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Mertens L, Singh G, Armenian S, Chen MH, Dorfman AL, Garg R, Husain N, Joshi V, Leger KJ, Lipshultz SE, Lopez-Mattei J, Narayan HK, Parthiban A, Pignatelli RH, Toro-Salazar O, Wasserman M, Wheatley J. Multimodality Imaging for Cardiac Surveillance of Cancer Treatment in Children: Recommendations From the American Society of Echocardiography. J Am Soc Echocardiogr 2023; 36:1227-1253. [PMID: 38043984 DOI: 10.1016/j.echo.2023.09.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/05/2023]
Affiliation(s)
- Luc Mertens
- Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Gautam Singh
- Children's Hospital of Michigan, Detroit, Michigan; Central Michigan University School of Medicine, Saginaw, Michigan
| | - Saro Armenian
- City of Hope Comprehensive Cancer Center, Duarte, California
| | - Ming-Hui Chen
- Boston Children's Hospital and Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Adam L Dorfman
- University of Michigan, C.S. Mott Children's Hospital, Ann Arbor, Michigan
| | - Ruchira Garg
- Cedars-Sinai Heart Institute, Los Angeles, California
| | | | - Vijaya Joshi
- St. Jude Children's Research Hospital/University of Tennessee College of Medicine, Memphis, Tennessee
| | - Kasey J Leger
- University of Washington, Seattle Children's Hospital, Seattle, Washington
| | - Steven E Lipshultz
- University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Oishei Children's Hospital, Roswell Park Comprehensive Cancer Center, Buffalo, New York
| | | | - Hari K Narayan
- University of California San Diego, Rady Children's Hospital San Diego, San Diego, California
| | - Anitha Parthiban
- Texas Children's Hospital, Baylor College of Medicine, Houston, Texas
| | | | - Olga Toro-Salazar
- Connecticut Children's Medical Center, University of Connecticut School of Medicine, Hartford, Connecticut
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The Assessment of Myocardial Longitudinal Strain in a Paediatric Spanish Population Using a New Software Analysis. J Clin Med 2022; 11:jcm11123272. [PMID: 35743343 PMCID: PMC9224625 DOI: 10.3390/jcm11123272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Accepted: 06/03/2022] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Two-dimensional speckle-tracking echocardiography (2DSTE) has been present for years. However, it is underutilized due to the expertise and time requirements for its analysis. Our aims were to provide strain values in a paediatric Spanish population and to assess the feasibility and reproducibility of a new strain software analysis in our environment. METHODS A cross-sectional study of 156 healthy children aged 6 to 17 years. Longitudinal strain (LS) analysis of the left ventricle, right ventricle, and left atrium was performed. Feasibility and reproducibility were assessed. The associations of clinical and echocardiographic variables with strain values were investigated by multivariate analysis. RESULTS Mean age was 11 ± 3 years (50% female). Feasibility of LS measurement ranged from 94.2% for left ventricle global LS (LVGLS) to 98.1% for other chamber strain parameters. Strain values were 26.7 ± 2.3% for LVGLS; 30.5 ± 4.4% and 26.9 ± 4% for right ventricle free wall LS (RVFWLS) and four chambers view LS (RV4CLS) respectively; and 57.8 ± 10.5%, 44.9 ± 9.5%, and 12.9 ± 5.5% for left atrium LS reservoir phase (LALSr), conduct phase (LALScd) and contraction phase (LALSct), also respectively. Body surface area (BSA) and age presented a negative correlation with strain values. Higher values were found in females than in males, except for LALScd. Excellent intra- and inter-observer reproducibility were found for right and left ventricular strain measurement, with intraclass correlation coefficients (ICC) ranging from 0.88 to 0.98, respectively. In conclusion, we described strain values in a healthy Spanish paediatric population. LS assessment by this new strain analysis software by semi-automatic manner was highly feasible and reproducible.
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Kamel H, Elsayegh AT, Nazmi H, Attia HM. Assessment of left ventricular systolic function using two- and three-dimensional speckle tracking echocardiography among healthy preschool-age pediatric children. Egypt Heart J 2022; 74:21. [PMID: 35347471 PMCID: PMC8960099 DOI: 10.1186/s43044-022-00258-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Accepted: 03/19/2022] [Indexed: 11/10/2022] Open
Abstract
Background Accurate measurements of left ventricular (LV) volumes and function are important in the management of patients with various cardiac abnormalities. Two-dimensional (2D) speckle tracking echocardiography (STE) is shown to be accurate in detecting subclinical myocardial dysfunction when most of the conventional echocardiography parameters were normal. Three-dimensional (3D) echocardiography is a new noninvasive imaging technique that has been shown to be accurate in determining cardiac volume and performance. Establishment of normal range values of 3D STE over a different range of ages is crucial before applying this recent technology in clinical applications. This study aimed to assess feasibility of 3D LV STE and establish normal values for the LV systolic function among healthy Egyptian preschool-age pediatric population using 2D and 3D STE.
