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Özde Ş, Kayapınar O, Doğru M, Aktüre G, Kaya A, Coşkun G, Keskin M, Özde C. Evaluation of the Early Effects of Childhood Asthma and Its Treatment on Cardiac Function as Revealed by Two-Dimensional Speckle-Tracking Echocardiography. Pediatr Cardiol 2024; 45:858-866. [PMID: 36038783 DOI: 10.1007/s00246-022-02941-w] [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: 01/18/2022] [Accepted: 05/16/2022] [Indexed: 11/24/2022]
Abstract
There is minimal information available regarding the early effects of bronchial asthma (BA) and its treatment on cardiac function in children. We used two-dimensional speckle-tracking echocardiography (2D-STE) to evaluate cardiac function before and after the treatment of childhood BA. We enrolled 44 children with moderate and severe BA who had not been treated over the preceding 3 months or who were newly diagnosed. All children received the same treatment (that recommended by the Global Initiative for Asthma [GINA] in 2017). All children also underwent transthoracic 2D-STE before treatment and 6 months later. Clinical data were compared before and after treatment. After treatment, significant increases were evident in right ventricular (RV) systolic and diastolic strain, as well as the systolic strain rate. Before and after treatment, the RV global longitudinal systolic strains were - 22.8 ± 3.6 and - 25.1 ± 4.5, respectively (p = 0.036); the RV global longitudinal diastolic strains were - 18.5 ± 6.0 and - 21.5 ± 5.2, respectively (p = 0.038); and the RV systolic strain rates were - 1.26 ± 0.4 and - 1.12 ± 0.3, respectively (p = 0.025). After treatment, significant increases were observed in the right atrial (RA) peak longitudinal strain and strain rate. Before and after treatment, the RA peak atrial longitudinal strains were 32.5 ± 10.8 and 44.7 ± 11.2, respectively (p = 0.042) and the RA longitudinal strain rates were - 1.6 ± 0.3 and - 2.0 ± 0.5, respectively (p = 0.041). RV and RA subclinical dysfunction may develop in children with early-stage BA. However, asthma treatment appears to improve such dysfunction. In children with BA, clinical and subclinical changes in cardiac functions can be easily detected via 2D-STE.
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Affiliation(s)
| | | | | | | | - Adnan Kaya
- Duzce Universitesi Tip Fakultesi, Duzce, Turkey
| | | | | | - Cem Özde
- Duzce Universitesi Tip Fakultesi, Duzce, Turkey
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Besci Ö, Akçura YD, Acinikli KY, Kağızmanlı GA, Demir K, Böber E, Kır M, Abacı A. Aromatase Inhibitors May Increase the Risk of Cardiometabolic Complications in Adolescent Boys. Pediatr Cardiol 2024; 45:228-239. [PMID: 37544952 DOI: 10.1007/s00246-023-03260-4] [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: 04/14/2023] [Accepted: 07/30/2023] [Indexed: 08/08/2023]
Abstract
INTRODUCTION Aromatase inhibitors (AIs) are increasingly used in children and adolescents to augment adult height. The aim of this study was to investigate the effects AIs have on cardiac morphology, functions and their relation to several metabolic parameters in adolescent boys. METHODS Three groups matched for sex (boys, n = 67), age (median age 13.5 years), weight, height, body mass index, and puberty stages were enrolled: (i) Group 1: 23 patients using AIs (only AI (n = 6) or in combination with growth hormone (GH) (n = 17)) for at least 6 months; (ii) Group 2: 22 patients using only GH, and (iii) Group 3: 22 healthy boys. Two-dimensional, M-mode conventional Doppler and tissue Doppler examinations of the left ventricle (LV) were performed. Bioelectrical bioimpedance analyses was conducted and follicle-stimulating hormone, luteinizing hormone, total testosterone, lipid, and hemogram parameters were obtained. RESULTS Patients in Group 1 had significantly higher serum total testosterone (p < 0.001) and hemoglobin (p < 0.001) levels, fat free mass (p = 0.005), LV mass (LVM) (p = 0.002), as well as increased LV posterior wall diameter (LVPWD) (p = 0.002), interventricular septum diameter (IVSD) (p = 0.019), and myocardial systolic wave velocity (Sm) (p = 0.020) compared to the two other control groups. No significant differences were observed in terms of diastolic and systolic functions and lipid profiles (p > 0.05). There were positive correlations between total testosterone, hemoglobin levels, LVM, LVPWD and IVSD (p < 0.05). CONCLUSION Increased LVM, LVPWD, IVSD and Sm of patients receiving AI therapy in comparison to the control groups, and the significant correlations of these parameters with total testosterone and hemoglobin levels were determined as potential side effects of AIs. These findings emphasize the need of routine cardiac follow-up in patients using AIs.
