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Qin X, Dan Y, Wang H, Sun L, Ji W, Bai J, Mamtili I, Zhang K, Zheng J. Effect of Ciprofol on Left Ventricular Myocardial Strain and Myocardial Work in Children Undergoing Cardiac Surgery: A Single-center Double-blind Randomized Noninferiority Study. J Cardiothorac Vasc Anesth 2024:S1053-0770(24)00370-7. [PMID: 38908938 DOI: 10.1053/j.jvca.2024.05.036] [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: 03/25/2024] [Revised: 05/12/2024] [Accepted: 05/29/2024] [Indexed: 06/24/2024]
Abstract
OBJECTIVE The current work was designed to compare the effects of ciprofol and propofol on left ventricular systolic function and myocardial work by noninvasive speckle-tracking echocardiography in children undergoing surgical repair of atrial septal or ventricular septal defects. DESIGN A single-center double-blind randomized noninferiority study was conducted. SETTING The research occurred at a tertiary care center affiliated with Shanghai Jiao Tong University, China. PARTICIPANTS One hundred and twelve children aged 1 month to 16 years undergoing atrial septal or ventricular septal defect surgery with cardiopulmonary bypass were included. INTERVENTIONS One hundred and twelve children were allocated randomly to receive ciprofol (n = 67) or propofol (n = 45) in a 1.5:1 ratio. Ciprofol or propofol were intravenously infused at loading doses of 0.4 mg/kg or 2.0 mg/kg, respectively, over 30 seconds, depending on the physical condition of each patient. When the bispectral index was maintained between 45 and 55 after induction, transthoracic echocardiography, including apical two-chamber, three-chamber, and four-chamber views, were collected bedside. MEASUREMENTS AND MAIN RESULTS Of the 112 patients enrolled, 104 completed the study. Global longitudinal strain in the ciprofol and propofol groups after anesthesia was -17.3% (95% confidence interval [CI] -18.0% to -16.6%) and -17.8% (95% CI -18.7 to -17.0%) in the full analysis set and -17.5% (95% CI -18.2% to -16.9%) and -17.8% (95% CI -18.7% to -17.0%) in the per-protocol set, respectively. The noninferiority margin was set at 2% and confirmed with a lower limit of two-sided 95% CI for the intergroup difference of 1.58% in the full analysis set and 1.34% in the per-protocol set. There were no significant differences between the groups in left ventricular systolic and diastolic function and myocardial work indices. Postoperative vasoactive-inotropic score, NT-proBNP, duration of mechanical ventilation, and the length of stay in the cardiac intensive care unit and hospital were also comparable between the two groups (all p > 0.05). CONCLUSIONS Ciprofol did not show different effects on myocardial function and postoperative outcomes from propofol. Further, on the sensitive cardiac systole marker global longitudinal strain, ciprofol demonstrated noninferiority to propofol. Ciprofol might be an alternative solution for cardiac anesthesia in children with congestive heart disease with mild lesion.
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Affiliation(s)
- Xiaoxue Qin
- Department of Anesthesiology, Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China; Department of Anesthesiology, National Children's Medical Center, Shanghai, China; Department of Anesthesiology, Shanghai Xuhui Central Hospital, Shanghai, China
| | - Yingzhi Dan
- Department of Anesthesiology, Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China; Department of Anesthesiology, National Children's Medical Center, Shanghai, China
| | | | - Liping Sun
- Department of Anesthesiology, Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China; Department of Anesthesiology, National Children's Medical Center, Shanghai, China
| | - Wei Ji
- Department of Anesthesiology, Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China; Department of Anesthesiology, National Children's Medical Center, Shanghai, China
| | - Jie Bai
- Department of Anesthesiology, Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China; Department of Anesthesiology, National Children's Medical Center, Shanghai, China; Department of Anesthesiology, Shanghai Children's Medical Center Hainan Branch, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Ilyar Mamtili
- Department of Anesthesiology, Shanghai Xuhui Central Hospital, Shanghai, China
| | - Kan Zhang
- Department of Anesthesiology, Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China; Department of Anesthesiology, National Children's Medical Center, Shanghai, China; Department of Anesthesiology, Shanghai Children's Medical Center Hainan Branch, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jijian Zheng
- Department of Anesthesiology, Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China; Department of Anesthesiology, National Children's Medical Center, Shanghai, China.
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Mohammadi H, Hosseini H, Bordbar M, Mehdizadegan N, Amoozgar H, Edraki MR, Naghshzan A, Naderi N, Abedi E, Keshavarz K. Permanent longitudinal strain damage of cardiotoxic drugs in childhood cancer: What is the safe level? Ann Pediatr Cardiol 2024; 17:36-44. [PMID: 38933046 PMCID: PMC11198932 DOI: 10.4103/apc.apc_146_23] [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: 10/01/2023] [Revised: 02/02/2024] [Accepted: 02/02/2024] [Indexed: 06/28/2024] Open
Abstract
Objective Anthracycline administration in children is associated with cardiac dysfunction. Speckle-tracking echocardiography (STE) can detect subclinical cardiac damage that may go undetected by conventional two-dimensional (2D) echocardiography. This study aims to investigate medium-term anthracycline cardiotoxicity using STE and determine a safer administrable level of anthracyclines (ACs). Methods This observational case-control study enrolled 37 healthy controls and 78 pediatric cancer survivors who received chemotherapy. The patients were divided into two groups: cardiotoxic received (CR) and cardiotoxic free (CF). Data on segmental longitudinal strain (LS), global LS (GLS), and 2D echocardiographic parameters were collected after a drug-free period of at least one year. Results A total of 115 children with a mean age of 108 ± 55 months, of whom 66% were males, were included in the study. Both the groups of cancer survivors exhibited significantly reduced GLS compared to healthy controls (CR vs. controls, P = 0.001; CF vs. controls, P = 0.013), but no significant difference in left ventricular ejection fraction (LVEF) was observed (P = 0.75). Overall, cancer survivors treated with ACs demonstrated a significant reduction in strain in 10 left ventricular segments, particularly in the basal segments (P < 0.05). Among CR patients, those with impaired GLS (n = 43, GLS worse than -21.9) had significantly higher mean age and cumulative anthracycline dose compared to CR patients with normal GLS (age, P = 0.024; anthracycline dosage, P = 0.036). Using an anthracycline cutoff of 223 mg/m2 resulted in a higher detection rate (49% vs. 25%) and fewer missed cases (51% vs. 74%) compared to the 360 mg/m2 anthracycline cutoff. Conclusion Childhood cancer survivors demonstrate significantly reduced GLS while preserving a normal LVEF, which does not differ significantly from reference values of healthy children. The reduction in strain appears to be associated with higher anthracycline doses and older age. Lowering the anthracycline threshold to 223 mg/m2 may improve the predictability of a decline in cardiac function using strain imaging at medium-term follow-up.
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Affiliation(s)
- Hamid Mohammadi
- Department of Pediatric, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Hossein Hosseini
- Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mohammadreza Bordbar
- Hematology Research Center, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Nima Mehdizadegan
- Cardiovascular Research Center, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Hamid Amoozgar
- Cardiovascular Research Center, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mohammad Reza Edraki
- Neonatal Research Center, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Amir Naghshzan
- Cardiovascular Research Center, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Nima Naderi
- Anesthesiology and Critical Care Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Elham Abedi
- Hematology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Kambiz Keshavarz
- Social Determinants of Health Research Center, School of Medicine, Yasuj University of Medical Sciences, Yasuj, Iran
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Acheampong B, Parra D, Havens C, Jantzen D, Godown J, Soslow J. Vendor independent myocardial strain values in children. Echocardiography 2023; 40:30-36. [PMID: 36477911 PMCID: PMC9893106 DOI: 10.1111/echo.15499] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Revised: 10/11/2022] [Accepted: 11/14/2022] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Two-dimensional (2D) strain imaging has become an important tool in assessing subclinical myocardial dysfunction in children. However, there are no published normal values for vendor-independent strain software. The aim of this study was to estimate 2D strain values in a cohort of healthy children using Tomtec cardiac performance analysis (CPA), a vendor-independent software. METHODS Transthoracic echocardiograms of healthy pediatric outpatients (0-18 years) were retrospectively analyzed from the Vanderbilt Pediatric Heart Institute using CPA. The cardiac assessment included global longitudinal strain (GLS), global longitudinal strain rate (GLSR), global circumferential strain (GCS), and global circumferential strain rate (GCSR). Mean strain values with standard deviation (SD) are reported. The Wilcoxon rank sum test, linear regression, and one-way analysis of variance were used to assess differences among the various groups. RESULTS Among 142 children analyzed, 79 (56%) were male, and the median age was 5.5 (range, 0-18) years. The mean (SD) strain values were GLS -19.3 ± 3.4, GLSR -1.1 ± .22; GCS -24.7 ± 4.3, GCSR -1.5 ± .28. Age accounted for <8% of the variation in GLS, GCS, and GCSR. However, for GLSR, there was a statistically significant difference between younger and older age groups with higher GLSR in the younger age group. Age accounted for ∼25% of the variation in GLSR (R2 = .25, p < 0.001). There were no significant differences in strain based on sex. CONCLUSION We report normal myocardial strain values in healthy children by age for strain using CPA. These values add to the growing body of literature on myocardial strain in children and provide necessary data for the interpretation of strain imaging.
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Affiliation(s)
- Benjamin Acheampong
- Division of Pediatric Cardiology, Department of Pediatrics, University of Nebraska Medical Center, Omaha, Nebraska
- Division of Pediatric Cardiology, Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - David Parra
- Division of Pediatric Cardiology, Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Corey Havens
- Division of Pediatric Cardiology, Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - David Jantzen
- Division of Pediatric Cardiology, Department of Pediatrics, University of Nebraska Medical Center, Omaha, Nebraska
| | - Justin Godown
- Division of Pediatric Cardiology, Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Jonathan Soslow
- Division of Pediatric Cardiology, Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee
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Voges I, Negwer I, Caliebe A, Boroni Grazioli S, Daubeney PEF, Uebing A, Pennell DJ, Krupickova S. Myocardial Deformation in the Pediatric Age Group: Normal Values for Strain and Strain Rate Using 2D Magnetic Resonance Feature Tracking. J Magn Reson Imaging 2022; 56:1382-1392. [PMID: 35072310 DOI: 10.1002/jmri.28073] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Revised: 01/05/2022] [Accepted: 01/08/2022] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Myocardial deformation can be assessed from routine cardiac magnetic resonance (MR) images using two-dimensional feature tracking (2D-FT). Although reference values are essential for implementation of strain imaging in clinical practice, data for the healthy pediatric age group are limited. PURPOSE To provide pediatric MR reference values for strain and strain rate for all four heart chambers. STUDY TYPE Retrospective. SUBJECTS One hundred and fifty-seven healthy children from two institutions (102 male, age 4.7-18 years). FIELD STRENGTH/SEQUENCE 1.5 T; balanced steady-state free precession sequence. ASSESSMENT Left ventricular (LV) global and regional longitudinal, circumferential, and radial strain and strain rate as well as right ventricular (RV) and atrial global and regional longitudinal strain and strain rate were measured in two-, three-, and four-chamber views and the short axis stack. The relationships between strain parameters and age, height, weight, and gender were investigated. Age- and height-specific centile curves and tables were created for LV strain and strain rate. For all other global strain parameters, the mean was calculated as a reference. STATISTICAL TESTS Lambda-mu-sigma (LMS)-method of Cole and Green, univariable, and multivariable linear regression models. A P value <0.05 was considered to be statistically significant. RESULTS Age, height and weight had a significant influence on LV global strain values. These parameters also showed an influence on RV strain but only in boys (girls P = 0.12) and none of the variables had a significant influence on atrial strain (P = 0.19-0.49). Gender differences were only found for RV strain values. DATA CONCLUSION Pediatric potential reference values for myocardial deformation parameters of both ventricles and atria are provided. The values may serve as a reference in future studies and clinical practice. LEVEL OF EVIDENCE 3 TECHNICAL EFFICACY: Stage 5.
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Affiliation(s)
- Inga Voges
- Department of Congenital Heart Disease and Pediatric Cardiology, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany.,German Centre for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Kiel, Germany
| | - Inken Negwer
- Department of Congenital Heart Disease and Pediatric Cardiology, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Amke Caliebe
- Department of Medical Informatics and Statistics, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany.,Medical Faculty, Kiel University, Kiel, Germany
| | - Simona Boroni Grazioli
- Department of Congenital Heart Disease and Pediatric Cardiology, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Piers E F Daubeney
- Department of Pediatric Cardiology, Royal Brompton Hospital, London, UK.,Cardiovascular Sciences, Imperial College, London, UK
| | - Anselm Uebing
- Department of Congenital Heart Disease and Pediatric Cardiology, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany.,German Centre for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Kiel, Germany
| | - Dudley J Pennell
- Cardiovascular Sciences, Imperial College, London, UK.,CMR Unit, Royal Brompton Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Sylvia Krupickova
- Department of Pediatric Cardiology, Royal Brompton Hospital, London, UK.,Cardiovascular Sciences, Imperial College, London, UK.,CMR Unit, Royal Brompton Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK
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Toma D, Toganel R, Fagarasan A, Cucerea M, Gabor-Miklosi D, Cerghit-Paler A, Iurian DR, Gozar H, Moldovan E, Iancu M, Gozar L. Interobserver Agreement and Reference Intervals for Biventricular Myocardial Deformation in Full-Term, Healthy Newborns: A 2D Speckle-Tracking Echocardiography-Based Strain Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19148620. [PMID: 35886472 PMCID: PMC9315515 DOI: 10.3390/ijerph19148620] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Revised: 07/08/2022] [Accepted: 07/13/2022] [Indexed: 02/04/2023]
Abstract
Data regarding reference intervals for strain parameters derived from 2D speckle-tracking echocardiography in full-term newborns are limited and still under development. Our objectives were to establish the level of reproducibility and reference intervals in assessing myocardial function using 2D speckle-tracking echocardiography for longitudinal and regional strain measurements. A total of 127 full-term newborns were examined to be included in the study, of which 103 were analyzed. We used two-dimensional acquisitions from apical four-chamber view of both ventricles and analyzed the autostrain function offline. We obtained interobserver agreement between the two observers ranging from good to excellent for all speckle-tracking parameters except for the strain of the medial portion of the left ventricle (LV) lateral wall and the strain measured on the basal portion of the inter-ventricular septum, which reflected a fair interobserver reproducibility (ICC = 0.52, 95% IC: 0.22–0.72 and ICC = 0.43, 95% IC: 0.12–0.67, respectively). The reference values obtained for the LV peak longitudinal strain were between −24.65 and −14.62, those for the right ventricle (RV) free wall were from −28.69 to −10.68, and those for the RV global four-chamber were from −22.30 to −11.37. In conclusion, two-dimensional peak longitudinal LV and RV strains are reproducible with good to excellent agreement and may represent a possible alternative for the cardiac assessment of healthy newborns in the clinical practice.
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Affiliation(s)
- Daniela Toma
- Department of Pediatric Cardiology, Emergency Institute for Cardiovascular Diseases and Transplantation, 540136 Targu Mures, Romania; (D.T.); (A.F.); (D.G.-M.); (A.C.-P.); (D.-R.I.); (L.G.)