Results A total of 200 subjects (95%) met the criteria for 2DSTE analysis, 10 were excluded from the 2D analysis and 180 subjects (85%) met the criteria for 3D STE analysis. Regarding the 2D STE GLS, the mean was -22.1345 ± 2.166%, GCS was f -19.02 ± 1.23%, and GRS was 42.25 ± 2.35%. There was a strongly positive significant correlation between age and 2D values of GLS (P = 0.001). The GCS showed a weakly positive nonsignificant correlation with age (P = 0.28), while GRS showed a strongly negative significant correlation with age (P = 0.001). Regarding the 3D STE data, GLS mean was -20.48 ± 1.526%, GCS mean was -13.90 ± 2.05%, while GRS mean was 47.21 ± 2.382%. 3D GLS values had a strongly positive significant correlation with age (P = 0.001). While GCS showed a weakly positive nonsignificant correlation (P = 0.955), GRS showed a strongly negative significant correlation (P = 0.001). Linear correlation analysis of 2D and 3D values of strain showed that GLS had a strongly positive significant correlation (P = 0.001), while GCS showed a weakly positive nonsignificant correlation (P = 0.161) and GRS showed a strongly positive significant correlation (P = 0.001). Conclusions 3D global strain analysis using the 3D STE is feasible in the preschool-age pediatric population. Results were almost concordant with previous observations in most of the values except for GCS, especially 3D values which could be attributed to different vendor system used and different ethnicity. Further studies are required to reinforce these data using the GE vendor machine.
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Affiliation(s)
- Heba Kamel
- Congenital and Structural Heart Disease Unit, Cardiology Department, Ain Shams University Hospital, Nargess 3, Fifth Settlement, Abbassya, Cairo, 11835, Egypt.
| | - Ayah Tarek Elsayegh
- Congenital and Structural Heart Disease Unit, Cardiology Department, Ain Shams University Hospital, Nargess 3, Fifth Settlement, Abbassya, Cairo, 11835, Egypt
| | - Hany Nazmi
- Congenital and Structural Heart Disease Unit, Cardiology Department, Ain Shams University Hospital, Nargess 3, Fifth Settlement, Abbassya, Cairo, 11835, Egypt
| | - Hebatallah Mohamed Attia
- Congenital and Structural Heart Disease Unit, Cardiology Department, Ain Shams University Hospital, Nargess 3, Fifth Settlement, Abbassya, Cairo, 11835, Egypt
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Comprehensive evaluation of left ventricular deformation using speckle tracking echocardiography in normal children: comparison of three-dimensional and two-dimensional approaches. Cardiovasc Ultrasound 2022; 20:3. [PMID: 35086543 PMCID: PMC8793178 DOI: 10.1186/s12947-022-00273-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2021] [Accepted: 01/11/2022] [Indexed: 11/10/2022] Open
Abstract
Background Three-dimensional (3D) speckle tracking echocardiography (STE) can overcome some of the inherent limitations of two-dimensional (2D) STE; however, clinical experience is lacking. We aimed to assess and compare the feasibility, agreement, and reproducibility of left ventricular (LV) global longitudinal (GLS), and regional strain by 3D vs 2D STE in normal children. Methods Healthy pediatric subjects (n = 105, age mean = 11.2 ± 5.5 years) were prospectively enrolled. Three-dimensional and 2D LV GLS, as well as regional strain in 16 myocardial segments were quantified. Bland Altman analysis, intra- class correlation coefficients (ICC), percent error and linear regression were used for agreement and correlation between the two techniques. Analysis and acquisition times were compared. Inter- and intra-observer reproducibility was assessed in 20 studies. Results There was good to excellent agreement for 2D and 3D global longitudinal strain (ICC =0.82) and modest agreement for regional strain (ICC range 0.43–0.71). Both methods had high feasibility (88.6% for 2D vs 85.7% for 3D, p = 0.21), although 3D STE required significantly shorter acquisition and analysis time than 2D STE (acquisition time 1 ± 1.2 mins vs 2.4 ± 1 mins; p = 0.03, analysis time = 3.3 ± 1 mins vs 8.2 ± 2.5 mins; p = 0.001, respectively). Inter and intra-observer reproducibility was excellent for GLS by the two techniques (ICC = 0.78–0.93) but moderate to poor for regional strain (ICC = 0.21–0.64). Conclusion Three-dimensional global LV strain is as feasible and reproducible as 2D strain, with good agreement yet significantly more efficient acquisition and analysis. Regional strain is less concordant and 2D and 3D values should not be used interchangeably. 3D LV GLS may represent a viable alternative in evaluation of LV deformation in pediatric subjects. 1. Adequate feasibility of 3D STE in pediatrics; comparable to 2D STE. 2. Significantly shorter acquisition and analysis time for 3D GLS compared to 2D GLS. 3. Excellent agreement between 3D and 2D LV GLS and moderate to poor agreement between regional strain values. 4. Excellent inter and intra-observer reproducibility for GLS by the two techniques, and fair to poor reproducibility for regional strain (higher for apical than basal regions).