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Affiliation(s)
- Özge Besci
- Division of Pediatric Endocrinology, Faculty of Medicine, Dokuz Eylül University, Inciraltı-Balcova, İzmir, 35340, Turkey
| | - Yağmur Damla Akçura
- Division of Pediatric Cardiology, Faculty of Medicine, Dokuz Eylül University, İzmir, Turkey
| | - Kübra Yüksek Acinikli
- Division of Pediatric Endocrinology, Faculty of Medicine, Dokuz Eylül University, Inciraltı-Balcova, İzmir, 35340, Turkey
| | - Gözde Akın Kağızmanlı
- Division of Pediatric Endocrinology, Faculty of Medicine, Dokuz Eylül University, Inciraltı-Balcova, İzmir, 35340, Turkey
| | - Korcan Demir
- Division of Pediatric Endocrinology, Faculty of Medicine, Dokuz Eylül University, Inciraltı-Balcova, İzmir, 35340, Turkey
| | - Ece Böber
- Division of Pediatric Endocrinology, Faculty of Medicine, Dokuz Eylül University, Inciraltı-Balcova, İzmir, 35340, Turkey
| | - Mustafa Kır
- Division of Pediatric Cardiology, Faculty of Medicine, Dokuz Eylül University, İzmir, Turkey
| | - Ayhan Abacı
- Division of Pediatric Endocrinology, Faculty of Medicine, Dokuz Eylül University, Inciraltı-Balcova, İzmir, 35340, Turkey.
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Wagdy R, El-Deriny G. Evaluation of cardiac function in asthmatic children by Tissue Doppler Echocardiography. Egypt Heart J 2023; 75:38. [PMID: 37133715 PMCID: PMC10156881 DOI: 10.1186/s43044-023-00363-4] [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: 09/06/2022] [Accepted: 04/25/2023] [Indexed: 05/04/2023] Open
Abstract
BACKGROUND Bronchial asthma is a global health problem with rising prevalence in developing countries. Children with severe asthma can experience cor pulmonale later in life, but little is known about the cardiac changes that might be present earlier in mild or moderate severity of disease. This study aimed to evaluate biventricular function among children suffering from persistent asthma by Tissue Doppler Echocardiography (TDE). RESULTS Thirty-five asthmatic children enrolled from Alexandria Children's Hospital between September 2021 to May 2022; they were compared to 35 healthy matched children. Chronic respiratory disease, cardiac disease, or other comorbidities were excluded. The mean age of cases was 8.87 ± 2.03 years with a male/female ratio of 54.3%:45.7%. There were 28.3% mild cases, 45.7% moderate, and 25.7% severe. Conventional echocardiographic variables of cardiac function were normal for both ventricles. The TDE indices of medial mitral annulus (S' velocity and peak E') were significantly reduced (14.55 ± 2.30 and 14.69 ± 2.30) versus controls (15.68 ± 1.96, 15.69 ± 1.76, P; 0.044, P < 0.0045) but with preserved LV function. The lateral tricuspid annulus (S' velocity and peak E') was significantly reduced (11.53 ± 3.24 and 11.56 ± 3.18) versus controls (15.71 ± 0.98, 16.02 ± 1.75, < 0.001*), while E/A and IVRT were significantly increased (1.49 ± 0.06 versus 1.70 ± 0.18 and 102.39 ± 5.37 versus 140.10 ± 34.35, respectively, P < 0.001*) with impaired RV function. Peak expiratory flow rate (PEFR) was negatively correlated with the IVRT of the tricuspid annulus (P = 0.002, r = -0.503*) and to the E'/A' (P = 0.036, r =-0.355*). All TDE variables of lateral tricuspid annulus of severe subgroups were significantly changed versus moderate or mild subgroups. CONCLUSIONS Tissue Doppler echocardiography is the recommended modality for early detection of biventricular cardiac dysfunction among children with different levels of asthma severity. Periodic screening is advised through the use of IVRT especially for RV.
