":"10.1016\/j.cjcpc.2023.01.001","volume":"2","author":"AK Mahendran","year":"2023","unstructured":"Mahendran AK et al (2023) Exercise pathophysiology and testing in individuals with a fontan circulation. CJC Pediatr Congenit Heart Dis 2(3):112\u2013123","journal-title":"CJC Pediatr Congenit Heart Dis"},{"issue":"10","key":"4250_CR23","doi-asserted-by":"publisher","first-page":"775","DOI":"10.2459\/JCM.0b013e328011c999","volume":"8","author":"T Takken","year":"2007","unstructured":"Takken T et al (2007) Exercise limitation in patients with Fontan circulation: a review. J Cardiovasc Med (Hagerstown) 8(10):775\u2013781","journal-title":"J Cardiovasc Med (Hagerstown)"},{"issue":"2","key":"4250_CR24","doi-asserted-by":"publisher","first-page":"105","DOI":"10.1111\/chd.12222","volume":"10","author":"H Ohuchi","year":"2015","unstructured":"Ohuchi H et al (2015) Prognostic value of exercise variables in 335 patients after the Fontan operation: a 23-year single-center experience of cardiopulmonary exercise testing. Congenit Heart Dis 10(2):105\u2013116","journal-title":"Congenit Heart Dis"},{"issue":"7","key":"4250_CR25","doi-asserted-by":"publisher","first-page":"1967","DOI":"10.1016\/S0735-1097(01)01266-9","volume":"37","author":"H Ohuchi","year":"2001","unstructured":"Ohuchi H et al (2001) Influence of ventricular morphology on aerobic exercise capacity in patients after the Fontan operation. J Am Coll Cardiol 37(7):1967\u20131974","journal-title":"J Am Coll Cardiol"},{"issue":"20","key":"4250_CR26","doi-asserted-by":"publisher","first-page":"2115","DOI":"10.1016\/j.jacc.2012.08.970","volume":"60","author":"KM Shafer","year":"2012","unstructured":"Shafer KM et al (2012) The importance of the muscle and ventilatory blood pumps during exercise in patients without a subpulmonary ventricle (Fontan operation). J Am Coll Cardiol 60(20):2115\u20132121","journal-title":"J Am Coll Cardiol"},{"issue":"3","key":"4250_CR27","doi-asserted-by":"publisher","first-page":"818","DOI":"10.1016\/j.athoracsur.2007.11.009","volume":"85","author":"A Giardini","year":"2008","unstructured":"Giardini A et al (2008) Natural history of exercise capacity after the Fontan operation: a longitudinal study. Ann Thorac Surg 85(3):818\u2013821","journal-title":"Ann Thorac Surg"}],"container-title":["Pediatric Cardiology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00246-026-04250-y.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s00246-026-04250-y","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00246-026-04250-y.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,16]],"date-time":"2026-06-16T21:34:40Z","timestamp":1781645680000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s00246-026-04250-y"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,4,7]]},"references-count":27,"alternative-id":["4250"],"URL":"https:\/\/doi.org\/10.1007\/s00246-026-04250-y","relation":{},"ISSN":["0172-0643","1432-1971"],"issn-type":[{"value":"0172-0643","type":"print"},{"value":"1432-1971","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,4,7]]},"assertion":[{"value":"16 November 2025","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"24 March 2026","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"7 April 2026","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The authors declare no competing interests.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing Interests"}},{"value":"The authors have no conflicts of interest to disclose.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing Interests"}}]}}