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Lianza AC, Leal GN, Aikawa NE, Kozu KT, Diniz MDFR, Sawamura KSS, Menezes CRB, Martins CL, Campos LM, Elias AM, Silva CA. Heart function in juvenile idiopathic arthritis patients: A biventricular two-dimensional speckle-tracking echocardiography study. Mod Rheumatol 2021; 32:1122-1128. [PMID: 34726237 DOI: 10.1093/mr/roab086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Revised: 09/19/2021] [Accepted: 09/27/2021] [Indexed: 11/14/2022]
Abstract
OBJECTIVES We evaluated cardiac function in juvenile idiopathic arthritis (JIA) patients by 2D speckle-tracking echocardiography (2DSTE) and to assess possible associations with clinical, laboratorial, and treatment data. METHODS A group of 42 JIA patients and 42 healthy controls were evaluated using both conventional echocardiography and 2DSTE. JIA patients underwent clinical and laboratory assessment. RESULTS Conventional echocardiography data demonstrated normal left ventricular (LV) ejection fraction in both groups (71 vs. 71%; p = .69). 2DSTE analysis demonstrated that JIA patients presented significantly lower LV global systolic longitudinal strain (LVGLS) (-18.76 vs. -22%; p < .0001), LV systolic strain rate (LVSSR) (1.06 vs. 1.32 s-1; p < .0001), LV diastolic strain rate (LVDSR) (1.58 vs. 1.8 s-1; p < .0137), right ventricular global systolic strain (RVGLS) (-24.1% vs. -27.7%; p = .0002), and right ventricular systolic strain rate (RVSSR) (1.4 vs. 1.8 s-1; p = .0035). JIA patients under biological agents presented higher LVGLS (p = .02) and RVLS (p = .01). We also detected an association between LVGLS and C-reactive protein [CRP; -20% in normal CRP (10/42) vs. -18% in elevated CRP patients (32/42), p = .03]. CONCLUSIONS JIA patients present different echocardiographic status from healthy patients. Moreover, our data suggest that JIA patients under biological agents present association with better cardiac function as shown by strain analysis.