- Department of Pediatrics, “George Emil Palade” University of Medicine, Pharmacy, Science and Technology of Targu Mures, 540139 Targu Mures, Romania;
| | - Rodica Toganel
- Department of Pediatrics, “George Emil Palade” University of Medicine, Pharmacy, Science and Technology of Targu Mures, 540139 Targu Mures, Romania;
| | - Amalia Fagarasan
- Department of Pediatric Cardiology, Emergency Institute for Cardiovascular Diseases and Transplantation, 540136 Targu Mures, Romania; (D.T.); (A.F.); (D.G.-M.); (A.C.-P.); (D.-R.I.); (L.G.)
- Department of Pediatrics, “George Emil Palade” University of Medicine, Pharmacy, Science and Technology of Targu Mures, 540139 Targu Mures, Romania;
| | - Manuela Cucerea
- Department of Neonatology, County Emergency Hospital Targu Mures, 540136 Targu Mures, Romania;
- Department M3, Pediatric IV, “George Emil Palade” University of Medicine, Pharmacy, Science and Technology of Targu Mures, 540139 Targu Mures, Romania
| | - Dorottya Gabor-Miklosi
- Department of Pediatric Cardiology, Emergency Institute for Cardiovascular Diseases and Transplantation, 540136 Targu Mures, Romania; (D.T.); (A.F.); (D.G.-M.); (A.C.-P.); (D.-R.I.); (L.G.)
| | - Andreea Cerghit-Paler
- Department of Pediatric Cardiology, Emergency Institute for Cardiovascular Diseases and Transplantation, 540136 Targu Mures, Romania; (D.T.); (A.F.); (D.G.-M.); (A.C.-P.); (D.-R.I.); (L.G.)
- Department of Pediatrics, “George Emil Palade” University of Medicine, Pharmacy, Science and Technology of Targu Mures, 540139 Targu Mures, Romania;
| | - Diana-Ramona Iurian
- Department of Pediatric Cardiology, Emergency Institute for Cardiovascular Diseases and Transplantation, 540136 Targu Mures, Romania; (D.T.); (A.F.); (D.G.-M.); (A.C.-P.); (D.-R.I.); (L.G.)
| | - Horea Gozar
- Department of Pediatric Surgery, “George Emil Palade” University of Medicine, Pharmacy, Science and Technology of Targu Mures, 540139 Targu Mures, Romania;
| | - Elena Moldovan
- Pediatric Intensive Care Unit, Emergency Institute for Cardiovascular Diseases and Transplantation, 540136 Targu Mures, Romania;
| | - Mihaela Iancu
- Department of Medical Informatics and Biostatistics, Faculty of Medicine, “Iuliu Hațieganu” University of Medicine and Pharmacy Cluj-Napoca, 400012 Cluj-Napoca, Romania
- Correspondence: ; Tel.: +40-0740-130888
| | - Liliana Gozar
- Department of Pediatric Cardiology, Emergency Institute for Cardiovascular Diseases and Transplantation, 540136 Targu Mures, Romania; (D.T.); (A.F.); (D.G.-M.); (A.C.-P.); (D.-R.I.); (L.G.)
- Department of Pediatrics, “George Emil Palade” University of Medicine, Pharmacy, Science and Technology of Targu Mures, 540139 Targu Mures, Romania;
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Nahili KA, Saleem I, Ahmad S, Ahmed ET, Rajaa NA. Left ventricular strain in neonates using 2-dimensional speckle tracking: Normal range and relation with bi-plan ejection fraction. Echocardiography 2022; 39:1074-1081. [PMID: 35785490 DOI: 10.1111/echo.15414] [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: 04/07/2022] [Revised: 05/24/2022] [Accepted: 06/13/2022] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVES Echocardiographic assessment of Left ventricular systolic function is traditionally being performed by estimation of fractional shortening (FS) and ejection fraction (EF). Speckle tracking echocardiography (STE) is a promising tool for assessment of myocardial function. The aim of this study is to evaluate the global longitudinal strain (GLS) using 2D-STE in healthy neonates to establish normal reference ranges. METHOD It is a retrospective study through an analysis of transthoracic echocardiogram of normal healthy neonates. We enrolled all neonates in our institution from January 1st, 2021 to February 28th, 2021. 2-D STE was used to assess left ventricular GLS from the apical views. RESULTS 185 neonates were enrolled. Mean value for left ventricle GLS (%) was -19.9 ± 1.2, GLS-derived EF (%) was 60.0 ± 2.7; while the left ventricle EF by biplane Simpson's method (%) was 61.0 ± 3. There is a good positive correlation between the Left Ventricle EF by biplane Simpson's method and EF by 2-D STE, which was statistically significant (r = .294, n = 102, p = .003). Apical 4-chamber longitudinal strain and strain-derived EF is significantly correlated with GLS and bi-plan EF respectively. CONCLUSION 2-STE is feasible technique for analyzing newborn myocardial systolic function. The normal range of GLS in neonates is not much different than reported for the pediatric. There is a good positive correlation between the Left Ventricle EF by 2-D STE and EF by biplane method.
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Affiliation(s)
- Khaled Al Nahili
- Pediatric Cardiology Departement, Prince Sultan Cardiac Center, Riyadh, Saudi Arabia.,Pediatric Cardiology Departement, Khamis Mushait Maternity and Children Hospital, Aseer, Saudi Arabia
| | - Irfan Saleem
- Pediatric Cardiology Departement, Prince Sultan Cardiac Center, Riyadh, Saudi Arabia
| | - Salim Ahmad
- Pediatric Cardiology Departement, Prince Sultan Cardiac Center, Riyadh, Saudi Arabia
| | - El Tayeb Ahmed
- Pediatric Cardiology Departement, Prince Sultan Cardiac Center, Riyadh, Saudi Arabia
| | - Najlaa Al Rajaa
- Pediatric Cardiology Departement, Prince Sultan Cardiac Center, Riyadh, Saudi Arabia
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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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To go left or right? Driving towards the best direction in paediatric pacing. Cardiol Young 2022; 33:760-765. [PMID: 35673795 DOI: 10.1017/s1047951122001688] [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] [Indexed: 11/05/2022]
Abstract
BACKGROUND Permanent pacing in children with isolated congenital complete atrioventricular block may cause left ventricular dysfunction. To prevent it, alternative pacing sites have been proposed: left ventricular epicardial or selective right ventricular endocardial pacing. AIMS To compare the functional outcome (left ventricular systolic function and synchrony) in paediatric patients with congenital complete atrioventricular block and left ventricular apical epicardial or right ventricular transvenous mid-septal pacing. METHODS Retrospective study. Epicardial leads were implanted by standard surgical technique, transvenous leads by 3D electroanatomic mapping systems. 3D mapping acquired 3D right ventricular local pacing map and defined the narrowest paced QRS site. 3D mapping guided screw-in bipolar leads on that ventricular site. Electrocardiogram (ECG) (QRS duration) and echocardiographic data (synchrony: interventricular mechanical delay, septal to posterior wall motion delay, systolic dyssynchrony index; contractility: global longitudinal strain, ejection fraction) were recorded. Data are reported as median [interquartile ranges]. p < 0.05 was significant. RESULTS There were 19 transvenous systems (age 8.8 [6-14] years; right ventricular mid-septum) and 17 epicardial systems (0.04 [0.001-0.6] years; left ventricular apex). Post-implantation QRS significantly widened either in endocardial or in epicardial patients. Most patients reached 4-year follow-up. One-year and 4-year ejection fraction and global longitudinal strain were mostly within normal limits and did not show significant differences between the two groups and between the same endocardial/epicardial group. Synchrony parameters were within normal limits in the two groups. CONCLUSIONS Left ventricular apical epicardial pacing and 3D mapping-guided right ventricular mid-septal pacing preserved left ventricular contractility and synchrony in children and adolescents with congenital complete atrioventricular block at short-/mid-term follow-up, without relevant significant differences between the two groups.
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Malakan Rad E, Momtazmanesh S. COVID-19-induced silent myocarditis and newly developed hypertension in a 3-year-old boy. Egypt Heart J 2022; 74:44. [PMID: 35639214 PMCID: PMC9152834 DOI: 10.1186/s43044-022-00282-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: 01/28/2022] [Accepted: 04/17/2022] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND COVID-19 myocarditis occurs in 7-28% of patients admitted in the hospital with or without multisystem inflammatory syndrome. It may present as fulminant myocarditis. Dilated cardiomyopathy as a sequela of COVID-19 myocarditis has been reported in the pediatric population. However, to date, no case of silent COVID-19 myocarditis progressing to dilated cardiomyopathy has been reported in children. Furthermore, although newly developed hypertension as a sequela of COVID-19 infection has been reported in adults, there is no report of newly developed COVID-induced hypertension in children. We report a 3-year-old boy with silent COVID-19 myocarditis progressing to dilated cardiomyopathy and newly developed systemic hypertension. CASE PRESENTATION A 3-year-old boy was referred to the emergency department because of respiratory distress. The parents gave a history of SARS-CoV-2 infection in the child 5 months ago that was manifested as fever and cough, for which he was treated as an outpatient. Echocardiographic examination revealed a severe decrease in left ventricular systolic function in favor of dilated cardiomyopathy. Cardiac magnetic resonance imaging established the diagnosis of myocarditis. The patient left ventricular systolic function did not improve after 2 weeks of intravenous inotropic support. Therefore, the child was transferred to another tertiary center with extracorporeal membrane oxygenation and pediatric cardiac transplantation facilities. CONCLUSIONS COVID-19 can induce silent myocarditis with progression to dilated cardiomyopathy and newly developed systemic hypertension. Thus, a thorough examination of the heart and measurement of blood pressure are mandatory in every child with COVID-19 infection. Cardiac MR is an indispensable tool in the diagnosis, follow-up, and prognostication of COVID-19 myocarditis. Moreover, four-chamber speckle tracking strain imaging showed apical rocking in all the four heart chambers in this child with opposite direction in the failed left ventricle compared with other cardiac chambers. Lastly, the presence of septal flash on M-mode echocardiography, apical rocking and prestretch-rebound stretch patterns on longitudinal strain imaging of the failed left ventricle in this child may be of predictive value for response to cardiac resynchronization therapy.
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Affiliation(s)
- Elaheh Malakan Rad
- Department of Pediatric Cardiology, Children’s Medical Center (Pediatric Center of Excellence), Tehran University of Medical Sciences, Tehran, Iran
| | - Sara Momtazmanesh
- School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
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10
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Prognostic utility of echocardiographically derived left ventricular strain in assessing neonatal enteroviral myocarditis outcome. Cardiol Young 2022; 33:704-709. [PMID: 35582979 DOI: 10.1017/s1047951122001512] [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] [Indexed: 11/05/2022]
Abstract
BACKGROUND Neonatal enteroviral myocarditis is a rare but potentially fatal illness. We sought to identify echocardiographic markers at diagnosis that could help risk-stratify infants for poor outcome and to characterise late sequelae. METHODS We reviewed data for infants <30 days of age diagnosed with enteroviral myocarditis between 1999 and 2019 at Children's Wisconsin. Echo measures were collected retrospectively from the initial neonatal study including left ventricular ejection fraction, shortening fraction, diastolic and systolic dimensions, and peak global circumferential and longitudinal strain. RESULTS Fourteen neonates were diagnosed at an average age of 11 days. All had abnormal left ventricular ejection fraction (mean 38%; range 22-53%) at diagnosis. Three infants died, and one required transplantation during initial hospital. The 10 transplant-free survivors had significantly better global circumferential strain and global longitudinal strain at the initial echo compared to the 4 who died or needed transplant (global circumferential strain -13.2% versus -6.8%, p = 0.005; global longitudinal strain -8.8% versus -4.7%, p = 0.016). All other measures of left ventricular systolic function/dimensions were similar between the two groups. Follow-up data were available for 8/10 survivors; 5/8 had a persistently abnormal echo at an average interval of 8.3 years. 4/8 developed a left ventricular aneurysm that was consistently localised to the posterior basal wall. CONCLUSIONS Neonatal enteroviral myocarditis carries a high risk of early mortality and late morbidity. Echo-derived left ventricular strain measures have utility in risk stratifying infants with enteroviral myocarditis. Most survivors continue to have late dysfunction necessitating cardiology surveillance and medical therapy.
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11
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Moosmann J, Gentles T, Occleshaw C, Mitchelson B. COVID Vaccine-Associated Myocarditis in Adolescent Siblings: Does It Run in the Family? Vaccines (Basel) 2022; 10:vaccines10040611. [PMID: 35455360 PMCID: PMC9028976 DOI: 10.3390/vaccines10040611] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Revised: 04/12/2022] [Accepted: 04/12/2022] [Indexed: 12/18/2022] Open
Abstract
The development of myocarditis after receiving messenger RNA vaccination against COVID-19 is well documented, particularly in adolescent and young adult males. We report a case of vaccine-associated myocarditis in adolescent brothers following their second dose of the BNT162b2 mRNA vaccine (Pfizer-BioNTech, Mainz, Germany). This report illustrates the need to better understand the mechanisms leading to myocarditis after mRNA vaccination.
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Affiliation(s)
- Julia Moosmann
- Green Lane Paediatric and Congenital Cardiac Service, Starship Children’s Hospital, Auckland 1023, New Zealand; (J.M.); (T.G.)
| | - Thomas Gentles
- Green Lane Paediatric and Congenital Cardiac Service, Starship Children’s Hospital, Auckland 1023, New Zealand; (J.M.); (T.G.)
- Paediatrics, Child and Youth Health, University of Auckland, Auckland 1023, New Zealand
| | | | - Bryan Mitchelson
- Green Lane Paediatric and Congenital Cardiac Service, Starship Children’s Hospital, Auckland 1023, New Zealand; (J.M.); (T.G.)
- Correspondence: ; Tel.: +64-(0)21-624-346
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12
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Bragantini G, Bartolacelli Y, Balducci A, Ciuca C, Gesuete V, Palleri D, Assenza GE, Mariucci E, Angeli E, Gargiulo GD, Donti A. Left ventricle function after arterial switch procedure for D-transposition of the great arteries: Long term evaluation by speckle-tracking analysis. INTERNATIONAL JOURNAL OF CARDIOLOGY CONGENITAL HEART DISEASE 2022. [DOI: 10.1016/j.ijcchd.2022.100374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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13
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Kotby AA, Ebrahim SOS, Al-Fahham MM. Reference centiles for left ventricular longitudinal global and regional systolic strain by automated functional imaging in healthy Egyptian children. Cardiol Young 2022; 33:1-9. [PMID: 35241202 DOI: 10.1017/s1047951122000129] [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] [Indexed: 11/07/2022]
Abstract
BACKGROUND Two-dimensional speckle tracking echocardiography-derived left ventricular longitudinal systolic strain is an important myocardial deformation parameter for assessing the systolic function of the left ventricle. Strain values differ according to the vendor machine and software. This study aimed to provide normal reference values for global and regional left ventricular longitudinal systolic strain in Egyptian children using automated functional imaging software integrated into the General Electric healthcare machine and to study the correlation between the global longitudinal left ventricular systolic strain and age, body size, vital data, and some echocardiographic parameters. METHODS Healthy children (250) aged from 1 to 16 years were included. Conventional echocardiography was done to measure the left ventricular dimensions and function. Automated functional imaging was performed to measure the global and regional peak longitudinal systolic strain. RESULTS The global longitudinal strain was -21.224 ± 1.862%. The regional strain was -20.68 ± 2.11%, -21.06 ± 1.84%, and -21.86 ± 2.71% at the basal, mid, and apical segments, respectively. The mean values of the systolic longitudinal strain become significantly more negative from base to apex. Age differences were found as regard to global and regional longitudinal strain parameters but no gender differences. The global peak longitudinal systolic strain correlated positively with age. No correlations were found with either the anthropometric parameters or the vital data. CONCLUSIONS Age-specific normal values for two-dimensional speckle tracking-derived left ventricular longitudinal regional and global systolic strain are established using automated functional imaging.
