Assessment of global and regional strain left ventricular in patients with preserved ejection fraction after Fontan operation using a tissue tracking technique

  • Liwei Hu
  • Aimin Sun
  • Chen Guo
  • Rongzhen Ouyang
  • Qian Wang
  • Xiaofen Yao
  • Yumin ZhongEmail author
Original Paper


To evaluate the use of the tissue tracking (TT) technique to measure myocardial strain left ventricular in post-Fontan children with preserved ejection fraction (pEF). Nineteen (male/female, 10/9) patients with univentricular hearts after completion of the Fontan circulation (post-Fontan group) and 19 age- and gender-matched healthy children (control group) were retrospectively enrolled. Cardiovascular magnetic resonance (CMR) imaging was conducted on a 1.5-T MRI scanner. Global and regional strains of the left ventricle in post-Fontan patients (EF > 55%) and controls were obtained using CMR-TT software. The Mann–Whitney U test was used to compare parameters between the two groups. Correlation between EF and strain was investigated using Pearson correlation coefficients. The Bland–Altman method was used to identify the inter- and intra-observer agreement in measurement of global strain. Global longitudinal strain was lower in post-Fontan patients than in healthy controls (− 18.87 ± 4.61 vs. −19.72 ± 1.58; P = 0.54), though the difference was not statistically significant. Global circumferential strain and global radial strain were significantly lower in post-Fontan patients than in healthy controls (− 14.55 ± 3.79 vs. −19.91 ± 1.97; P < 0.001; and 29.62 ± 8.41 vs. 36.85 ± 5.95; P = 0.01; respectively). The regional circumferential strain (RCS) decrease was marked in regional segments compare with post-Fontan patients and controls (basal, − 11.81 ± 2.98 vs. − 16.21 ± 2.72, P < 0.001; mid, − 15.05 ± 3.31 vs. − 20.17 ± 2.28, P = 0.005; apical, − 16.86 ± 3.09 vs. − 23.37 ± 2.62, P < 0.001). All circumferential and longitudinal parameters had an inter-observer ICC of ≥ 0.85, but this coefficient was lower for radial parameters. CMR-TT appears to be a feasible technique for identification of early myocardial dysfunction in post-Fontan with pEF.


Fontan Cardiac magnetic resonance Strain Pediatric 



Cardiovascular magnetic resonance


Ejection fraction


Tissue tracking


Global circumferential strain


Global longitudinal strain


Global radial strain


Left ventricular ejection fraction


Preserved ejection fraction


Regional circumferential strain


Regional radial strain


Steady-state free procession



The authors appreciate Hai-Tao You and Tong–Tong Han at the Circle Imaging Systems, Circle CVI Corporation Canada for their technical assistance.

Author contribution

LH—Study concepts and design; LH, AS—Clinical studies; YZ, LH, RO, CG, AS—Experimental studies/data analysis; YZ, LH, QW, AS—Statistical analysis; LH, AS, RO—Manuscript preparation; LH—Manuscript editing.


This work was supported by the Shanghai Municipal Commission of Health and Family Planning (Grant No. 20164Y0150); the Medical Engineering Cross Research Foundation of Shanghai Jiao Tong University (Grant No. YG2015QN25); and the Shanghai Hospital Development Center New Technology and Joint Research Projects (Grant No. SHDC12015128).

Compliance with ethical standards

Conflict of interest

The authors have no conflicts of interest to declare.

Ethical approval

The study was approved by ethics committees of the University of Shanghai Jiao Tong University (SCMCIRB-K2017062). This study was approved by the ethics committee of our hospital, and all procedures were in accordance with the Declaration of Helsinki.

Informed consent

The parents gave informed consent to the participation of their children.


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Copyright information

© Springer Nature B.V. 2018

Authors and Affiliations

  1. 1.Diagnostic Imaging Center of Shanghai Children’s Medical CenterShanghai Jiao Tong University School of MedicineShanghaiPeople’s Republic of China

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