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Affiliation(s)
- Alessandro C Lianza
- Echocardiography Laboratory, Instituto da Criança e do Adolescente do Hospital das Clinicas da Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil.,Echocardiography laboratory, Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - Gabriela N Leal
- Echocardiography Laboratory, Instituto da Criança e do Adolescente do Hospital das Clinicas da Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil.,Echocardiography laboratory, Hospital Sírio Libânes, São Paulo, Brazil
| | - Nádia E Aikawa
- Pediatric Rheumatology Unit, Instituto da Criança e do Adolescente do Hospital das Clinicas da Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Katia T Kozu
- Pediatric Rheumatology Unit, Instituto da Criança e do Adolescente do Hospital das Clinicas da Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Maria De Fátima R Diniz
- Echocardiography Laboratory, Instituto da Criança e do Adolescente do Hospital das Clinicas da Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Karen S S Sawamura
- Echocardiography Laboratory, Instituto da Criança e do Adolescente do Hospital das Clinicas da Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Carolina R B Menezes
- Echocardiography Laboratory, Instituto da Criança e do Adolescente do Hospital das Clinicas da Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Camila Lino Martins
- Echocardiography Laboratory, Instituto da Criança e do Adolescente do Hospital das Clinicas da Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Lucia M Campos
- Pediatric Rheumatology Unit, Instituto da Criança e do Adolescente do Hospital das Clinicas da Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Adriana M Elias
- Pediatric Rheumatology Unit, Instituto da Criança e do Adolescente do Hospital das Clinicas da Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Clovis A Silva
- Pediatric Rheumatology Unit, Instituto da Criança e do Adolescente do Hospital das Clinicas da Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
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Left ventricular longitudinal strain and strain rate measurements in paediatric patients in long-term treatment for Chagas disease. Cardiol Young 2021; 31:1451-1457. [PMID: 33650485 DOI: 10.1017/s1047951121000408] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
INTRODUCTION Previous echocardiographic studies failed to show residual alterations of heart function in paediatric patients that have received treatment for Chagas disease. While the echocardiogram is the fundamental front-line tool for evaluating heart function, the appearance of new techniques allows a more detailed analysis. We aimed to evaluate systolic and diastolic function with new techniques in a paediatric population with Chagas disease several years after treatment completion. MATERIAL AND METHODS Echocardiograms were obtained from 84 Chagas disease patients (48 female) and 27 healthy controls. All patients had received treatment concluding on average 10 years prior to the study. The prospective analysis considered cardiac dimensions and cardiac function using two-dimensional, M-mode, Doppler and tissue Doppler imaging with emphasis on measuring longitudinal strain in the left ventricle by speckle tracking. Ejection fraction was measured with three-dimensional echocardiography. RESULTS Patients had an age of 14.2 ± 5.7 years (6-33) at the time of evaluation. Global and segmental motility of the left ventricle was normal in all patients. Ejection fraction was 59.2 ± 6.5 and 57.4 ± 6.5% (p = 0.31) in patients and controls respectively. Left ventricular global longitudinal systolic strain was -19 ± 2.4% in patients and -19 ± 3.6% (p = 0.91) in controls. No significant differences were found in remaining systolic and diastolic function measurements. CONCLUSIONS Paediatric patients that have received treatment for Chagas disease, evaluated with either conventional techniques or new tools, do not show significant long-term alterations of ventricular function.
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Nemes A, Kormányos Á, Kalapos A, Domsik P, Gyenes N, Ambrus N, Lengyel C. Normal reference values of left ventricular strain parameters in healthy adults: Real-life experience from the single-center three-dimensional speckle-tracking echocardiographic MAGYAR-Healthy Study. JOURNAL OF CLINICAL ULTRASOUND : JCU 2021; 49:368-377. [PMID: 33185300 DOI: 10.1002/jcu.22940] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Revised: 10/07/2020] [Accepted: 10/12/2020] [Indexed: 06/11/2023]
Abstract
INTRODUCTION A number of studies defined normal reference values of three-dimensional (3D) speckle-tracking echocardiography (3DSTE)-derived left ventricular (LV) strains. The present study aimed to quantify normal reference values of LV strains in healthy adult population in real clinical world settings in different age groups, and to determine age- and gender-dependence of these variables in a high volume single center. METHODS The present prospective study included 296 healthy adult subjects. Among them, 124 were excluded due to inferior image quality during the 6-year recruitment period (2011-2017). The remaining population was further divided into four subgroups based on age decades. RESULTS While global radial (RS) strain showed an increase-decrease-increase pattern with age, circumferential, longitudinal, and area strains (CS, LS, AS, respectively) were nonsignificantly lower in older ages. Only global LV-LS showed gender-dependency with higher values in females. Although moderately higher RS and 3DS and lower LS, and AS were observed in males, clear gender-dependency could not be detected in different age decades. CONCLUSIONS This study provides normal reference values of 3DSTE-derived global, segmental, mean segmental, and regional LV strains in healthy adult subjects based on real-life clinical experience. Age-, gender-, and functional nonuniformity of LV strains were also defined.