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Affiliation(s)
- Alyaa A Kotby
- Pediatric Department, Pediatric Cardiology Unit, Faculty of Medicine, Ain Shams University, Abbasia 11566, Cairo, Egypt
| | - Sahar O S Ebrahim
- Pediatric Department, Pediatric Cardiology Unit, Faculty of Medicine, Ain Shams University, Abbasia 11566, Cairo, Egypt
| | - Marwa M Al-Fahham
- Pediatric Department, Pediatric Cardiology Unit, Faculty of Medicine, Ain Shams University, Abbasia 11566, Cairo, Egypt
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14
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Sitte V, Burkhardt B, Weber R, Kretschmar O, Hersberger M, Bergsträsser E, Christmann M. Advanced Imaging and New Cardiac Biomarkers in Long-term Follow-up After Childhood Cancer. J Pediatr Hematol Oncol 2022; 44:e374-e380. [PMID: 33828032 DOI: 10.1097/mph.0000000000002156] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Accepted: 03/04/2021] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Pathologic ejection fraction (EF), shortening fraction (FS), and standard heart failure biomarkers (high sensitive troponin T and N-terminal brain natriuretic peptide) during follow-up after childhood cancer have been associated with irreversible cardiac damage. We aimed to evaluate strain imaging values by echocardiography and new biomarkers for heart failure with preserved ejection fraction (HFpEF) as potential more sensitive parameters for cardiac deterioration in childhood cancer survivors (CCS). MATERIALS AND METHODS Prospective study with 50 CCS (median 16.2 y) at a median follow-up of 13 years. In addition to standard echo and laboratory parameters for heart failure, strain measurements and new biomarkers, including myocardial inflammation (interleukin 6), extracellular matrix (ECM) remodeling (C-telopeptide for type I collagen, intact N-terminal propeptide of type III procollagen), and other heart failure biomarkers (galectin 3, solutable ST2, growth differentiation factor 15), were obtained and compared with 50 healthy controls. RESULTS No significant differences in EF, FS, high sensitive troponin T, N-terminal brain natriuretic peptide, interleukin 6, solutable ST2, and galectin 3 were found between study and control groups. In contrast, strain imaging showed significant differences between both groups (global longitudinal strainGLS -16.1% vs. -20.4%, P<0.0001; global circumferential strain -14.3 vs. -21.4%, P<0.0001), detecting 66% (global longitudinal strain) and 76% (global circumferential strain) of patients with pathologic values in contrast to 6% (EF) and 16% (FS) for standard parameters. Markers for disturbances of ECM remodeling (C-telopeptide for type I collagen, intact N-terminal propeptide of type III procollagen, each P<0.0001) and growth differentiation factor 15 (P<0.0001) were significantly different between the groups. CONCLUSION Strain imaging and new cardiac biomarkers used in HFpEF focusing on ECM remodeling appear to be more sensitive in detecting early remodeling processes in CCS than standard echo and laboratory parameters.
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Affiliation(s)
| | | | - Roland Weber
- Department of Paediatric Cardiology, Heart Center
| | | | | | - Eva Bergsträsser
- Department of Paediatric Oncology, University Children's Hospital, Zurich, Switzerland
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15
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Left Ventricular Systolic Impairment after Pediatric Cardiac Surgery Assessed by STE Analysis. Healthcare (Basel) 2021; 9:healthcare9101338. [PMID: 34683018 PMCID: PMC8544436 DOI: 10.3390/healthcare9101338] [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: 07/18/2021] [Revised: 09/27/2021] [Accepted: 10/05/2021] [Indexed: 11/17/2022] Open
Abstract
Background: Speckle-tracking echocardiography (STE) has gained increasing value in the evaluation of congenital heart diseases (CHD); however, its use in pediatric cardiac surgery is limited. Aim: To evaluate left ventricular (LV) systolic impairment after biventricular pediatric cardiac surgery by STE strain (ε) analysis. Methods: We prospectively enrolled 117 children undergoing cardiac surgery for CHD. Echocardiography was performed at four different times: pre-operatively, 12–36 h (Time 1), 3–5 days (Time 2), and 6–8 days (Time 3). Images were obtained in the 4-2-and 3 apical chamber’s views to derive LV global and regional (basal/mid/apical) ε values. Results: At different postoperative times, we performed 320 examinations in 117 children (mean age: 2.4 ± 3.9, range: 0–16 years); 117 age-matched healthy children served as controls. All global, basal, and mid LVε values decreased after surgery; the lowest values being at Time 1 (p < 0.0001), which increased thereafter. At discharge, all global, basal, and mid LVε values remained lower than in pre-operative and healthy children (p < 0.05). Instead, apical segments (lowest at baseline) increased after surgery (p < 0.0001) but remained lower compared to controls. LV ejection fraction (LVEF) decreased at Time 1 (p = 0.0004) but promptly recovered to Time 2 and normalized at Time 3. Conclusions: STE ε analysis revealed a significant LV systolic impairment after surgery with amelioration thereafter but incomplete normalization at discharge. Base-apex differences emerged with apical segments that, contrary to all the other regions, showed relative hypercontractility after surgery. The slower recovery of LVε values compared to LVEF suggests that STE ε analysis may be more accurate for the follow-up of mild LV post-surgical impairment.
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16
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Šileikienė R, Adamonytė K, Ziutelienė A, Ramanauskienė E, Vaškelytė JJ. Atrial and Ventricular Structural and Functional Alterations in Obese Children. ACTA ACUST UNITED AC 2021; 57:medicina57060562. [PMID: 34199362 PMCID: PMC8228452 DOI: 10.3390/medicina57060562] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Revised: 05/28/2021] [Accepted: 05/31/2021] [Indexed: 12/02/2022]
Abstract
Background and objectives: Childhood obesity has reached epidemic levels in the world. Obesity in children is defined as a body mass index (BMI) equal to or above the 95th percentile for age and sex. The aim of this study was to determine early changes in cardiac structure and function in obese children by comparing them with their nonobese peers, using echocardiography methods. Materials and methods: The study enrolled 35 obese and 37 age-matched nonobese children. Standardized 2-dimensional (2D), pulsed wave tissue Doppler, and 2D speckle tracking echocardiography were performed. The z-score BMI and lipid metabolism were assessed in all children. Results: Obese children (aged 13.51 ± 2.15 years; 20 boys; BMI z-score of 0.88 ± 0.63) were characterized by enlarged ventricular and atrial volumes, a thicker left ventricular posterior wall, and increased left ventricular mass. Decreased LV and RV systolic and diastolic function was found in obese children. Atrial peak negative (contraction) strain (−2.05% ± 2.17% vs. −4.87% ± 2.97%, p < 0.001), LV and RV global longitudinal strain (−13.3% ± 2.88% vs. −16.87% ± 3.39%; −12.51% ± 10.09% vs. −21.51% ± 7.42%, p < 0.001), and LV global circumferential strain (−17.0 ± 2.7% vs. −19.5 ± 2.9%, p < 0.001) were reduced in obese children. LV torsion (17.94° ± 2.07° vs. 12.45° ± 3.94°, p < 0.001) and normalized torsion (2.49 ± 0.4°/cm vs. 1.86 ± 0.61°/cm, p = 0.001) were greater in obese than nonobese children. A significant inverse correlation was found between LV and RV global longitudinal strain and BMI (r = −0.526, p < 0.01; r = −0.434, p < 0.01) and total cholesterol (r = −0.417, p < 0.01). Multivariate analysis revealed that the BMI z-score was independently related to LV and RV global longitudinal strain as well as LV circumferential and radial strain. Conclusion: 2D speckle tracking echocardiography is beneficial in the early detection of regional LV systolic and diastolic dysfunctions, with preserved ejection fraction as well as additional RV and atrial involvement, in obese children. Obesity may negatively influence atrial and ventricular function, as measured by 2D speckle tracking echocardiography. Obese children, though they are apparently healthy, may have subclinical myocardial dysfunction.
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Affiliation(s)
- Rima Šileikienė
- Department of Pediatric Cardiology, Medical Academy, Lithuanian University of Health Sciences, Eivenių 2, LT 50009 Kaunas, Lithuania;
- Correspondence: ; Tel.: +370-686-85370 or +370-37-326272; Fax: +370-37-327160
| | - Karolina Adamonytė
- Department of Children Diseases, Medical Academy, Lithuanian University of Health Sciences, LT 47130 Kaunas, Lithuania; (K.A.); (E.R.)
| | - Aristida Ziutelienė
- Department of Pediatric Cardiology, Medical Academy, Lithuanian University of Health Sciences, Eivenių 2, LT 50009 Kaunas, Lithuania;
| | - Eglė Ramanauskienė
- Department of Children Diseases, Medical Academy, Lithuanian University of Health Sciences, LT 47130 Kaunas, Lithuania; (K.A.); (E.R.)
| | - Jolanta Justina Vaškelytė
- Department of Cardiology, Medical Academy, Lithuanian University of Health Sciences, LT 44307 Kaunas, Lithuania;
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Whipple NS, Joshi VM, Naik RJ, Mentnech T, McFarland MM, Nolan VG, Hankins JS. Sickle cell disease and ventricular myocardial strain: A systematic review. Pediatr Blood Cancer 2021; 68:e28973. [PMID: 33742492 PMCID: PMC9116158 DOI: 10.1002/pbc.28973] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Revised: 01/18/2021] [Accepted: 02/08/2021] [Indexed: 12/21/2022]
Abstract
Cardiac disease is the primary cause of death in sickle cell disease (SCD). Cardiac abnormalities begin in childhood and progress throughout life. Right and left ventricular (RV, LV) myocardial strain are early markers of systolic dysfunction but are not well investigated among individuals with SCD. The objectives of this review were to (1) identify all published studies that have evaluated ventricular myocardial strain, (2) summarize their values, and (3) compare findings with those obtained from controls. From search results of four electronic databases-Medline, Embase, Scopus, and Web of Science-42 potential articles were identified, of which 18 articles and 17 studies met eligibility criteria for inclusion. The evaluated studies demonstrate that RV and LV myocardial strain are generally abnormal in individuals with SCD compared with controls, despite having normal ejection/shortening fraction. Myocardial strain has been inconsistently evaluated in this population and should be considered any time an echocardiogram is performed.
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Affiliation(s)
- Nicholas S Whipple
- Division of Pediatric Hematology/Oncology, Department of Pediatrics, Primary Children's Hospital, University of Utah, Salt Lake City, Utah, USA
| | - Vijaya M Joshi
- Division of Pediatric Cardiology, Department of Pediatrics, University of Tennessee College of Medicine, Memphis, Tennessee, USA
- Cardiopulmonary Services, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Ronak J Naik
- Division of Pediatric Cardiology, Department of Pediatrics, University of Tennessee College of Medicine, Memphis, Tennessee, USA
- Cardiopulmonary Services, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Tisha Mentnech
- North Carolina State University Libraries, Raleigh, North Carolina, USA
| | - Mary M McFarland
- Eccles Health Sciences Library, University of Utah, Salt Lake City, Utah, USA
| | - Vikki G Nolan
- Division of Epidemiology, Biostatistics and Environmental Health, School of Public Health, University of Memphis, Memphis, Tennessee, USA
| | - Jane S Hankins
- Department of Hematology, St Jude Children's Research Hospital, Memphis, Tennessee, USA
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18
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Fu M, Hu X, Sun S, Yi S, Zhang Y, Feng Y, Zhou Y, Geng Q, Dong H. Relationship Between Masked Hypertension Measured by Ambulatory Blood Pressure Monitoring and Left Ventricular Global Longitudinal Strain: A Retrospective Study. Int J Gen Med 2021; 14:2053-2061. [PMID: 34079345 PMCID: PMC8164706 DOI: 10.2147/ijgm.s310414] [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: 03/18/2021] [Accepted: 05/05/2021] [Indexed: 11/23/2022] Open
Abstract
Purpose Masked hypertension (MHT), as an independent clinical entity, the cardiac dysfunction caused by it can be early detected through left ventricular global longitudinal strain (GLS), yet the quantitative relation between MHT and GLS is still unclear. Therefore, we tried to conduct a community-based retrospective study to define this relationship. Patients and Methods A total of 308 enrolled participants from Dongguan, China, were divided into non-hypertension (NHT) and MHT groups. Baseline characteristics were recorded, and echocardiography and 24-hour ambulatory blood pressure monitoring were performed. Linear regression analysis and receiver-operating characteristic (ROC) curve analysis were used to assess the associations between MHT and GLS in univariate and multivariate models, and the dose–response curve was plotted to demonstrate their relationship. Results The mean age of the NHT and MHT groups was 57 and 60 years, respectively. Signs of left ventricular diastolic function, E/A was reduced and E/e’ was increased in the MHT group while those of the NHT group were nearly normal. The MHT group also showed a significantly lower (“worse”) GLS than NHT (−15.2% vs −19.9%, P < 0.001) while left ventricular ejection fraction (LVEF) did not differ between the groups. Worse GLS was independently and significantly associated with MHT both in univariate (odds ratio [OR]: 1.97, P < 0.001) and stepwise multivariate regression analysis (OR: 1.99, P < 0.001). Comparison of ROC curve results showed that area under curve of GLS was larger than that of E/e’ both in unadjusted (0.8673 vs 0.6831) and adjusted model (0.9178 vs 0.8284). Further analysis showed adjusted nonlinear correlation between MHT and GLS. Conclusion Based on the relationship between MHT and GLS, in clinical practice, GLS measurement could facilitate diagnosis for suspected MHT patients and could define the extent of left ventricular dysfunction for diagnosed MHT patients.
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Affiliation(s)
- Ming Fu
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, People's Republic of China
| | - Xiangming Hu
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, Guangdong, China.; Department of Cardiology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, People's Republic of China
| | - Shuo Sun
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, People's Republic of China
| | - Shixin Yi
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, People's Republic of China
| | - Ying Zhang
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, People's Republic of China
| | - Yingqing Feng
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, People's Republic of China
| | - Yingling Zhou
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, People's Republic of China
| | - Qingshan Geng
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, People's Republic of China
| | - Haojian Dong
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, People's Republic of China
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19
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Pieles GE, Alkon J, Manlhiot C, Fan CPS, Kinnear C, Benson LN, Mital S, Friedberg MK. Association between genetic variants in the HIF1A-VEGF pathway and left ventricular regional myocardial deformation in patients with hypertrophic cardiomyopathy. Pediatr Res 2021; 89:628-635. [PMID: 32375165 DOI: 10.1038/s41390-020-0929-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2019] [Revised: 02/02/2020] [Accepted: 02/17/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND Information on genetic etiology of pediatric hypertrophic cardiomyopathy (HCM) rarely aids in risk stratification and prediction of disease onset. Little data exist on the association between genetic modifiers and phenotypic expression of myocardial performance, hampering an individual precision medicine approach. METHODS Single-nucleotide polymorphism genotyping for six previously established disease risk alleles in the hypoxia-inducible factor-1α-vascular endothelial growth factor pathway was performed in a pediatric cohort with HCM. Findings were correlated with echocardiographic parameters of systolic and diastolic myocardial deformation measured by two-dimensional (2-D) speckle-tracking strain. RESULTS Twenty-five children (6.1 ± 4.5 years; 69% male) with phenotypic and genotypic (60%) HCM were included. Out of six risk alleles tested, one, VEGF1 963GG, showed an association with reduced regional systolic and diastolic left ventricular (LV) myocardial deformation. Moreover, LV average and segmental systolic and diastolic strain and strain rate were significantly reduced, as assessed by the standardized difference, in patients harboring the risk allele. CONCLUSIONS This is the first study to identify an association between a risk allele in the VEGF pathway and regional LV myocardial function, with the VEGF1 963GG allele associated with reduced LV systolic and diastolic myocardial performance. While studies are needed to link this information to adverse clinical outcomes, this knowledge may help in risk stratification and patient management in HCM. IMPACT Risk allele in the VEGF gene impacts on LV myocardial deformation phenotype in children with HCM. LV 2-D strain is significantly reduced in patients with risk allele compared to non-risk allele patients within HCM patient groups. Describes that deficiencies in LV myocardial performance in children with HCM are associated with a previously identified risk allele in the angiogenic transcription factor VEGF. First study to identify an association between a risk allele in the VEGF pathway and regional LV myocardial deformation measured by 2-D strain in children with HCM.
