{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,6]],"date-time":"2026-01-06T13:12:26Z","timestamp":1767705146352,"version":"3.44.0"},"reference-count":35,"publisher":"Oxford University Press (OUP)","issue":"9","license":[{"start":{"date-parts":[[2025,7,1]],"date-time":"2025-07-01T00:00:00Z","timestamp":1751328000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"funder":[{"name":"Biostatistics, Epidemiology and Research Design (BERD) Resource"},{"name":"Center for Clinical and Translational Science"},{"DOI":"10.13039\/100000050","name":"National Heart, Lung, and Blood Institute","doi-asserted-by":"publisher","award":["R01 HL158517","R01 HL160761","R01 HL162830"],"award-info":[{"award-number":["R01 HL158517","R01 HL160761","R01 HL162830"]}],"id":[{"id":"10.13039\/100000050","id-type":"DOI","asserted-by":"publisher"}]},{"name":"Al-Bahar Research"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,8,29]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Aims<\/jats:title>\n                  <jats:p>Systemic ventricular (SV) strain imaging improves early detection of systolic dysfunction in patients with congenital heart disease and biventricular circulation. However, its role for risk stratification in the Fontan population has not been systematically studied. We hypothesized that among Fontan patients with normal SV ejection fraction (Echo_EF) at baseline, those with reduced SV longitudinal strain (Echo_LS) would have a higher risk of progressive SV systolic dysfunction, greater neurohormonal activation, and cardiovascular events (heart failure hospitalization\/death\/transplant) during follow-up.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods and results<\/jats:title>\n                  <jats:p>We studied adults with Fontan palliation and normal SV systolic function (Echo_EF &amp;gt;50%) at baseline who underwent follow-up echocardiogram &amp;gt;36 months after the baseline echocardiogram. Echo_LS was assessed from the apical 4-chamber window using speckle tracking echocardiography. Patients were divided into reduced vs. normal Echo_LS groups, using \u221218% as the cut-off point. Echo_LS, Echo_EF, and NT-proBNP were assessed at baseline and follow-up encounters. Of 272 patients (age, 28 \u00b1 8 years), 98 (36%) and 174 (64%) had reduced vs. normal Echo_LS. The reduced_Echo_LS group had progressive SV systolic dysfunction [worse temporal decline in Echo_EF (relative_\u0394_Echo_EF \u221212.8% vs. \u22122.1%, P &amp;lt; 0.001)], and higher prevalence of new-onset SV systolic dysfunction [30% (29\/98) vs. 8% (13\/174), P &amp;lt; 0.001]. The reduced Echo_LS group also had greater neurohormonal activation [relative \u0394_ NT-proBNP 36 (95%CI, 27\u201343) % vs. 17 (95%CI, 11\u201323) %, P &amp;lt; 0.001], and higher risk of cardiovascular events (adjusted hazard ratio 1.84, P = 0.009).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusion<\/jats:title>\n                  <jats:p>Echo_LS improves risk stratification in Fontan patients with normal Echo_EF and may provide an opportunity for early interventions to improve outcomes.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/ehjci\/jeaf189","type":"journal-article","created":{"date-parts":[[2025,7,1]],"date-time":"2025-07-01T14:05:32Z","timestamp":1751378732000},"page":"1579-1588","source":"Crossref","is-referenced-by-count":1,"title":["Role of strain imaging for risk stratification in Fontan patients with normal ventricular ejection fraction"],"prefix":"10.1093","volume":"26","author":[{"given":"Ahmed T","family":"Abdelhalim","sequence":"first","affiliation":[{"name":"Department of Cardiovascular Medicine, Mayo Clinic and Foundation , 200 First Street SW, Rochester, MN 55905 ,","place":["USA"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ali","family":"Ali","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Medicine, Mayo Clinic and Foundation , 200 First Street SW, Rochester, MN 55905 ,","place":["USA"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sara","family":"ElZalabany","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Medicine, Mayo Clinic and Foundation , 200 First Street SW, Rochester, MN 55905 ,","place":["USA"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Amr","family":"Moustafa","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Medicine, Mayo Clinic and Foundation , 200 First Street SW, Rochester, MN 55905 ,","place":["USA"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ahmed E","family":"Ali","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Medicine, Mayo Clinic and Foundation , 200 First Street SW, Rochester, MN 55905 ,","place":["USA"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Luke J","family":"Burchill","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Medicine, Mayo Clinic and Foundation , 200 First Street SW, Rochester, MN 55905 ,","place":["USA"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Maan","family":"Jokhadar","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Medicine, Mayo Clinic and Foundation , 200 First Street SW, Rochester, MN 55905 ,","place":["USA"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Naser M","family":"Ammash","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Medicine, Mayo Clinic and Foundation , 200 First Street SW, Rochester, MN 55905 ,","place":["USA"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Heidi M","family":"Connolly","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Medicine, Mayo Clinic and Foundation , 200 First Street SW, Rochester, MN 55905 ,","place":["USA"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alexander C","family":"Egbe","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Medicine, Mayo Clinic and Foundation , 200 First Street SW, Rochester, MN 55905 ,","place":["USA"]}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[2025,7,1]]},"reference":[{"key":"2025082819521652000_jeaf189-B1","first-page":"S32","article-title":"Redefining expectations of long-term survival after the Fontan procedure: twenty-five years of follow-up from the entire population of Australia and New Zealand","volume":"130","author":"d'Udekem","year":"2014","journal-title":"Circulation"},{"key":"2025082819521652000_jeaf189-B2","doi-asserted-by":"crossref","first-page":"751","DOI":"10.1136\/heartjnl-2019-315430","article-title":"Reintervention and survival in 1428 patients in the Australian and New Zealand Fontan Registry","volume":"106","author":"Daley","year":"2020","journal-title":"Heart"},{"key":"2025082819521652000_jeaf189-B3","doi-asserted-by":"crossref","first-page":"132658","DOI":"10.1016\/j.ijcard.2024.132658","article-title":"Clinical characteristics and outcomes in middle-aged Fontan patients","volume":"418","author":"Egbe","year":"2024","journal-title":"Int J Cardiol"},{"key":"2025082819521652000_jeaf189-B4","doi-asserted-by":"crossref","first-page":"825","DOI":"10.1093\/ejcts\/ezv072","article-title":"Results of extracardiac conduit total cavopulmonary connection in 500 patients","volume":"48","author":"Nakano","year":"2015","journal-title":"Eur J Cardiothorac Surg"},{"key":"2025082819521652000_jeaf189-B5","doi-asserted-by":"crossref","first-page":"e010404","DOI":"10.1161\/CIRCHEARTFAILURE.122.010404","article-title":"Prognostic value of the anatomic-physiologic classification in adults with congenital heart disease","volume":"16","author":"Egbe","year":"2023","journal-title":"Circ Heart Fail"},{"key":"2025082819521652000_jeaf189-B6","doi-asserted-by":"crossref","first-page":"e009675","DOI":"10.1161\/CIRCHEARTFAILURE.122.009675","article-title":"Incidence