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Affiliation(s)
- Attila Nemes
- Department of Medicine, Medical Faculty, Albert Szent-Györgyi Clinical Center, University of Szeged, Szeged, Hungary
| | - Árpád Kormányos
- Department of Medicine, Medical Faculty, Albert Szent-Györgyi Clinical Center, University of Szeged, Szeged, Hungary
| | - Anita Kalapos
- Department of Medicine, Medical Faculty, Albert Szent-Györgyi Clinical Center, University of Szeged, Szeged, Hungary
| | - Péter Domsik
- Department of Medicine, Medical Faculty, Albert Szent-Györgyi Clinical Center, University of Szeged, Szeged, Hungary
| | - Nándor Gyenes
- Department of Medicine, Medical Faculty, Albert Szent-Györgyi Clinical Center, University of Szeged, Szeged, Hungary
| | - Nóra Ambrus
- Department of Medicine, Medical Faculty, Albert Szent-Györgyi Clinical Center, University of Szeged, Szeged, Hungary
| | - Csaba Lengyel
- Department of Medicine, Medical Faculty, Albert Szent-Györgyi Clinical Center, University of Szeged, Szeged, Hungary
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Jone PN, Le L, Pan Z, Colen T, Shigemitsu S, Khoo NS, Goot BH, Parthiban A, Harrild DM, Ferraro AM, Marx G. A multicenter study of three-dimensional echocardiographic evaluation of normal pediatric left ventricular volumes and function. Echocardiography 2021; 38:641-645. [PMID: 33682205 DOI: 10.1111/echo.15026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Accepted: 02/23/2021] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Three-dimensional echocardiography (3DE) evaluation of left ventricular (LV) volume and function in pediatrics compares favorably with cardiac magnetic resonance imaging. The aim of this study was to establish from a multicenter, normal pediatric z-score values of 3DE left ventricular volumes and function. METHODS Six hundred and ninety-eight healthy children (ages 0-18 years) were recruited from five centers. LV 3DE was acquired from the 4-chamber view. A vendor-independent software analyzed end-diastolic volume (EDV), end-systolic volume (ESV), stroke volume (SV), and ejection fraction (EF) using semi-automated quantification. Body surface area (BSA)-based z-scores were generated. Intraobserver and interobserver variability were calculated using intraclass correlation (ICC) and repeatability coefficient (RC). RESULTS Z-scores were generated for ESV, EDV, and SV. The ICC for intraobserver variability for EDV, ESV, and SV was 0.99, 0.99, and 0.99, respectively. The ICC for interobserver variability for EDV, ESV, and SV was 0.98, 0.94, and 0.98, respectively. The RC for intraobserver and interobserver variability for LV EF was 4.39% (95% CI: 3.01, 5.59) and interobserver was 7.08% (95%CI: 5.51, 8.42). CONCLUSIONS We report pediatric z-scores for normal LV volumes using the semi-automated method from five centers, enhancing its generalizability. 3DE evaluation of LV volumes and EF in pediatric patients is highly reproducible.
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Affiliation(s)
- Pei-Ni Jone
- Pediatric Cardiology, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, CO, USA
| | - Lisa Le
- Pediatric Cardiology, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, CO, USA
| | - Zhaoxing Pan
- Research Institute, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, CO, USA
| | - Tim Colen
- Stollery Children's Hospital, University of Alberta, Edmonton, AB, Canada
| | - Sachie Shigemitsu
- Stollery Children's Hospital, University of Alberta, Edmonton, AB, Canada
| | - Nee S Khoo
- Stollery Children's Hospital, University of Alberta, Edmonton, AB, Canada
| | - Benjamin H Goot
- Herma Heart Institute, Children's Wisconsin, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Anitha Parthiban
- Children's Mercy Hospital, University of Missouri, Kansas City, MO, USA
| | - David M Harrild
- Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | | | - Gerald Marx
- Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
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Impact of Reverse Left Ventricular Remodeling on Outcomes of Patients with Anomalous Left Coronary Artery from the Pulmonary Artery after Surgical Correction. Pediatr Cardiol 2021; 42:425-431. [PMID: 33394115 DOI: 10.1007/s00246-020-02500-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Accepted: 11/16/2020] [Indexed: 10/22/2022]
Abstract
The impact of reverse left ventricular remodeling (r-LVR) on clinical outcomes after surgical correction of anomalous left coronary artery from the pulmonary artery (ALCAPA) remains unclear. This study aims to examine the prognostic significance of r-LVR in patients with ALCAPA after surgery. We prospectively identified 61 patients undergoing surgical correction for ALCAPA; 54 patients had adequate echocardiographic image quality with quantitative biplane analysis performed both at baseline and at 30-day postoperative follow-up. Postoperative r-LVR was defined as a reduction of ≥ 10% in left ventricular end-diastolic volume index during follow-up. Cox proportional-hazards regression was used to investigate the independent association of r-LVR and all-cause mortality. Among 54 patients (age: 21.2 ± 7 months; 37% females), r-LVR occurred in 35 patients (64.8%) after surgery. Compared to patients with r-LVR, patients without r-LVR had significantly higher level of N-terminal pro B-type natriuretic peptide (NT-proBNP) [2176 (711, 4219) vs 998 (623, 2145) P < 0.001] and lower survival rate (47.3% vs 82.9%, HR = 5.72 [1.96 to 17.20], P < 0.001) at 1-year follow-up. NT-proBNP (OR = 2.27 [1.67 to 18.3], P = 0.02) was an independent predictor of r-LVR in multivariate analysis. Moreover, r-LVR was significantly associated with a lower rate of all-cause mortality (HR = 0.27 [0.08 to 0.98], P = 0.03) in multivariate analysis, even after adjustment for clinical and echocardiographic variables. R-LVR occurred in more than half of patients with ALCAPA undergoing surgical correction and it was associated with better clinical outcomes. NT-proBNP is an independent predictor of r-LVR.