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Affiliation(s)
- Guido E Pieles
- Department of Pediatrics, Labatt Family Heart Centre, Hospital for Sick Children, University of Toronto, Toronto, ON, Canada. .,NIHR Cardiovascular Biomedical Research Centre, Bristol Heart Institute, Bristol, UK.
| | - Jaime Alkon
- Department of Pediatrics, Labatt Family Heart Centre, Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Cedric Manlhiot
- Department of Pediatrics, Labatt Family Heart Centre, Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Chun-Po Steve Fan
- Department of Pediatrics, Labatt Family Heart Centre, Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Caroline Kinnear
- Department of Pediatrics, Labatt Family Heart Centre, Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Leland N Benson
- Department of Pediatrics, Labatt Family Heart Centre, Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Seema Mital
- Department of Pediatrics, Labatt Family Heart Centre, Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Mark K Friedberg
- Department of Pediatrics, Labatt Family Heart Centre, Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
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20
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You J, Yu JJ, Kim MJ, Cha S, Baek JS, Choi ES, Kwon BS, Park CS, Yun TJ, Kim YH. Predictive Parameters of Decreased Left Ventricular Global Longitudinal Strain at 1 Month After Pediatric Heart Transplantation. Pediatr Cardiol 2021; 42:784-792. [PMID: 33464371 PMCID: PMC7814263 DOI: 10.1007/s00246-021-02542-z] [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: 09/01/2020] [Accepted: 01/05/2021] [Indexed: 11/27/2022]
Abstract
Previous reports indicate that the decreased left ventricular global longitudinal strain (LVGLS) seen in the early postoperative period of pediatric heart transplant patients generally recovers over the course of 1-2 years. In this study, we investigate the predictive capacity of preoperative parameters on the LVGLS decline seen at 1 month post transplant. Forty-six transplant subjects with 2D echocardiographic images sufficient for speckle tracking echocardiography were enrolled. We excluded patients diagnosed with cardiac allograft vasculopathy or with an episode of rejection 1 month before or after their echocardiographic examinations. The mean LVGLS was significantly reduced at 1 month when compared to 1 year following transplant (- 15.5% vs. - 19.4%, respectively, p < 0.001). The predictors of LVGLS that decline at 1 month were the LV mass z-score [odds ratio (OR) 1.452; 95% confidence interval (CI) 1.007-2.095, p = 0.046], recipient age (OR 1.124; 95% CI 1.015-1.245, p = 0.025), and donor age (OR 1.081; 95% CI 1.028-1.136, p = 0.002) in the univariate logistic regression analyses. Although multivariate analysis yielded no significant predictors, higher LV mass z-scores showed a trend associated with the decline of LVGLS (p = 0.087). The donor/recipient weight ratio was associated with the LV mass z-score (R2 = 0.412, p < 0.001).
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Affiliation(s)
- Jihye You
- Department of Pediatrics, Sejong General Hospital, Bucheon, Republic of Korea
| | - Jeong Jin Yu
- Department of Pediatrics, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-Gil, Songpa-Gu, Seoul, 138-736, Republic of Korea.
| | - Mi Jin Kim
- Department of Pediatrics, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-Gil, Songpa-Gu, Seoul, 138-736 Republic of Korea
| | - Seulgi Cha
- Department of Pediatrics, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-Gil, Songpa-Gu, Seoul, 138-736 Republic of Korea
| | - Jae Suk Baek
- Department of Pediatrics, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-Gil, Songpa-Gu, Seoul, 138-736 Republic of Korea
| | - Eun Seok Choi
- Department of Pediatric Cardiac Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Bo Sang Kwon
- Department of Pediatric Cardiac Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Chun Soo Park
- Department of Pediatric Cardiac Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Tae-Jin Yun
- Department of Pediatric Cardiac Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Young-Hwue Kim
- Department of Pediatrics, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-Gil, Songpa-Gu, Seoul, 138-736 Republic of Korea
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21
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Rubens-Figueroa JD, Cárdenas-Cardós R. Importance of cardio-oncology. How to detect suclinical heart failure. ARCHIVOS DE CARDIOLOGIA DE MEXICO 2021; 91:229-234. [PMID: 33887756 PMCID: PMC8295867 DOI: 10.24875/acm.19000394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Accepted: 02/07/2021] [Indexed: 11/17/2022] Open
Abstract
Today one of the main causes of mortality is cancer. Survival in cancer patients has increased from 1970 (25%) to the present (80%). Following the introduction of anthracyclines as a cancer treatment since 1960-70, more than 60% of patients are treated with these agents, although chemotherapeutic exposure leads to cardiovascular diseases as the main cause of mortality in surviving patients. of cancer in the 21st Century. There are multiple factors that increase the sensitivity of anthracyclic-induced cardiotoxicity. In 1970 the gold standard for the detection of ventricular dysfunction was endomyocardial biopsy, subsequently the detection and management of cardiotoxicity was guided by symptoms, in 1981 the detection of cardiotoxicity was reported with the determination of the ejection fraction of the left ventricle (LVEF), by 2D echocardiography. Currently, the 3D echocardiogram for LVEF and systolic and diastolic volumes have presented a high correlation of the values obtained by magnetic resonance imaging for the evaluation of cardiac function. Today strain, strain-rate and speckle tracking echocardiography are used to determine regional and global myocardial function. For a comprehensive assessment, these results can be complemented with cardiac biomarkers (troponins) and electrocardiographic changes. In this way, subclinical heart failure can be detected and timely treatment can be given.
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22
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Wang TKM, Desai MY, Collier P, Grimm RA, Griffin BP, Popović ZB. Determining the thresholds for abnormal left ventricular strains in healthy subjects by echocardiography: a meta-analysis. Cardiovasc Diagn Ther 2021; 10:1858-1873. [PMID: 33381430 DOI: 10.21037/cdt-20-711] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Background Left ventricular global longitudinal strain (LVGLS), circumferential strain (LVGCS) and radial strain (LVGRS) are echocardiographic parameters with wide clinical applicability. However, the thresholds for abnormal left ventricular (LV) strains, particularly the lower limits of normal (LLN), are not well established. This meta-analysis determined the mean and LLN of two- (2D) and three-dimensional (3D) LV strain in healthy subjects and factors that influence strain measurements. Methods We searched PubMed, Embase and Cochrane databases until 31 December 2019 for studies reporting left ventricular (LV) global strain in at least 50 healthy subjects. We pooled means and LLNs of 2D and 3D LV strain using random-effects models, and performed subgroup and meta-regression analysis for LVGLS. Results Forty-four studies were eligible totaling 8,910 subjects. The pooled means and LLNs (95% confidence intervals) were -20.1% (-20.7%, -19.6%) and -15.4% (-16.0%, -14.7%) respectively for 2D-LVGLS; -21.9% (-23.4%, -20.3%) and -15.3% (-16.9%, -13.8%) respectively for 2D-LVGCS; and 48.4% (43.8%, 53.0%) and 25.5% (17.8%, 33.1%) respectively for 2D-LVGRS. All pooled analyses demonstrated significant heterogeneity, and means and LLNs of and 3D-LV strains differed marginally from 2D. Only vendor software was associated with differences in pooled means and LLN of 2D-LVGLS. Conclusions In conclusion, pooled means and LLNs of 2D- and 3D-LV global strain parameters in healthy subjects were reported. Based on the pooled LLNs, thresholds for abnormal, borderline and normal strains can be defined, such as less negative than -14.7%, between -14.7% and -16.0% and more negative than -16.0% respectively for 2D-LVGLS, and 2D-LVGLS values are only affected by vendor software.
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Affiliation(s)
- Tom Kai Ming Wang
- Section of Cardiovascular Imaging, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Milind Y Desai
- Section of Cardiovascular Imaging, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Patrick Collier
- Section of Cardiovascular Imaging, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Richard A Grimm
- Section of Cardiovascular Imaging, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Brian P Griffin
- Section of Cardiovascular Imaging, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Zoran B Popović
- Section of Cardiovascular Imaging, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio, USA
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23
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Silvetti MS, Pazzano V, Battipaglia I, Saputo FA, Mizzon C, Gimigliano F, Ammirati A, Ravà L, Drago F. Three-dimensional guided selective right ventricular septal pacing preserves ventricular systolic function and synchrony in pediatric patients. Heart Rhythm 2020; 18:434-442. [PMID: 33307214 DOI: 10.1016/j.hrthm.2020.12.004] [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] [Received: 08/07/2020] [Revised: 11/11/2020] [Accepted: 12/03/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND Nonfluoroscopic 3-dimensional (3D) electroanatomic mapping systems (EAMs) have been developed to guide cardiac catheter navigation and reduce fluoroscopy. Selective right ventricular (RV) septal pacing could prevent pacing-induced left ventricular (LV) dysfunction. OBJECTIVE The purpose of this study was to determine whether EAM-guided selective RV septal pacing preserves LV contractility/synchrony in pediatric patients with complete atrioventricular block (CAVB) and no other congenital heart defects. METHODS Prospective analysis of children/adolescents who underwent EAM-guided selective RV pacing was performed. A 3D pacing map guided ventricular lead implantation at septal sites with narrow paced QRS. Serial echocardiograms were obtained after pacemaker implantation to monitor for function (volumes, ejection fraction [EF], global longitudinal/circumferential strain) and synchrony (interventricular mechanical delay, septal to posterior wall motion delay, systolic dyssynchrony index). Data are reported as median (25th-75th percentile). RESULTS Thirty-two CAVB patients (age 9.8 [7.0-14.0] years; 11 with a previous pacing system) underwent selective RV septal pacing (13 DDD, 19 VVIR pacemaker; midseptum 22, parahisian 7, RV outflow tract 3) with narrow paced QRS (110 [100-120] ms) and low radiation exposure. Follow-up over 24 (5-33) months showed preserved LV function and synchrony, without significant differences between pacing sites (midseptum-parahisian) and mode (VVIR-DDD). EF decreased after implantation in patients without previous pacing, although values were mainly within normal limits. Three parahisian patients underwent early lead repositioning. CONCLUSION EAM-guided selective RV septal pacing is a feasible technique associated with preserved LV systolic function and synchrony and low radiation exposure in pediatric patients with CAVB.
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Affiliation(s)
- Massimo Stefano Silvetti
- Paediatric Cardiology and Cardiac Arrhythmia/Syncope Unit, Bambino Gesù Children's Hospital IRCCS, Rome, Italy; European Reference Network for Rare and Low Prevalence Complex Disease of the Heart (ERN GUARD-Heart).
| | - Vincenzo Pazzano
- Paediatric Cardiology and Cardiac Arrhythmia/Syncope Unit, Bambino Gesù Children's Hospital IRCCS, Rome, Italy; European Reference Network for Rare and Low Prevalence Complex Disease of the Heart (ERN GUARD-Heart)
| | - Irma Battipaglia
- Paediatric Cardiology and Cardiac Arrhythmia/Syncope Unit, Bambino Gesù Children's Hospital IRCCS, Rome, Italy; European Reference Network for Rare and Low Prevalence Complex Disease of the Heart (ERN GUARD-Heart)
| | - Fabio Anselmo Saputo
- Paediatric Cardiology and Cardiac Arrhythmia/Syncope Unit, Bambino Gesù Children's Hospital IRCCS, Rome, Italy; European Reference Network for Rare and Low Prevalence Complex Disease of the Heart (ERN GUARD-Heart)
| | - Chiara Mizzon
- Paediatric Cardiology and Cardiac Arrhythmia/Syncope Unit, Bambino Gesù Children's Hospital IRCCS, Rome, Italy; European Reference Network for Rare and Low Prevalence Complex Disease of the Heart (ERN GUARD-Heart)
| | - Fabrizio Gimigliano
- Paediatric Cardiology and Cardiac Arrhythmia/Syncope Unit, Bambino Gesù Children's Hospital IRCCS, Rome, Italy; European Reference Network for Rare and Low Prevalence Complex Disease of the Heart (ERN GUARD-Heart)
| | - Antonio Ammirati
- Paediatric Cardiology and Cardiac Arrhythmia/Syncope Unit, Bambino Gesù Children's Hospital IRCCS, Rome, Italy; European Reference Network for Rare and Low Prevalence Complex Disease of the Heart (ERN GUARD-Heart)
| | - Lucilla Ravà
- Epidemiology Institute, Bambino Gesù Children's Hospital IRCCS, Rome, Italy
| | - Fabrizio Drago
- Paediatric Cardiology and Cardiac Arrhythmia/Syncope Unit, Bambino Gesù Children's Hospital IRCCS, Rome, Italy; European Reference Network for Rare and Low Prevalence Complex Disease of the Heart (ERN GUARD-Heart)
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24
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Characterisation of LV myocardial exercise function by 2-D strain deformation imaging in elite adolescent footballers. Eur J Appl Physiol 2020; 121:239-250. [PMID: 33030575 PMCID: PMC7815563 DOI: 10.1007/s00421-020-04510-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2019] [Accepted: 09/19/2020] [Indexed: 12/15/2022]
Abstract
Purpose Few data exist on the descriptions of LV myocardial mechanics and reserve during dynamic exercise of adolescent athletes. The aim of this study was to describe the LV myocardial and cardiopulmonary changes during exercise using 2-D strain deformation imaging. Methods Elite adolescent male football players (n = 42) completed simultaneous cardiopulmonary exercise testing (CPET) and exercise echocardiography measurement of LV myocardial deformation by 2-D strain imaging. LV longitudinal and circumferential 2-D strain and strain rates were analyzed at each stage during incremental exercise to a work rate of 150 W. Additionally, exercise LV myocardial deformation and its relation to metabolic exercise parameters were evaluated at each exercise stage and in recovery using repeated measures ANOVA, linear regression and paired t tests. Results LV peak systolic baseline 2-D strain (longitudinal: − 15.4 ± 2.5%, circumferential: − 22.5 ± 3.1%) increased with each exercise stage, but longitudinal strain plateaued at 50 W (mean strain reserve − 7.8 ± 3.0) and did not significantly increase compared to subsequent exercise stages (P > 0.05), whilst circumferential strain (mean strain reserve − 11.6 ± 3.3) significantly increased (P < 0.05) throughout exercise up to 150 W as the dominant mechanism of exercise LV contractility increase. Regression analyses showed LV myocardial strain increased linearly relative to HR, VO2 and O2 pulse (P < 0.05) for circumferential deformation, but showed attenuation for longitudinal deformation. Conclusion This study describes LV myocardial deformation dynamics by 2-D strain and provides reference values for LV myocardial strain and strain rate during exercise in adolescent footballers. It found important differences between LV longitudinal and circumferential myocardial mechanics during exercise and introduces a methodology that can be used to quantify LV function and cardiac reserve during exercise in adolescent athletes.