and outcomes of advanced heart failure in adults with congenital heart disease","volume":"15","author":"Egbe","year":"2022","journal-title":"Circ Heart Fail"},{"key":"2025082819521652000_jeaf189-B7","doi-asserted-by":"crossref","first-page":"2755","DOI":"10.1016\/j.jacc.2020.10.003","article-title":"Hemodynamic and clinical implications of impaired pulmonary vascular reserve in the Fontan circulation","volume":"76","author":"Egbe","year":"2020","journal-title":"J Am Coll Cardiol"},{"key":"2025082819521652000_jeaf189-B8","doi-asserted-by":"crossref","first-page":"803","DOI":"10.1002\/ejhf.1365","article-title":"Haemodynamic profiles in adult Fontan patients: associated haemodynamics and prognosis","volume":"21","author":"Miranda","year":"2019","journal-title":"Eur J Heart Fail"},{"key":"2025082819521652000_jeaf189-B9","doi-asserted-by":"crossref","first-page":"842","DOI":"10.4070\/kcj.2017.0105","article-title":"Where is the \u201coptimal\u201d Fontan hemodynamics?","volume":"47","author":"Ohuchi","year":"2017","journal-title":"Korean Circ J"},{"key":"2025082819521652000_jeaf189-B10","doi-asserted-by":"crossref","first-page":"9","DOI":"10.1016\/j.ahj.2017.03.020","article-title":"Hemodynamic determinants of mortality after Fontan operation","volume":"189","author":"Ohuchi","year":"2017","journal-title":"Am Heart J"},{"key":"2025082819521652000_jeaf189-B11","doi-asserted-by":"crossref","first-page":"e004515","DOI":"10.1161\/CIRCHEARTFAILURE.117.004515","article-title":"Hemodynamics of Fontan failure: the role of pulmonary vascular disease","volume":"10","author":"Egbe","year":"2017","journal-title":"Circ Heart Fail"},{"key":"2025082819521652000_jeaf189-B12","doi-asserted-by":"crossref","first-page":"419","DOI":"10.1016\/j.jacc.2020.05.059","article-title":"Relationship of ventricular morphology and atrioventricular valve function to long-term outcomes following Fontan procedures","volume":"76","author":"Moon","year":"2020","journal-title":"J Am Coll Cardiol"},{"key":"2025082819521652000_jeaf189-B13","doi-asserted-by":"crossref","first-page":"419","DOI":"10.1016\/j.amjcard.2009.03.058","article-title":"Comparison of echocardiographic and cardiac magnetic resonance imaging measurements of functional single ventricular volumes, mass, and ejection fraction (from the pediatric heart network Fontan cross-sectional study)","volume":"104","author":"Margossian","year":"2009","journal-title":"Am J Cardiol"},{"key":"2025082819521652000_jeaf189-B14","doi-asserted-by":"crossref","first-page":"e006738","DOI":"10.1161\/CIRCIMAGING.117.006738","article-title":"Impact of ventricular morphology on fiber stress and strain in Fontan patients","volume":"11","author":"Ghelani","year":"2018","journal-title":"Circ Cardiovasc Imaging"},{"key":"2025082819521652000_jeaf189-B15","doi-asserted-by":"crossref","first-page":"e81","DOI":"10.1016\/j.jacc.2018.08.1029","article-title":"2018 AHA\/ACC Guideline for the Management of Adults With Congenital Heart Disease: a report of the American College of Cardiology\/American Heart Association task force on clinical practice guidelines","volume":"73","author":"Stout","year":"2019","journal-title":"J Am Coll Cardiol"},{"key":"2025082819521652000_jeaf189-B16","doi-asserted-by":"crossref","first-page":"4153","DOI":"10.1093\/eurheartj\/ehaa701","article-title":"The ESC clinical practice guidelines for the management of adult congenital heart disease 2020","volume":"41","author":"Baumgartner","year":"2020","journal-title":"Eur Heart J"},{"key":"2025082819521652000_jeaf189-B17","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.echo.2014.10.003","article-title":"Recommendations for cardiac chamber quantification by echocardiography in adults: an update from the American society of echocardiography