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Abstract
Supplemental Digital Content is available in the text. Objectives: Circulatory dysfunction has been associated with mortality in children with septic shock. However, the mortality risk attributable to myocardial dysfunction per se has not been established, and the association between myocardial dysfunction and mortality is confounded by illness severity. The objective was to determine if sepsis-associated myocardial dysfunction defined by low left ventricular ejection fraction or global longitudinal strain is associated with mortality in pediatric septic shock after adjusting for baseline mortality probability. Design: Retrospective, observational study. Setting: Single-center, quaternary-care PICU. Patients: Children less than 18 years old admitted to the PICU from 2003 to 2018 who had an echocardiogram performed within 48 hours of septic shock identification and Pediatric Sepsis Biomarker Risk Model II data available. Interventions: None. Measurements and Main Results: All echocardiograms were reread by a cardiologist blinded to patient data for left ventricular ejection fraction and global longitudinal strain. Low left ventricular ejection fraction was defined as less than 45%, and low global longitudinal strain was defined as greater than z score of –2 for body surface area. Multivariable logistic regression separately analyzed the associations of low left ventricular ejection fraction and low global longitudinal strain with mortality, adjusting for Pediatric Sepsis Biomarker Risk Model II mortality risk. A post hoc logistic regression analyzed the association of left ventricular ejection fraction as a continuous variable with mortality, where linearity was maintained for left ventricular ejection fraction less than 65%. Eighteen percent of 181 children had low left ventricular ejection fraction. After adjusting for baseline mortality risk, low left ventricular ejection fraction remained independently associated with mortality (odds ratio, 4.4 [1.0–19.8]; p = 0.0497). Likewise, left ventricular ejection fraction was associated with mortality (odds ratio, 0.96 [0.93–0.99]; p = 0.037) on multivariable analysis for left ventricular ejection fraction less than 65%. Thirty-six percent of 169 children had low global longitudinal strain, and low global longitudinal strain was also independently associated with mortality (odds ratio, 4.6 [1.2–18.0]; p = 0.027). Conclusions: Sepsis-associated myocardial dysfunction, whether defined by low left ventricular ejection fraction or low global longitudinal strain, is an independent risk factor for mortality in pediatric septic shock after accounting for the confounding effects of septic shock severity.
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Truong VT, Phan HT, Ngo TNM, Nguyen TTH, Ngo HT, Tran NB, Palmer C, Alsaied T, Tretter JT, Levy PT, Chung ES, Mazur W. Normal Ranges of Left Ventricular Strain by Three-Dimensional Speckle-Tracking Echocardiography in Children: A Meta-Analysis. J Am Soc Echocardiogr 2020; 33:1407-1408.e1. [PMID: 32792321 DOI: 10.1016/j.echo.2020.06.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Revised: 06/18/2020] [Accepted: 06/19/2020] [Indexed: 11/27/2022]
Affiliation(s)
- Vien T Truong
- The Christ Hospital Health Network, Cincinnati, Ohio; Sue and Bill Butler Research Fellow, The Linder Research Center, Cincinnati, Ohio
| | - Hoang T Phan
- Pham Ngoc Thach University of Medicine, Ho Chi Minh City, Vietnam; Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania
| | - Tam N M Ngo
- Pham Ngoc Thach University of Medicine, Ho Chi Minh City, Vietnam
| | | | - Ha T Ngo
- Children's Hospital 1, Ho Chi Minh City, Vietnam
| | - Ngoc B Tran
- Pham Ngoc Thach University of Medicine, Ho Chi Minh City, Vietnam
| | | | - Tarek Alsaied
- Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | | | - Philip T Levy
- Boston Children's Hospital and Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
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