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Influence of patent ductus arteriosus on left ventricular myocardial deformation in preterm neonates in the early neonatal period. Early Hum Dev 2020; 147:105093. [PMID: 32526629 DOI: 10.1016/j.earlhumdev.2020.105093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Revised: 05/19/2020] [Accepted: 05/26/2020] [Indexed: 11/20/2022]
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26
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Pieles GE, Stuart AG. The adolescent athlete's heart; A miniature adult or grown-up child? Clin Cardiol 2020; 43:852-862. [PMID: 32643161 PMCID: PMC7403711 DOI: 10.1002/clc.23417] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Revised: 06/16/2020] [Accepted: 06/26/2020] [Indexed: 12/18/2022] Open
Abstract
The systematic development of early age talent in sports academies has led to the professionalization of pediatric sport and the sports physician need to be aware of pediatric cardiological problems. Research into the medical cardiac care and assessment of the pediatric athlete are accumulating, but specific pediatric international guidelines are not available yet and reference data for ECG and echocardiography are incomplete, in particular for the age group <12 years of age. This article is an introduction to the physiological and diagnostics specifics of the pediatric athlete. The focus lies in the differences in presentation and diagnosis between pediatric and adult athletes for the most common pathologies. Reference data for electrical and structural adaptations to intensive exercise are sparse particularly in athletes aged below 12 years old. Training related changes include decrease of resting heart rate, increase of cardiac output, ventricular cavity size, and wall thickness. Cardiac hypertrophy is less pronounced in pediatric athletes, as HR mediated cardiac output increase to endurance exercise is the dominant mechanism in peripubertal children. As in adults, the most pronounced cardiovascular adaptations appear in classical endurance sports like rowing, triathlon, and swimming, but the specifics of pediatric ECG and echocardiographic changes need to be considered.
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Affiliation(s)
- Guido E Pieles
- National Institute for Health Research (NIHR) Cardiovascular Biomedical Research Centre, Congenital Heart Unit, Bristol Heart Institute, Bristol, UK.,Institute of Sport, Exercise and Health, University College London, London, UK
| | - A Graham Stuart
- National Institute for Health Research (NIHR) Cardiovascular Biomedical Research Centre, Congenital Heart Unit, Bristol Heart Institute, Bristol, UK
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Roudijk RW, Evertz R, Teske AJ, Marcelis C, Bosboom D, Velthuis BK, Udink ten Cate FE, te Riele AS. Arrhythmogenic Right Ventricular Cardiomyopathy in a Pediatric Patient. JACC Case Rep 2020; 2:919-924. [PMID: 34317382 PMCID: PMC8302029 DOI: 10.1016/j.jaccas.2020.01.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Revised: 11/29/2019] [Accepted: 01/06/2020] [Indexed: 01/27/2023]
Abstract
Arrhythmogenic right ventricular cardiomyopathy (ARVC) is rarely diagnosed in childhood. We describe the case of a 9-year-old girl with genetically confirmed ARVC who presented with syncope, ventricular arrhythmia, and biventricular myocardial dysfunction. This case highlights the need for development of pediatric ARVC diagnosis criteria specific for pediatric patients and discusses potential diagnostic improvement using echocardiographic deformation imaging. (Level of Difficulty: Beginner.).
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Affiliation(s)
- Rob W. Roudijk
- Department of Cardiology, Division of Heart and Lungs, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Reinder Evertz
- Department of Cardiology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Arco J. Teske
- Department of Cardiology, Division of Heart and Lungs, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Carlo Marcelis
- Department of Clinical Genetics, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Dennis Bosboom
- Department of Radiology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Birgitta K. Velthuis
- Department of Radiology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Floris E.A. Udink ten Cate
- Department of Pediatric Cardiology, Academic Center for Congenital Heart Disease, Amalia Children’s Hospital, Radboud University Medical Center, Nijmegen, the Netherlands
- Division of Pediatric Cardiology, Department of Pediatrics, Sophia Children’s Hospital, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Anneline S.J.M. te Riele
- Department of Cardiology, Division of Heart and Lungs, University Medical Center Utrecht, Utrecht, the Netherlands
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Garg A, Manalo R, Gorla SR, Luzzo C, Hunter J, Swaminathan S, Kardon RE. Establishment of Myocardial Strain Measurement Data in Pediatric Patients Without Structural Heart Disease: A Single Center Study. Pediatr Cardiol 2020; 41:892-898. [PMID: 32095851 DOI: 10.1007/s00246-020-02328-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Accepted: 02/17/2020] [Indexed: 01/09/2023]
Abstract
Accurate assessment of LV systolic function remains a challenge, especially in the pediatric population. Myocardial strain measurement by 2D speckle tracking echocardiography (2DSTE) is a relatively new modality for assessment of regional and global myocardial wall motion. This study aims to establish the normative value among various pediatric age groups at a large pediatric tertiary care institution and to describe the challenges encountered in establishing such strain data. Transthoracic echocardiograms were acquired in 121 healthy children (age 0-21 years) and were retrospectively analyzed. The global longitudinal strain (GLS) was obtained by 2D speckle tracking using Philips Epiq7® and QLAB post processing software. The normative value for left ventricular GLS (%) obtained in our study was - 20.8 ± 2.3 (< 1 year); - 21.4 ± 2.2 (1-4 years); - 19.6 ± 2.4 (5-9 years); - 19.4 ± 2.6 (10-14 years); - 18.9 ± 3.0 (15-21 years). There was a statistically significant difference in GLS between the different age groups. The BMI (kg/m2) of assessed subjects were 14.6 ± 2.3 (< 1 year); 16.3 ± 1.5 (1-4 years); 16.7 ± 2.3 (5-9 years); 21.3 ± 4.6 (10-14 years); 23.9 ± 5.9 (15-21 years). There was no significant difference in GLS by gender or by BMI found in our study. We present our experience with establishment of normative values of 2DSTE in our pediatric echocardiography lab. This study shows that age is the major determinant of variation in peak GLS in healthy subjects, emphasizing the importance of establishment of normative data among various age groups in pediatrics.
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Affiliation(s)
- Ashish Garg
- Division of Pediatric Cardiology, Holtz Children's Hospital, Jackson Memorial Medical Center, University of Miami Miller School of Medicine, Miami, FL, USA. .,Division of Pediatric Cardiology, Holtz Children's Hospital, Jackson Memorial Medical Center, University of Miami Miller School of Medicine, 1611 NW 12 Avenue, North Wing, Room 109, Miami, FL, 33136, USA.
| | - Rachel Manalo
- Division of Pediatric Cardiology, Holtz Children's Hospital, Jackson Memorial Medical Center, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Sudheer R Gorla
- Division of Pediatric Cardiology, Holtz Children's Hospital, Jackson Memorial Medical Center, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Christopher Luzzo
- Division of Pediatric Cardiology, Holtz Children's Hospital, Jackson Memorial Medical Center, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Juanita Hunter
- Division of Pediatric Cardiology, Holtz Children's Hospital, Jackson Memorial Medical Center, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Sethuraman Swaminathan
- Division of Pediatric Cardiology, Holtz Children's Hospital, Jackson Memorial Medical Center, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Richard E Kardon
- Division of Pediatric Cardiology, Holtz Children's Hospital, Jackson Memorial Medical Center, University of Miami Miller School of Medicine, Miami, FL, USA
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Pieles GE, Oberhoffer R. The Assessment of the Paediatric Athlete. J Cardiovasc Transl Res 2020; 13:306-312. [PMID: 32367344 PMCID: PMC7360531 DOI: 10.1007/s12265-020-10005-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Accepted: 04/15/2020] [Indexed: 12/27/2022]
Abstract
The success of systematic early age talent development has led to the professionalisation of youth sports academies used by clubs and governing bodies alike, and sports physicians are nowadays commonly confronted with paediatric cardiological problems. Medical cardiac care of the paediatric athlete is however in its infancy, and the international guidelines that are present for adult athletes, are not yet available. Similarly, reference data for ECG and echocardiography are incomplete. The aim of this article is to provide and introduction to the cardiac care of the paediatric athlete to facilitate healthy and above all, safe talent development, but also provide guidance on how to distinguish adaptive, beneficial cardiovascular remodelling from underlying pathology of congenital or inherited cardiovascular disease. Differences in presentation, diagnosis and treatment between childhood and adult athletes are highlighted and can educate the reader in the emerging field of paediatric sports cardiology.
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Affiliation(s)
- Guido E Pieles
- Congenital Heart Unit, Bristol Heart Institute, Upper Maudlin Street, Bristol, BS2 8BJ, UK.
| | - Renate Oberhoffer
- Department of Sports and Health Sciences, Technical University Munich, Georg Brauchle Ring, 80992, Munich, Germany
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30
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Silvetti MS, Muzi G, Unolt M, D'Anna C, Saputo FA, Di Mambro C, Albanese S, Ammirati A, Ravà L, Drago F. Left ventricular (LV) pacing in newborns and infants: Echo assessment of LV systolic function and synchrony at 5‐year follow‐up. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2020; 43:535-541. [DOI: 10.1111/pace.13908] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Revised: 02/10/2020] [Accepted: 03/15/2020] [Indexed: 11/29/2022]
Affiliation(s)
- Massimo Stefano Silvetti
- Pediatric Cardiology and Cardiac Arrhythmias UnitDepartment of Pediatric Cardiology and Cardiac SurgeryBambino Gesù Children's Hospital and Research Institute Rome Italy
| | - Giulia Muzi
- Pediatric Cardiology and Cardiac Arrhythmias UnitDepartment of Pediatric Cardiology and Cardiac SurgeryBambino Gesù Children's Hospital and Research Institute Rome Italy
| | - Marta Unolt
- Pediatric Cardiology and Cardiac Arrhythmias UnitDepartment of Pediatric Cardiology and Cardiac SurgeryBambino Gesù Children's Hospital and Research Institute Rome Italy
| | - Carolina D'Anna
- Pediatric Cardiology and Cardiac Arrhythmias UnitDepartment of Pediatric Cardiology and Cardiac SurgeryBambino Gesù Children's Hospital and Research Institute Rome Italy
| | - Fabio Anselmo Saputo
- Pediatric Cardiology and Cardiac Arrhythmias UnitDepartment of Pediatric Cardiology and Cardiac SurgeryBambino Gesù Children's Hospital and Research Institute Rome Italy
| | - Corrado Di Mambro
- Pediatric Cardiology and Cardiac Arrhythmias UnitDepartment of Pediatric Cardiology and Cardiac SurgeryBambino Gesù Children's Hospital and Research Institute Rome Italy
| | - Sonia Albanese
- Cardiac Surgery UnitBambino Gesù Children's Hospital and Research Institute Rome Italy
| | - Antonio Ammirati
- Pediatric Cardiology and Cardiac Arrhythmias UnitDepartment of Pediatric Cardiology and Cardiac SurgeryBambino Gesù Children's Hospital and Research Institute Rome Italy
| | - Lucilla Ravà
- Epidemiology UnitBambino Gesù Children's Hospital and Research Institute Rome Italy
| | - Fabrizio Drago
- Pediatric Cardiology and Cardiac Arrhythmias UnitDepartment of Pediatric Cardiology and Cardiac SurgeryBambino Gesù Children's Hospital and Research Institute Rome Italy
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31
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Naqvi N, Babu-Narayan SV, Krupickova S, Muthialu N, Maiya S, Chandershekar P, Cheang MH, Kostolny M, Tsang V, Marek J. Myocardial Function Following Repair of Anomalous Origin of Left Coronary Artery from the Pulmonary Artery in Children. J Am Soc Echocardiogr 2020; 33:622-630. [PMID: 32122741 DOI: 10.1016/j.echo.2019.12.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2018] [Revised: 11/22/2019] [Accepted: 12/19/2019] [Indexed: 11/24/2022]
Abstract
OBJECTIVE We aimed to assess the change in global and regional myocardial function before and after surgical revascularization and their added value when compared with conventional measures in children with anomalous left coronary artery from the pulmonary artery (ALCAPA). METHODS Advanced echocardiographic assessment was performed pre- and postoperatively in 22 children with ALCAPA (eight male; median surgery age, 0.4 years; interquartile range, 0.21-1.05) and 22 healthy controls. Measurements included global and segmental longitudinal, radial, and circumferential two-dimensional speckle-tracking strain and postsystolic index. RESULTS Global strains were lower in preoperative patients than in controls (longitudinal: -9% vs -21%; P < .001; circumferential: -11% vs -21%; P < .001; radial: 18% vs 60%; P < .001) and improved postoperatively when compared with preoperative findings (longitudinal: -9% pre vs -16% post; P = .002, circumferential:-11% pre vs -17% post; P = .012, radial: 18% pre vs 53% post; P = .001). Preoperatively, patients with normal global systolic function on conventional echocardiography had significantly impaired global longitudinal and radial strain compared with healthy controls. Global mechanical dyssynchrony improved significantly postoperatively (longitudinal postsystolic index 43 pre vs 6 post, P < .001; circumferential 15 pre vs 2 post, P = .001; radial 48 pre vs 5 post, P = .003). Despite overall improvement in most segments, global longitudinal and circumferential and segmental peak strain in some of the segments supplied by the ALCAPA remained postoperatively abnormal. CONCLUSIONS This study shows that myocardial deformation indices were a more sensitive measure of LV dysfunction in patients before and after ALCAPA repair than conventional echocardiographic measures. We believe, therefore, they should be added to routine preoperative and serial postoperative follow-up assessment.
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Affiliation(s)
- Nitha Naqvi
- Cardiorespiratory Unit, Great Ormond Street Hospital for Children, London, United Kingdom
| | - Sonya V Babu-Narayan
- Department of Adult Congenital Heart Disease, Royal Brompton Hospital, National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - Sylvia Krupickova
- Department of Adult Congenital Heart Disease, Royal Brompton Hospital, National Heart and Lung Institute, Imperial College London, London, United Kingdom; Department of Paediatric Cardiology, Royal Brompton Hospital, London, United Kingdom
| | - Nagarajan Muthialu
- Cardiorespiratory Unit, Great Ormond Street Hospital for Children, London, United Kingdom
| | - Shreesha Maiya
- Department of Paediatric Cardiology, Royal Brompton Hospital, London, United Kingdom
| | - Prathiba Chandershekar
- Cardiorespiratory Unit, Great Ormond Street Hospital for Children, London, United Kingdom
| | - Mun Hong Cheang
- Institute of Cardiovascular Sciences University College London, London, United Kingdom
| | - Martin Kostolny
- Cardiorespiratory Unit, Great Ormond Street Hospital for Children, London, United Kingdom
| | - Victor Tsang
- Cardiorespiratory Unit, Great Ormond Street Hospital for Children, London, United Kingdom; Institute of Cardiovascular Sciences University College London, London, United Kingdom
| | - Jan Marek
- Cardiorespiratory Unit, Great Ormond Street Hospital for Children, London, United Kingdom; Institute of Cardiovascular Sciences University College London, London, United Kingdom.