and the European association of cardiovascular imaging","volume":"28","author":"Lang","year":"2015","journal-title":"J Am Soc Echocardiogr"},{"key":"2025082819521652000_jeaf189-B18","doi-asserted-by":"crossref","first-page":"H743","DOI":"10.1152\/ajpheart.00828.2014","article-title":"Strain and strain rate by speckle-tracking echocardiography correlate with pressure-volume loop-derived contractility indices in a rat model of athlete's heart","volume":"308","author":"Kovacs","year":"2015","journal-title":"Am J Physiol Heart Circ Physiol"},{"key":"2025082819521652000_jeaf189-B19","doi-asserted-by":"crossref","first-page":"1947","DOI":"10.1016\/j.jacc.2018.02.064","article-title":"Global longitudinal strain to predict mortality in patients with acute heart failure","volume":"71","author":"Park","year":"2018","journal-title":"J Am Coll Cardiol"},{"key":"2025082819521652000_jeaf189-B20","doi-asserted-by":"crossref","first-page":"2751","DOI":"10.1016\/j.jacc.2014.01.073","article-title":"Use of myocardial strain imaging by echocardiography for the early detection of cardiotoxicity in patients during and after cancer chemotherapy: a systematic review","volume":"63","author":"Thavendiranathan","year":"2014","journal-title":"J Am Coll Cardiol"},{"key":"2025082819521652000_jeaf189-B21","doi-asserted-by":"crossref","first-page":"1668","DOI":"10.1016\/j.jcmg.2021.01.036","article-title":"Left ventricular global longitudinal strain is superior to ejection fraction for prognostication in Ebstein anomaly","volume":"14","author":"Egbe","year":"2021","journal-title":"JACC Cardiovasc Imaging"},{"key":"2025082819521652000_jeaf189-B22","doi-asserted-by":"crossref","first-page":"e011739","DOI":"10.1161\/CIRCIMAGING.120.011739","article-title":"Hemodynamics and clinical implications of occult left ventricular dysfunction in adults undergoing Ebstein anomaly repair","volume":"14","author":"Egbe","year":"2021","journal-title":"Circ Cardiovasc Imaging"},{"key":"2025082819521652000_jeaf189-B23","doi-asserted-by":"crossref","first-page":"503","DOI":"10.1016\/j.jacc.2023.05.045","article-title":"Prognostic performance of right ventricular global longitudinal strain measurements in patients with Ebstein anomaly","volume":"82","author":"Egbe","year":"2023","journal-title":"J Am Coll Cardiol"},{"key":"2025082819521652000_jeaf189-B24","doi-asserted-by":"crossref","first-page":"566","DOI":"10.1016\/j.jcmg.2021.09.016","article-title":"Prognostic implications of progressive systemic ventricular dysfunction in congenitally corrected transposition of great arteries","volume":"15","author":"Egbe","year":"2022","journal-title":"JACC Cardiovasc Imaging"},{"key":"2025082819521652000_jeaf189-B25","doi-asserted-by":"crossref","first-page":"e014865","DOI":"10.1161\/CIRCIMAGING.122.014865","article-title":"Prognostic value of left ventricular global longitudinal strain in patients with congenital heart disease","volume":"15","author":"Egbe","year":"2022","journal-title":"Circ Cardiovasc Imaging"},{"key":"2025082819521652000_jeaf189-B26","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.echo.2018.06.004","article-title":"Guidelines for performing a comprehensive transthoracic echocardiographic examination in adults: recommendations from the American society of echocardiography","volume":"32","author":"Mitchell","year":"2019","journal-title":"J Am Soc Echocardiogr"},{"key":"2025082819521652000_jeaf189-B27","doi-asserted-by":"crossref","first-page":"672","DOI":"10.1161\/HYPERTENSIONAHA.121.17515","article-title":"Persistent hypertension and left ventricular hypertrophy after repair of native coarctation of aorta in adults","volume":"78","author":"Egbe","year":"2021","journal-title":"Hypertension"},{"key":"2025082819521652000_jeaf189-B28","doi-asserted-by":"crossref","first-page":"1590","DOI":"10.1016\/j.jacc.2023.02.031","article-title":"Exercise