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32
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Serial cardiovascular magnetic resonance feature tracking indicates early worsening of cardiac function in Fontan patients. Int J Cardiol 2020; 303:23-29. [DOI: 10.1016/j.ijcard.2019.12.041] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Revised: 10/18/2019] [Accepted: 12/19/2019] [Indexed: 12/18/2022]
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Lin HY, Chuang CK, Lee CL, Chen MR, Sung KT, Lin SM, Hou CJY, Niu DM, Chang TM, Hung CL, Lin SP. Cardiac Evaluation using Two-Dimensional Speckle-Tracking Echocardiography and Conventional Echocardiography in Taiwanese Patients with Mucopolysaccharidoses. Diagnostics (Basel) 2020; 10:diagnostics10020062. [PMID: 31979324 PMCID: PMC7168914 DOI: 10.3390/diagnostics10020062] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Revised: 01/12/2020] [Accepted: 01/21/2020] [Indexed: 12/19/2022] Open
Abstract
Background: Mucopolysaccharidoses (MPSs) are a group of rare inherited metabolic disorders that can damage various organs, including the heart. Cardiac abnormalities have been observed in patients with all MPS types, with the most documented abnormalities being cardiac valvular regurgitation and stenosis, valvular thickening, and hypertrophic cardiomyopathy. Methods: Cardiac features of 53 Taiwanese patients with MPS (31 men and 22 women; age range 1.1–34.9 years; seven with MPS I, 16 with MPS II, nine with MPS III, 14 with MPS IVA, and seven with MPS VI) were evaluated using two-dimensional speckle-tracking echocardiography and conventional echocardiography. Results: The mean z scores of the global longitudinal strain (GLS), left ventricular mass index (LVMI), interventricular septum diameter in diastole (IVSd), left ventricular posterior wall diameter in diastole (LVPWd), and aortic diameter of the 53 patients with MPS were 1.71, 0.35, 1.66, 1.03, and 3.15, respectively. Furthermore, z scores >2 were identified in 45%, 13%, 40%, 13%, and 70% of the GLS, LVMI, IVSd, LVPWd, and aortic diameter, respectively. The most severe GLS was observed in those with MPS VI, followed by in those with MPS II and MPS I. The GLS z score was positively correlated with the LVMI z score (p < 0.01). Moreover, diastolic dysfunction (reversed ratio between early and late (atrial) ventricular filling velocity (E/A ratio < 1)) was identified in 12 patients (23%). Ejection and shortening fractions were abnormal in four (8%) and seven (13%) patients, respectively. Mitral regurgitation (MR) (92%) was the most common valvular heart disease, followed by aortic regurgitation (AR) (57%), mitral stenosis (MS) (21%), and aortic stenosis (AS) (15%). The z scores of the GLS and LVMI and severity scores of the MS, MR, AS, and AR were all positively correlated with increasing age (p < 0.05). Twenty patients (38%) had a left ventricular remodeling pattern. Conclusions: The most significant left ventricular myocardial deformation, hypertrophy and valvular heart disease were observed in the patients with MPS VI, II, and I, followed by those with MPS IV; in contrast, patients with MPS III had the mildest manifestations. Cardiac abnormalities in patients with MPS worsened with increasing age in accordance with the progressive nature of this disease.
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Affiliation(s)
- Hsiang-Yu Lin
- Department of Medicine, MacKay Medical College, New Taipei City 25245, Taiwan; (H.-Y.L.); (M.-R.C.); (K.-T.S.); (S.-M.L.)
- Department of Pediatrics, MacKay Memorial Hospital, Taipei 10449, Taiwan
- Department of Medical Research, MacKay Memorial Hospital, New Taipei City 25160, Taiwan;
- MacKay Junior College of Medicine, Nursing and Management, Taipei 11260, Taiwan
- Department of Medical Research, China Medical University Hospital, China Medical University, Taichung 40402, Taiwan
- Institute of Biomedical Sciences, MacKay Medical College, New Taipei City 25245, Taiwan
| | - Chih-Kuang Chuang
- Department of Medical Research, MacKay Memorial Hospital, New Taipei City 25160, Taiwan;
- College of Medicine, Fu-Jen Catholic University, Taipei 24205, Taiwan
| | - Chung-Lin Lee
- Department of Pediatrics, MacKay Memorial Hospital, Hsinchu 30071, Taiwan;
- Institute of Clinical Medicine, National Yang-Ming University, Taipei 11221, Taiwan;
| | - Ming-Ren Chen
- Department of Medicine, MacKay Medical College, New Taipei City 25245, Taiwan; (H.-Y.L.); (M.-R.C.); (K.-T.S.); (S.-M.L.)
- Department of Pediatrics, MacKay Memorial Hospital, Taipei 10449, Taiwan
- MacKay Junior College of Medicine, Nursing and Management, Taipei 11260, Taiwan
| | - Kuo-Tzu Sung
- Department of Medicine, MacKay Medical College, New Taipei City 25245, Taiwan; (H.-Y.L.); (M.-R.C.); (K.-T.S.); (S.-M.L.)
- Division of Cardiology, Department of Internal Medicine, MacKay Memorial Hospital, Taipei 10449, Taiwan;
| | - Shan-Miao Lin
- Department of Medicine, MacKay Medical College, New Taipei City 25245, Taiwan; (H.-Y.L.); (M.-R.C.); (K.-T.S.); (S.-M.L.)
- Department of Pediatrics, MacKay Memorial Hospital, Taipei 10449, Taiwan
- MacKay Junior College of Medicine, Nursing and Management, Taipei 11260, Taiwan
| | - Charles Jia-Yin Hou
- Division of Cardiology, Department of Internal Medicine, MacKay Memorial Hospital, Taipei 10449, Taiwan;
| | - Dau-Ming Niu
- Institute of Clinical Medicine, National Yang-Ming University, Taipei 11221, Taiwan;
- Department of Pediatrics, Taipei Veterans General Hospital, Taipei 11217, Taiwan
| | - Tung-Ming Chang
- Department of Pediatric Neurology, Changhua Christian Children’s Hospital, Changhua 500, Taiwan;
- School of Medicine, Kaohsiung Medical University, Kaohsiung 80708, Taiwan
| | - Chung-Lieh Hung
- Department of Medicine, MacKay Medical College, New Taipei City 25245, Taiwan; (H.-Y.L.); (M.-R.C.); (K.-T.S.); (S.-M.L.)
- Department of Medical Research, MacKay Memorial Hospital, New Taipei City 25160, Taiwan;
- Division of Cardiology, Department of Internal Medicine, MacKay Memorial Hospital, Taipei 10449, Taiwan;
- Correspondence: (C.-L.H.); (S.-P.L.); Tel.: +886-2-2543-3535 (ext. 3090) (S.-P.L.); Fax: +886-2-2543-3642 (S.-P.L.)
| | - Shuan-Pei Lin
- Department of Medicine, MacKay Medical College, New Taipei City 25245, Taiwan; (H.-Y.L.); (M.-R.C.); (K.-T.S.); (S.-M.L.)
- Department of Pediatrics, MacKay Memorial Hospital, Taipei 10449, Taiwan
- Department of Medical Research, MacKay Memorial Hospital, New Taipei City 25160, Taiwan;
- Department of Infant and Child Care, National Taipei University of Nursing and Health Sciences, Taipei 11219, Taiwan
- Correspondence: (C.-L.H.); (S.-P.L.); Tel.: +886-2-2543-3535 (ext. 3090) (S.-P.L.); Fax: +886-2-2543-3642 (S.-P.L.)
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What is Left Ventricular Strain in Healthy Neonates? A Systematic Review and Meta-analysis. Pediatr Cardiol 2020; 41:1-11. [PMID: 31673733 DOI: 10.1007/s00246-019-02219-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2019] [Accepted: 10/15/2019] [Indexed: 12/15/2022]
Abstract
Reference values for left ventricular systolic strain in healthy neonates are necessary for clinical application of strain. The objectives of this systematic review were to identify echocardiographic studies that presented left ventricular strain values in healthy neonates, perform a meta-analysis for speckle tracking-derived global longitudinal strain, and identify areas that require further investigation. A structured search was applied to MEDLINE, Embase, and Cochrane Central Register of Clinical Trials in search of echocardiographic studies that presented left ventricular strain in healthy neonates. 244 studies were identified, of which 16 studies including speckle tracking and tissue Doppler strain in the longitudinal, radial, and circumferential directions passed the screening process. Out of these 16 studies, a meta-analysis was performed on the 10 studies that reported speckle tracking global longitudinal strain. Mean speckle tracking-derived global longitudinal strain was 21.0% (95% Confidence Interval 19.6-22.5%, strain given as positive values). When the studies were divided into subgroups, mean speckle tracking global longitudinal strain from the four-chamber view was 19.5% (95% Confidence Interval 18.0-21.0%) and that derived from all three apical views was 22.5% (95% CI 20.6-24.7%), indicating that global longitudinal strain from the four-chamber view is slightly lower than global longitudinal strain from all three apical views. Neonatal strain values were close to strain values in older subjects found in previous meta-analyses. Further studies are recommended that examine strain rate, segmental strain values, strain derived from short axis views, and strain in the first few hours after birth.
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Penk J, Mukadam S, Zaidi SJ, Cui V, Metzger R, Roberson DA, Li Y. Comparison of Semi-Automated Versus Manual Quantitative Right Ventricular Assessment in Hypoplastic Left Heart Syndrome. Pediatr Cardiol 2020; 41:69-76. [PMID: 31659391 DOI: 10.1007/s00246-019-02223-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Accepted: 10/15/2019] [Indexed: 11/26/2022]
Abstract
Quantitative echocardiographic evaluation is important for systemic right ventricles, but its asymmetric shape makes this challenging and time consuming when performed manually. Semi-automated software could make these quantitative measures easier to accomplish in the clinical setting. We hypothesized that semi-automated software would approximate manual measures of right ventricular size and function. Children with hypoplastic left heart who had echocardiograms were prospectively identified. These measurements were performed using manual and semi-automated techniques: end-diastolic and end-systolic area, fractional area change (FAC), dimensions (longitudinal, basal and mid-cavitary diameters), and tricuspid annular plane systolic excursion (TAPSE). Agreement between measures was evaluated. Sixty-three echocardiograms were analyzed. Intra- and inter-observer reliability was acceptable and similar between methods except that inter-observer reliability for the manual method was superior for TAPSE. Correlation between methods was high (r > 0.9, p < 0.001) for most of the measures. Correlation for FAC was r = 0.79, and for TAPSE the correlation was r = 0.61 (both p < 0.001). The percent relative difference between manual and semi-automated methods was less than 6% for most measures. End-systolic area and FAC had a relative difference of 10% and 11% respectively. The only measure with substantial bias between the manual and semi-automated methods was TAPSE which had a relative difference of 52%. EchoInsight® semi-automated software provides similar measures of right ventricular dimensions and FAC in patients with hypoplastic left heart compared to manual measures. Measures of TAPSE do not correlate well between manual and semi-automated methods. Further research is warranted on the use of semi-automated analyses in this patient population.
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Affiliation(s)
- Jamie Penk
- Department of Pediatric Cardiology, Advocate Children's Hospital, 4440 W. 95th Street, Oak Lawn, Chicago, IL, 60453, USA.
- Lurie Children's Hospital, 225 E. Chicago Avenue, Box 21, Chicago, IL, 60611-2605, USA.
| | - Shireen Mukadam
- Department of Pediatric Cardiology, Advocate Children's Hospital, 4440 W. 95th Street, Oak Lawn, Chicago, IL, 60453, USA
| | - S Javed Zaidi
- Department of Pediatric Cardiology, Advocate Children's Hospital, 4440 W. 95th Street, Oak Lawn, Chicago, IL, 60453, USA
| | - Vivian Cui
- Department of Pediatric Cardiology, Advocate Children's Hospital, 4440 W. 95th Street, Oak Lawn, Chicago, IL, 60453, USA
| | - Robert Metzger
- Department of Pediatric Cardiology, Advocate Children's Hospital, 4440 W. 95th Street, Oak Lawn, Chicago, IL, 60453, USA
| | - David A Roberson
- Department of Pediatric Cardiology, Advocate Children's Hospital, 4440 W. 95th Street, Oak Lawn, Chicago, IL, 60453, USA
| | - Yi Li
- Department of Pediatric Cardiology, Advocate Children's Hospital, 4440 W. 95th Street, Oak Lawn, Chicago, IL, 60453, USA
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Subclinical myocardial disease in patients with primary hyperoxaluria and preserved left ventricular ejection fraction: a two-dimensional speckle-tracking imaging study. Pediatr Nephrol 2019; 34:2591-2600. [PMID: 31440827 DOI: 10.1007/s00467-019-04330-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Revised: 07/23/2019] [Accepted: 08/05/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND Primary hyperoxaluria (PH) is characterized by progressive chronic kidney disease (CKD) and systemic oxalate deposition. Myocardial dysfunction might be present early in the course of the disease. However, this hypothesis has not yet been tested in the PH population. Therefore, we aimed to determine whether strain imaging using two-dimensional speckle tracking echocardiography (2D-STE) might detect subclinical myocardial disease in otherwise asymptomatic PH patients. METHODS Prospective study of pediatric and adolescent PH patients with preserved LV ejection fraction (LV EF) and without renal replacement therapy. Subjects underwent conventional echocardiography and 2D-STE. Global (GLS) and segmental peak systolic LV longitudinal strain (LS) measurements were obtained. Data were compared with age- and gender-matched controls, and Z-scores were calculated as appropriate. RESULTS Fifteen PH patients (age 14.1 ± 5.9 years; 13/15 in CKD stages 1-2) were studied. Although LV EF was preserved (63 ± 6%) in patients, GLS was significantly impaired (GLS - 17.1 ± 2.2% vs - 22.4 ± 1.9%, p < 0.001). This was mainly due to decreased LS values in the apical segments (p < 0.05). Echocardiographic indices of ventricular wall thickness were significantly increased in patients compared to controls (all p < 0.03). GLS correlated significantly with Z-scores of diastolic interventricular wall thickness (r = - 0.57, p = 0.025) and moderately with serum creatinine levels (r = 0.53, p = 0.044). No correlation was found between GLS and blood pressure measurements. CONCLUSIONS Subclinical myocardial disease is already present early in the course of disease in PH patients with preserved LV EF and some degree of renal dysfunction, but without overt systemic oxalosis. Current recommendations to screen only PH patients with advanced CKD for cardiac disease should be revised accordingly.
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Clavero Adell M, Ayerza Casas A, Jiménez Montañés L, Palanca Arias D, López Ramón M, Alcalá Nalvaiz JT, Samper Villagrasa P. Evolution of strain and strain rate values throughout gestation in healthy fetuses. Int J Cardiovasc Imaging 2019; 36:59-66. [PMID: 31664680 DOI: 10.1007/s10554-019-01695-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Accepted: 09/03/2019] [Indexed: 12/14/2022]
Abstract
Myocardial deformation by speckle tracking echocardiography is a novel method for evaluating cardiac function. To test the hypothesis that right ventricular and left ventricular function have age-specific patterns of development, we tracked the evolution of ventricular strain mechanics by speckle tracking echocardiography in the fetus. We conducted a retrospective cross sectional echocardiography study in 154 healthy fetuses, and characterized cardiac function by measuring right and left ventricles global longitudinal strain and strain rate. Comparison of the data of both ventricles according to gestational age was carried out. The magnitudes of right and left ventricle global longitudinal strain show wide range values and decreased throughout gestation. Strain values are higher in left ventricle compared to the right one throughout pregnancy. Strain rate values were similar over gestation in each ventricle, but the magnitudes declined overtime in the right and left ventricle. The maturational patterns of left and right strain are gestational specific. With accepted physiological maturation patterns in healthy subjects, these myocardial deformation parameters can provide a valid basis that allows comparison between health and disease.
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Affiliation(s)
- Marcos Clavero Adell
- Miguel Servet University Hospital, Paseo Isabel La Católica, 1-3, 50009, Zaragoza, Spain.
| | | | | | | | - Marta López Ramón
- Pediatric Cardiology Unit, Miguel Servet University Hospital, Zaragoza, Spain
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Capotosto L, D'Ettorre G, Ajassa C, Cavallari N, Ciardi MR, Placanica G, Ricci S, Lucchetti P, Tanzilli G, Mangieri E, Gaudio C, Vullo V, Vitarelli A. Assessment of Biventricular Function by Three-Dimensional Speckle Tracking Echocardiography in Adolescents and Young Adults with Human Immunodeficiency Virus Infection: A Pilot Study. Cardiology 2019; 144:101-111. [PMID: 31614346 DOI: 10.1159/000503140] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2019] [Accepted: 09/03/2019] [Indexed: 11/19/2022]
Abstract
BACKGROUND The purpose of the study was to assess biventricular parameters of wall deformation with three-dimensional speckle tracking echocardiography (3DSTE) in adolescents and young adults with human immunodeficiency virus (HIV) infection on antiretroviral therapy in order to detect a possible subclinical myocardial dysfunction. METHODS Twenty-one patients aged 12-39 years with HIV, 21 normal controls of the same age and sex, and 21 patients with idiopathic nonischemic dilated cardiomyopathy (DCM) were studied with 3DSTE. All HIV patients were stable in terms of HIV infection, with no history of heart disease or other chronic systemic disease except HIV infection, and were on highly active antiretroviral therapy with good immunological control. Standard echocardiographic measures of left ventricular (LV)-right ventricular (RV) function were assessed. 3D LV global longitudinal strain (GLS), circumferential strain, radial strain, and LV twist were calculated. Global area strain (GAS) was calculated by 3DSTE as percentage variation in surface area defined by the longitudinal and circumferential strain vectors. 3D RV global and free-wall longitudinal strain (FWLS) were obtained. RESULTS LV GLS and GAS were lower in HIV patients compared to normal controls (p = 0.002, and p = 0.01, respectively). There were no significant differences in LV ejection fractions between the groups. There was a weak positive correlation between LV GLS and age (r = 0.215, p = 0.034) and a weak negative correlation between LV GLS and nadir-CD4 T-cells count (r = 0.198, p = 0.043). DCM patients had more marked and widespread reduction in LV GLS and GAS compared to controls (p < 0.001), whereas in HIV patients LV strain impairment (p < 0.05) was more localized in basal and apical regions. RV FWLS was significantly reduced in HIV patients when compared with the control group (p = 0.03). No patient had pulmonary systolic pressure higher than 35 mm Hg. CONCLUSIONS 3DSTE may help to identify HIV patients at high cardiovascular risk allowing early detection of biventricular dysfunction in the presence of normal LV ejection fraction and in the absence of pulmonary hypertension. LV strain impairment in HIV patients is less prominent and widespread compared to DCM patients.
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Affiliation(s)
| | | | - Camilla Ajassa
- Department of Infectious Diseases, Sapienza University, Rome, Italy
| | - Nelson Cavallari
- Department of Infectious Diseases, Sapienza University, Rome, Italy
| | | | | | - Serafino Ricci
- Department of Infectious Diseases, Sapienza University, Rome, Italy
| | - Pietro Lucchetti
- Department of Infectious Diseases, Sapienza University, Rome, Italy
| | | | | | - Carlo Gaudio
- Department of Cardiology, Sapienza University, Rome, Italy
| | - Vincenzo Vullo
- Department of Infectious Diseases, Sapienza University, Rome, Italy
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Dąbrowska-Kugacka A, Dorniak K, Meyer-Szary J, Rey AH, Lewicka E, Ostrowska K, Kwiatkowska J. Myocardial function in patients with anomalous left coronary artery from the pulmonary artery syndrome: A long-term speckle tracking echocardiographic study. PLoS One 2019; 14:e0223227. [PMID: 31613933 PMCID: PMC6793868 DOI: 10.1371/journal.pone.0223227] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Accepted: 09/16/2019] [Indexed: 11/23/2022] Open
Abstract
Background Anomalous origin of the left coronary artery (LCA) from the pulmonary artery (ALCAPA) is a rare congenital heart disease. Retrograde flow from the right coronary artery (RCA) through natural collaterals to the low-pressure main pulmonary artery causes extensive ischemia. Limited data concerning the extent of permanent myocardial damage and functional recovery after surgical repair in the long-term follow-up is available. Aim Determination of the incidence of incipient myocardial dysfunction in ALCAPA patients in the long-term observation using tissue Doppler and speckle tracking echocardiography. Methods and results Eighteen ALCAPA patients after surgical repair (at median age of 7 months, range 3–167) underwent echocardiographic examination after (median) 17 years. All but 4 patients in NYHA class II presented well at follow-up. No narrowing in proximal LCA was detected in color Doppler. The initial (pre-surgical) left ventricular (LV) ejection fraction of 33±17% almost normalized to 55±6%, but was lower than in the age, sex and body surface area matched control group: 62±5% (p<0.001). At follow-up, LV global longitudinal strain (LS): -15.8±3.3% vs -21.9±1.7%; right ventricular LS: -20.6±3.9% vs -24.9±4.6%; left atrial LS: 27.7±4.3% vs 41.0±11.5%; right atrial LS: 26.8±7.4% vs 44.0±7.9% and early pulsed wave to tissue Doppler mitral filling ratio (E/E’): 8.1±2.6 vs 5.8±1.3 were impaired in the ALCAPA population in comparison to the control group (p<0.01 for all comparisons). LV radial and circumferential strain did not differ between groups. Mean LS in the ALCAPA patients in the RCA region was -19.0±4.4%, while in the LCA region -13.8±7.3% (p<0.00001). Conclusions Despite good clinical condition and normalized LV ejection fraction in ALCAPA patients after surgical repair in the long-term follow-up, the diastolic and longitudinal systolic function of all cardiac chambers remained impaired, especially in the LCA region. Lifelong surveillance of repaired ALCAPA patients is needed.
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Affiliation(s)
| | - Karolina Dorniak
- Department of Noninvasive Cardiac Diagnostics, Medical University of Gdansk, Gdansk, Poland
| | - Jarosław Meyer-Szary
- Department of Pediatric Cardiology and Congenital Heart Disease, Medical University of Gdansk, Gdansk, Poland
| | - Agnieszka Herrador Rey
- Department of Pediatric Cardiology and Congenital Heart Disease, Medical University of Gdansk, Gdansk, Poland
| | - Ewa Lewicka
- Department of Cardiology and Electrotherapy, Medical University of Gdansk, Gdansk, Poland
| | - Katarzyna Ostrowska
- Department of Cardiology, Polish Mother's Memorial Hospital-Research Institute, Lodz, Poland
| | - Joanna Kwiatkowska
- Department of Pediatric Cardiology and Congenital Heart Disease, Medical University of Gdansk, Gdansk, Poland
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Ali YA, Hassan MA, EL Fiky AA. Assessment of left ventricular systolic function after VSD transcatheter device closure using speckle tracking echocardiography. Egypt Heart J 2019; 71:1. [PMID: 31659511 PMCID: PMC6821406 DOI: 10.1186/s43044-019-0001-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2019] [Accepted: 06/21/2019] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND This is a case-control study conducted on 30 children, 15 with VSD who performed VSD transcatheter device closure (group A) and 15 controls of matching age and gender (group B), in the period between September 2015 and February 2018. We aimed to assess the global left ventricular (LV) systolic function by 2D speckle tracking before and after ventricular septal defect (VSD) transcatheter closure, in comparison to normal controls. All patients were subjected to full history taking; general and cardiac examination; ECG; CXR; full transthoracic echocardiographic examination, including VSD number, size, and site; LV dimensions and volumes; estimated pulmonary artery pressure; right ventricular size and function; left ventricular circumferential; and radial strain imaging by 2D speckle tracking. Patients who had ventricular septal defect closed were reassessed by transthoracic echocardiography after 3 months. RESULTS The study included 15 children with VSD: 3 males and 12 females; their age ranged from 2 to 13 years; all had subaortic VSD except for 1 who had apical muscular VSD: VSD size ranged from 3 to 8 mm; PFM coil was used to close defect in all patients except for 2 patients who had an Amplatzer duct occlude I (ADOI) device, and 1 patient needed an additional vascular plug after significant hemolysis. Pre-procedurally, group A had a significantly higher LVEDD, LVESD, and LVEDV than group B. Mean circumferential strain was significantly higher (more negative) in group A than that in group B either pre- or post-procedure. Post-procedurally, there was a significant decrease in circumferential strain (less negative) and a significant increase in radial strain (more positive). CONCLUSION Following transcatheter VSD closure, there is a significant decrease in LV circumferential strain and a significant increase in LV radial strain, which conclude a decrease in LV volume overload with the improvement of its contractility.
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Adar A, Ghelani SJ, Sleeper LA, Lu M, Marcus E, Ferraro AM, Colan SD, Banka P, Powell AJ, Harrild DM. Normal Values for Left Ventricular Strain and Synchrony in Children Based on Speckle Tracking Echocardiography. Am J Cardiol 2019; 123:1546-1554. [PMID: 30857642 DOI: 10.1016/j.amjcard.2019.01.044] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Revised: 01/17/2019] [Accepted: 01/22/2019] [Indexed: 02/07/2023]
Abstract
Strain and synchrony are associated with clinical outcomes in children with heart diseases. Robust normative data for these values, measured by 2-dimensional speckle tracking echocardiography (2DSTE), are limited. Therefore, we aimed to derive normal ranges and z-scores of 2DSTE strain and synchrony parameters in children. Subjects were <21 years old with structurally and functionally normal hearts. High frame-rate 2-dimensional echocardiographic images were retrospectively analyzed to measure longitudinal (LS) and circumferential (CS) strain and synchrony; views used were apical 4, 2, and 3-chamber (AP 4, 2, 3) and mid-papillary short-axis (SAX-M). Synchrony measures included standard deviation of time to peak strain, maximal wall delay, and cross-correlation mean segmental delay; these were calculated without and with heart rate (HR) correction (divided by √RR). Z-score equations were created for AP4 and SAX-M strain components. n = 312 subjects (40% female) were included (age 3 days to 20.5 years). Mean strain values (%) were: AP4 -24.4 ± 3.2, AP2 -24.2 ± 3.3, AP3 -24.6 ± 3.4, SAX-M -25.8 ± 3.4. Significant differences between ages were present for all strain components (AP4 p < 0.001; AP2 p = 0.003; AP3 p = 0.014; SAX-M p = 0.01). LS components decreased with increasing age and body surface area (p < 0.001 for all); CS did not. Longitudinal, but not circumferential, synchrony parameters decreased with age; however, these were nonsignificant after HR correction. In conclusion, normal pediatric 2DSTE strain and synchrony parameters and z-scores are reported to provide a foundation for incorporation into clinical practice. LS decline with age whereas CS does not. Age-related decreases in LS synchrony were mostly nonsignificant when corrected for HR.
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Affiliation(s)
- Adi Adar
- Department of Cardiology, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Sunil J Ghelani
- Department of Cardiology, Boston Children's Hospital, Boston, Massachusetts, USA; Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA
| | - Lynn A Sleeper
- Department of Cardiology, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Minmin Lu
- Department of Cardiology, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Edward Marcus
- Department of Cardiology, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Alessandra M Ferraro
- Department of Cardiology, Boston Children's Hospital, Boston, Massachusetts, USA; Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA
| | - Steven D Colan
- Department of Cardiology, Boston Children's Hospital, Boston, Massachusetts, USA; Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA
| | - Puja Banka
- Department of Cardiology, Boston Children's Hospital, Boston, Massachusetts, USA; Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA
| | - Andrew J Powell
- Department of Cardiology, Boston Children's Hospital, Boston, Massachusetts, USA; Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA
| | - David M Harrild
- Department of Cardiology, Boston Children's Hospital, Boston, Massachusetts, USA; Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA.
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Badran HM, Faheem N, Soliman M, Hamdy M, Yacoub M. Comparison of vector velocity imaging and three-dimensional speckle tracking echocardiography for assessment of left ventricular longitudinal strain in hypertrophic cardiomyopathy. Glob Cardiol Sci Pract 2019; 2019:6. [PMID: 31024948 PMCID: PMC6472697 DOI: 10.21542/gcsp.2019.6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Background: Vector velocity imaging (VVI) is a two-dimensional wall motion tracking method that can measure cardiac mechanics in hypertrophic cardiomyopathy (HCM). 3D-speckle tracking echocardiography (3D-STE) has been proven to be superior to conventional measures in assessment of LV function. The aim of this study was to compare the two technologies in the assessment of LV longitudinal strain (LS) in HCM patients. Methods: A total of 50 patients with HCM were investigated using VVI and 3D-STE in same setting. 3D-STE allows obtaining longitudinal, circumferential, radial and area strains (AS). Values of longitudinal strain (LS) and AS by 3D-STE were compared to VVI- derived analyses. Thereafter, VVI-LS values were correlated with LV phenotype. Last, the variability of VVI versus 3DE strain measurements as well as recorded time of analysis was assessed. Results: The absolute value of 3D-STE LS and AS is significantly higher than VVI-LS (P < 0.0001). VVI provided complete longitudinal LV strain information, similar to 3D-STE. There is excellent agreement between the two technologies-derived values, however, a greater number of segments could be analyzed using VVI (94.7%), compared with 3DE (62.1%). Despite VVI being more time consuming, VVI-LS is more correlated to LV mass index, mitral regurgitation severity and functional class when compared with 3D-STE LS and AS. Conclusions: VVI is a feasible modality for assessing LV longitudinal strain. Although VVI agreed well with 3D-STE for most of regional and global LS, a better correlation was found between VVI-LS and HCM phenotype. It is hypothesized that this discrepancy originates from the inferior imaging quality using 3D tracking algorithms.