capacity, NT-proBNP, and exercise hemodynamics in adults post-Fontan","volume":"81","author":"Miranda","year":"2023","journal-title":"J Am Coll Cardiol"},{"key":"2025082819521652000_jeaf189-B29","doi-asserted-by":"crossref","first-page":"17","DOI":"10.1002\/ejhf.2706","article-title":"Exercise-induced changes in pulmonary artery wedge pressure in adults post-Fontan versus heart failure with preserved ejection fraction and non-cardiac dyspnoea","volume":"25","author":"Miranda","year":"2023","journal-title":"Eur J Heart Fail"},{"key":"2025082819521652000_jeaf189-B30","doi-asserted-by":"crossref","first-page":"153","DOI":"10.1007\/s10554-018-1440-z","article-title":"Assessment of global and regional strain left ventricular in patients with preserved ejection fraction after Fontan operation using a tissue tracking technique","volume":"35","author":"Hu","year":"2019","journal-title":"Int J Cardiovasc Imaging"},{"key":"2025082819521652000_jeaf189-B31","doi-asserted-by":"crossref","first-page":"666","DOI":"10.1016\/j.echo.2014.01.027","article-title":"Atrial and ventricular mechanics in patients after Fontan-type procedures: atriopulmonary connection versus extracardiac conduit","volume":"27","author":"Li","year":"2014","journal-title":"J Am Soc Echocardiogr"},{"key":"2025082819521652000_jeaf189-B32","doi-asserted-by":"crossref","first-page":"1356","DOI":"10.1016\/j.jacc.2022.01.040","article-title":"Prevalence and prognostic implications of left ventricular systolic dysfunction in adults with congenital heart disease","volume":"79","author":"Egbe","year":"2022","journal-title":"J Am Coll Cardiol"},{"key":"2025082819521652000_jeaf189-B33","doi-asserted-by":"crossref","first-page":"131152","DOI":"10.1016\/j.ijcard.2023.131152","article-title":"Clinical benefits of angiotensin receptor-neprilysin inhibitor in adults with congenital heart disease","volume":"387","author":"Andi","year":"2023","journal-title":"Int J Cardiol"},{"key":"2025082819521652000_jeaf189-B34","doi-asserted-by":"crossref","first-page":"810","DOI":"10.1016\/j.jacc.2018.12.025","article-title":"Atrioventricular valve failure in Fontan palliation","volume":"73","author":"King","year":"2019","journal-title":"J Am Coll Cardiol"},{"key":"2025082819521652000_jeaf189-B35","doi-asserted-by":"crossref","first-page":"12","DOI":"10.1016\/j.ahj.2016.12.015","article-title":"Outcomes in adult Fontan patients with atrial tachyarrhythmias","volume":"186","author":"Egbe","year":"2017","journal-title":"Am Heart J"}],"container-title":["European Heart Journal - Cardiovascular Imaging"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/ehjcimaging\/advance-article-pdf\/doi\/10.1093\/ehjci\/jeaf189\/63638069\/jeaf189.pdf","content-type":"application\/pdf","content-version":"am","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/ehjcimaging\/article-pdf\/26\/9\/1579\/63638069\/jeaf189.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/ehjcimaging\/article-pdf\/26\/9\/1579\/63638069\/jeaf189.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,8,28]],"date-time":"2025-08-28T23:52:29Z","timestamp":1756425149000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/ehjcimaging\/article\/26\/9\/1579\/8180595"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,7,1]]},"references-count":35,"journal-issue":{"issue":"9","published-online":{"date-parts":[[2025,7,1]]},"published-print":{"date-parts":[[2025,8,29]]}},"URL":"https:\/\/doi.org\/10.1093\/ehjci\/jeaf189","relation":{},"ISSN":["2047-2404","2047-2412"],"issn-type":[{"type":"print","value":"2047-2404"},{"type":"electronic","value":"2047-2412"}],"subject":[],"published-other":{"date-parts":[[2025,9]]},"published":{"date-parts":[[2025,7,1]]}}}