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Affiliation(s)
- Hala Mahfouz Badran
- Cardiology Department, Menoufiya University, Egypt.,The BAHCM National Program, Egypt.,Aswan Heart Center, Aswan, Egypt
| | - Naglaa Faheem
- Cardiology Department, Menoufiya University, Egypt.,The BAHCM National Program, Egypt
| | | | | | - Magdi Yacoub
- The BAHCM National Program, Egypt.,Aswan Heart Center, Aswan, Egypt.,Imperial College, London, UK
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Reference values for two-dimensional myocardial strain echocardiography of the left ventricle in healthy children. Cardiol Young 2019; 29:325-337. [PMID: 30777588 DOI: 10.1017/s1047951118002378] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Myocardial deformation by speckle tracking echocardiography provides additional information on left ventricular function. Values of myocardial deformation (strain and strain rate) depend on the type of ultrasound machine and software that is used. Normative values for QLAB (Philips) are scarce, especially for children. It is important to evaluate the influence of age and body size on myocardial deformation parameters, since anthropometrics strongly influence many standard echocardiographic parameters. The aim of this study was to provide comprehensive normal values for myocardial deformation of the left ventricle using a Philips platform and to evaluate the association with anthropometric and standard echocardiographic parameters. METHODS Healthy children between 1 and 18 years of age were prospectively examined using a standard echocardiographic protocol. Short-axis and apical four-chamber, two-chamber, and three-chamber views were used to measure peak systolic circumferential and longitudinal strain and systolic and early diastolic strain rate of the left ventricle using dedicated software. RESULTS A total of 103 children were included with a mean age of 10.8 and inter-quartile range 7.3-14.3 years. Global circumferential strain values (±SD) were -24.2±3.5% at basal, -25.8±3.5% at papillary muscle, and -31.9±6.2% at apex levels. Global left ventricular longitudinal strain values were -20.6±2.6% in apical four-chamber view, -20.9±2.7% in apical two-chamber, and -21.0 ±2.7% in apical three-chamber. Age was associated with longitudinal strain, longitudinal systolic and early diastolic strain rate, but not with circumferential strain. CONCLUSIONS Normal values for left ventricular deformation parameters in children are obtained using a Philips platform. Age partly explains normal variation of strain and strain rate.
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Minatoguchi S, Yoshizane T, Tanaka R, Iwama M, Watanabe T, Sato H, Nagaya M, Ono K, Noda T, Watanabe S, Minatoguchi S, Kawasaki M. Left Ventricular Torsion in Hypertension and Hypertensive Heart Failure ― 3-Dimensional Speckle Tracking Echocardiography Assessment ―. Circ Rep 2019; 1:78-86. [PMID: 33693117 PMCID: PMC7890276 DOI: 10.1253/circrep.cr-19-0001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
Background:
Left ventricular (LV) torsion by contraction of inner and outer oblique muscles contributes to EF. Outer muscle plays a predominant role in torsion. We evaluated the impact of LV remodeling by hypertension (HTN) on torsion using 3-dimensional speckle tracking echocardiography (3D-STE). Methods and Results:
LV strain, strain rate during systole (SR-S) and torsion at endocardium, mid-wall and epicardium were assessed on 3D-STE in 53 controls and 186 HTN patients. Torsion was defined as the difference between apical and basal rotation divided by long axis length. LVEF and strain, SR-S and torsion in all 3 layers in HTN without LV hypertrophy (LVH) were similar to those in controls. LV longitudinal strain at endocardium in HTN with LVH decreased, whereas LVEF was similar to that in controls and, which was associated with increased torsion at epicardium. Reduced LVEF in hypertensive HF was associated with reduced strain, SR-S and torsion in all layers and with LV dilation. On multivariate analysis, epicardial torsion was an independent determinant of LVEF. At epicardial torsion cut-off 0.41, the sensitivity and specificity for the identification of HFrEF were 88% and 68%. Conclusions:
Torsion on 3D-STE may represent a compensatory mechanism to maintain LVEF despite reduced endocardial function, suggesting that the deterioration of torsion caused by insult to outer muscle and dilation may lead to HFrEF.
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Affiliation(s)
| | | | | | - Makoto Iwama
- Department of Cardiology, Gifu Prefectural General Medical Center
| | - Takatomo Watanabe
- Department of Cardiology, Gifu University Graduate School of Medicine
| | | | - Maki Nagaya
- Department of Cardiology, Gifu Prefectural General Medical Center
| | - Koji Ono
- Department of Cardiology, Gifu Prefectural General Medical Center
| | - Toshiyuki Noda
- Department of Cardiology, Gifu Prefectural General Medical Center
| | - Sachiro Watanabe
- Department of Cardiology, Gifu Prefectural General Medical Center
| | | | - Masanori Kawasaki
- Department of Cardiology, Gifu University Graduate School of Medicine
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Van Berendoncks AM, Van Gaal L, De Block C, Buys D, Salgado R, Vrints C, Shivalkar B. Abnormal longitudinal peak systolic strain in asymptomatic patients with type I diabetes mellitus. Echocardiography 2019; 36:478-485. [DOI: 10.1111/echo.14257] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2018] [Revised: 12/16/2018] [Accepted: 12/18/2018] [Indexed: 11/28/2022] Open
Affiliation(s)
| | - Luc Van Gaal
- Department of Endocrinology, Diabetology and Metabolic Diseases; Antwerp University Hospital; Edegem Belgium
| | - Christophe De Block
- Department of Endocrinology, Diabetology and Metabolic Diseases; Antwerp University Hospital; Edegem Belgium
| | - Davy Buys
- Department of Cardiology; Antwerp University Hospital; Edegem Belgium
| | - Rodrigo Salgado
- Department of Radiology; Antwerp University Hospital; Edegem Belgium
| | - Christiaan Vrints
- Department of Cardiology; Antwerp University Hospital; Edegem Belgium
| | - Bharati Shivalkar
- Department of Cardiology; Antwerp University Hospital; Edegem Belgium
- Universiteit Antwerpen; Wilrijk Belgium
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Speckle tracking echocardiography in healthy children: comparison between the QLAB by Philips and the EchoPAC by General Electric. Int J Cardiovasc Imaging 2019; 35:799-809. [DOI: 10.1007/s10554-018-01516-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2018] [Accepted: 12/15/2018] [Indexed: 11/26/2022]
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47
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Altit G, Bhombal S, Chock VY, Tacy TA. Immediate Postnatal Ventricular Performance Is Associated with Mortality in Hypoplastic Left Heart Syndrome. Pediatr Cardiol 2019; 40:168-176. [PMID: 30178190 DOI: 10.1007/s00246-018-1974-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Accepted: 08/29/2018] [Indexed: 11/29/2022]
Abstract
Right ventricular (RV) function as assessed by deformation has been evaluated prenatally and after palliation in hypoplastic left heart syndrome (HLHS). However, limited data exist about the immediate postnatal cardiac adaptation and RV function in HLHS. We compared echocardiographic measures of cardiac performance in HLHS versus controls in their first week of life. As a secondary objective, we evaluated if markers at the first echocardiogram were associated with mid- and long-term outcomes. Clinical and echocardiographic data of patients with HLHS between 2013 and 2016 were reviewed. The study population was matched with controls whose echocardiograms were obtained due to murmur or rule out coarctation. Speckle-tracking echocardiography was used to assess deformation. Thirty-four patients with HLHS and 28 controls were analyzed. Age at echocardiogram was similar between HLHS and controls. The RV of HLHS was compared to both RV and left ventricle (LV) of controls. HLHS deformation parameters [RV peak global longitudinal strain (GLS), global longitudinal strain rate (GLSR)] and tricuspid annular plane systolic excursion (TAPSE) were decreased compared to RV of controls. The LV-fractional area change, peak GLS, GLSR, circumferential strain, and strain rate of controls were higher than the RV of HLHS. Calculated cardiac output (CO) was higher in the HLHS group (592 vs. 183 mL/kg/min, p = 0.0001) but similar to the combined LV and RV output of controls. Later mortality or cardiac transplantation was associated with the RV CO and RV stroke distance at initial echocardiogram. Cox proportional hazard regression determined that restriction at atrial septum, decreased initial RV stroke distance and decreased TAPSE had a higher risk of death or cardiac transplantation. TAPSE and RV stroke distance by velocity time integral had adequate inter-reader variability by Bland-Altman plot and Pearson's correlation. Our study found that the HLHS RV deformation is decreased in the early postnatal period when compared to both LV and RV of controls, but deformation was not associated with mid- and long-term outcomes. Later mortality or cardiac transplantation was associated with decreased initial stroke distance and cardiac output. Early evaluation of patients with HLHS should include an assessment of stroke distance and future research should evaluate its implication in management strategies.
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Affiliation(s)
- Gabriel Altit
- Neonatology, McGill University - Montreal Children's Hospital, Montreal, QC, Canada.
| | - Shazia Bhombal
- Department of Developmental and Neonatal Medicine, Stanford University - Lucile Packard Children's Hospital, Palo Alto, CA, USA
| | - Valerie Y Chock
- Department of Developmental and Neonatal Medicine, Stanford University - Lucile Packard Children's Hospital, Palo Alto, CA, USA
| | - Theresa A Tacy
- Pediatric Cardiology, Stanford University - Lucile Packard Children's Hospital, Palo Alto, CA, USA
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Zhang C, Deng Y, Liu Y, Xu Y, Liu Y, Zhang L, Chen X, Xie M, Ge S. Preclinical cardiovascular changes in children with obesity: A real-time 3-dimensional speckle tracking imaging study. PLoS One 2018; 13:e0205177. [PMID: 30308043 PMCID: PMC6181343 DOI: 10.1371/journal.pone.0205177] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2018] [Accepted: 09/20/2018] [Indexed: 01/17/2023] Open
Abstract
The aims of this study were (1) to quantify changes in 3-dimensional (3D) strain in obese children using real-time 3D echocardiography (RT3DE) and 3D speckle tracking echocardiography (3DSTE), and (2) to investigate the utility of left ventricular (LV) strain variables in measuring early cardiovascular changes in children with obesity. A total of 181 obese children (study group) aged 4–18 years old were prospectively enrolled and compared with 229 healthy subjects (control group). We acquired demographic, clinical, biochemical, and 2D echocardiography/Doppler data. Also, RT3DE and 3DSTE were performed to measure LV volume, left ventricular ejection fraction (LVEF), LV mass (LVM), LV peak systolic global longitudinal strain (GLS), radial strain (GRS), circumferential strain (GCS), and global strain (GS). There were significant differences in anthropometric measurements, blood pressures, Cholesterol, C-reactive protein (CRP), Intima-media thickness (IMT), left atrium end-systolic dimension (LASD), interventricular septal end-diastolic dimension (IVSD), LV posterior wall end-diastolic dimension (LVPWD), LV end-diastolic dimension (LVEDD), LV end-systolic dimension (LVESD), LV end-diastolic volumes (LVEDV), and LV end-systolic volumes (LVESV), E and A velocities, E/A,e’, e’/a’, E/e’, LVM, LV mass index (LVMI), GLS, GRS, GCS, and GS between the study and control groups. The receiver operating characteristic curves (ROC) for the statistically significant echocardiographic variables showed that the range of areas of ROC curves varied from 0.76 (GLS), 0.74 (GRS), 0.72 (LASD), to 0.58 (LVESD), respectively. In conclusion, LV 3D strain variables by RT3DE and 3DSTE decrease in obese children. LV 3D strain is more sensitive than other echocardiographic and vascular ultrasound variables in detecting cardiovascular changes in children with obesity.
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Affiliation(s)
- Chunquan Zhang
- Department of Ultrasound, The Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Yiwen Deng
- Department of Ultrasound, The Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Yanna Liu
- Department of Ultrasound, The Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Yan Xu
- Department of Ultrasound, The Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Yanling Liu
- Department of Pediatrics, The Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Li Zhang
- Department of Ultrasound, Union Hospital, Tongji Medical College of Huazhong University of Science and Technology, Wuhan, China
| | - Xiongwen Chen
- Department of Physiology, Temple University School of Medicine, Philadelphia, PA, United States of America
| | - Mingxing Xie
- Department of Ultrasound, Union Hospital, Tongji Medical College of Huazhong University of Science and Technology, Wuhan, China
| | - Shuping Ge
- The Heart Center, St. Christopher's Hospital for Children and Drexel University College of Medicine, Philadelphia, PA, United States of America
- * E-mail:
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49
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Cote AT, Hosking M, Voss C, Human DG, Sandor GGS, Harris KC. Coronary artery intimal thickening and ventricular dynamics in pediatric heart transplant recipients. CONGENIT HEART DIS 2018; 13:663-670. [DOI: 10.1111/chd.12629] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2017] [Revised: 05/18/2018] [Accepted: 05/21/2018] [Indexed: 11/26/2022]
Affiliation(s)
- Anita T. Cote
- Department of Pediatrics; University of British Columbia & British Columbia Children’s Hospital Research Institute; Vancouver Canada
- School of Human Kinetics; Trinity Western University; Langley Canada
| | - Martin Hosking
- British Columbia Children’s Hospital, Children’s Heart Centre; Vancouver Canada
| | - Christine Voss
- Department of Pediatrics; University of British Columbia & British Columbia Children’s Hospital Research Institute; Vancouver Canada
- British Columbia Children’s Hospital, Children’s Heart Centre; Vancouver Canada
| | - Derek G Human
- British Columbia Children’s Hospital, Children’s Heart Centre; Vancouver Canada
| | - George G. S. Sandor
- Department of Pediatrics; University of British Columbia & British Columbia Children’s Hospital Research Institute; Vancouver Canada
- British Columbia Children’s Hospital, Children’s Heart Centre; Vancouver Canada
| | - Kevin C. Harris
- Department of Pediatrics; University of British Columbia & British Columbia Children’s Hospital Research Institute; Vancouver Canada
- British Columbia Children’s Hospital, Children’s Heart Centre; Vancouver Canada
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50
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Godown J, Dodd DA, Stanley M, Havens C, Xu M, Slaughter JC, Bearl DW, Soslow JH. Changes in left ventricular strain parameters following pediatric heart transplantation. Pediatr Transplant 2018; 22:e13166. [PMID: 29575396 PMCID: PMC6047919 DOI: 10.1111/petr.13166] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/19/2018] [Indexed: 11/30/2022]
Abstract
STE is increasingly utilized to assess strain in a variety of pathologies. Strain measurements have demonstrated utility following HTx and may aid in the detection of rejection and CAV. Strain parameters have not been well defined in the pediatric HTx population. This study aimed to describe strain in pediatric HTx recipients compared to controls and assess changes over time. All pediatric HTx recipients with available echocardiograms (2004-2015) without rejection or CAV were identified. Longitudinal and circumferential strain was measured at <1 month, 1 year, 3 years, and 5 years post-transplant and compared to controls. A total of 218 echocardiograms were analyzed in 79 HTx recipients. At <1 month post-transplant, there was a significant decrement in longitudinal strain (GLS -14.6 vs -19.2, P < .001) with concurrent augmentation of circumferential strain (GCS -27.3 vs -24.3, P = .005). By 1 year post-HTx, all strain parameters normalized and were not significantly different from the control population. In the absence of graft complications, strain parameters did not change up to 5 years post-transplant. Abnormal longitudinal strain parameters are present in the early post-HTx period with a compensatory increase in circumferential strain. These changes normalize by 1 year post-transplant and do not change over time in the absence of graft complications.
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Affiliation(s)
- Justin Godown
- Pediatric Cardiology, Monroe Carell Jr. Children's Hospital, Nashville, TN
| | - Debra A. Dodd
- Pediatric Cardiology, Monroe Carell Jr. Children's Hospital, Nashville, TN
| | - Michael Stanley
- Pediatric Cardiology, Monroe Carell Jr. Children's Hospital, Nashville, TN
| | - Corey Havens
- Pediatric Cardiology, Monroe Carell Jr. Children's Hospital, Nashville, TN
| | - Meng Xu
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN
| | - James C. Slaughter
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN
| | - David W. Bearl
- Pediatric Cardiology, Monroe Carell Jr. Children's Hospital, Nashville, TN
| | - Jonathan H. Soslow
- Pediatric Cardiology, Monroe Carell Jr. Children's Hospital, Nashville, TN
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