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Affiliation(s)
- Reham Wagdy
- Department of Pediatrics, Faculty of Medicne, Alexandria University, Alexandria, Egypt.
| | - Ghada El-Deriny
- Department of Pediatrics, Faculty of Medicne, Alexandria University, Alexandria, Egypt
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Karakaya Z, Cavkaytar Ö, Tosun Ö, Arga M. Subclinical cardiovascular dysfunction in children and adolescents with asthma. J Asthma 2020; 59:451-461. [PMID: 33251886 DOI: 10.1080/02770903.2020.1856866] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
BACKGROUND There is close association between asthma and cardiovascular functions as both diseases share common inflammatory pathways. The current study was aimed at investigating the risk factors, associated with endothelial and cardiac functions in children with newly-diagnosed mild-persistent asthma. METHODS A total of 33 steroid-naive asthmatic children [median(interquartile-range); 9.1 years(7.8-13.5)] and 16 healthy controls [11.5 years(9.9-13.6)] were included. Their demographic, clinical and laboratory findings were recorded. Carotid Artery intima-media thickness (CIMT), stiffness, distensibility and strain were measured as atheroclerosis markers. Conventional and tissue Doppler imaging was performed to evaluate ventricular function. RESULTS The patients with asthma had higher CIMT and stiffness and lower strain and distensibility compared to controls (p < 0.001 for all). There was a significant correlation between the duration of asthmatic symptoms and subclinical-atherosclerosis as well as peripheral eosinophil count (p < 0.001, p < 0.05). The patients had lower tricuspid-annular-plane-systolic-excursion (TAPSE), ejection time, and higher isovolumetric relaxation time (IRT), isovolumetric contraction time (ICT), and left ventricle myocardial performance index (LVMPI) than the control subjects (p < 0.001 for all). A positive correlation was also observed between the duration of asthmatic-symptoms and cardiac-function parameters. CONCLUSION Children with mild persistent asthma had subclinical atherosclerosis and ventricular dysfunction even in the early stage of disease. Symptom duration was closely associated with both subclinical atherosclerosis and ventricular dysfunction. Myocardial performance index was abnormal in the asthmatic children when assessed by tissue Doppler Imaging even though they had normal ejection fraction in conventional echocardiography. Future prospective studies with larger sample sizes are needed to confirm these findings and to assess the possible protective effect of ICSs in the prevention of subclinical atherosclerosis.
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Affiliation(s)
- Zeynep Karakaya
- Department of Pediatrics, Istanbul Medeniyet University Medical Faculty, İstanbul, Turkey
| | - Özlem Cavkaytar
- Department of Pediatric Allergy and Immunology, Istanbul Medeniyet University Medical Faculty, İstanbul, Turkey
| | - Öykü Tosun
- Department of Pediatric Cardiology, Istanbul Medeniyet University Medical Faculty, İstanbul, Turkey
| | - Mustafa Arga
- Department of Pediatric Allergy and Immunology, Istanbul Medeniyet University Medical Faculty, İstanbul, Turkey
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Baysal SS, Has M. Assessment of biventricular function with speckle tracking echocardiography in newly-diagnosed adult-onset asthma. J Asthma 2020; 59:306-314. [PMID: 33158387 DOI: 10.1080/02770903.2020.1847928] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVE There is limited number of studies on the effect of asthma disease on cardiac functions. The aim of this study was to investigate if there was any association between adult onset asthma and cardiac dysfunction. METHODS Total of 83 nonsmoking adult onset asthma patients aged between 18 and 65, and 83 control subjects with comparable age and sex distribution were included in the study.None of the subjects had any chronic cardiovascular or systemic diseases.Two-dimensional, M-mode and tissue Doppler examinations were performed. STE analysis was obtained using the QLAB software. Complete blood count and high-sensitive C-reactive protein (hsCRP) levels were measured. RESULTS There was no difference between two groups in terms of standard echocardiography and Doppler parameters. While tricuspid annular plane systolic excursion (TAPSE) was observed to be lower in asthmatics (24.9 ± 2.0 vs. 25.5 ± 2.1, p = 0.043), right ventricular myocardial performance index (RV MPI) was higher (0.36 ± 0.07 vs 0.32 ± 0.06, p˂0.001). There was no significant difference between the groups in terms of left ventricular STE parameters. Measurements of right ventricular global longitudinal strain (RVGLS) and right ventricular free wall strain (RVfree) were observed to be lower in the asthma group (-20.3 ± 2.9 vs -21.5 ± 2.9, p = 0.007; -24.0 ± 3.0 vs 25.1 ± 2.9, p = 0.009, respectively). CONCLUSION -We demonstrated that while adult onset mild-stage asthma patients have normal parameters in standard echocardiography, they have reduced right ventricular functions by STE.
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Affiliation(s)
- Sadettin Selçuk Baysal
- Cardiology Deparment, Şanlıurfa Mehmet Akif İnan Training and Research Hospital, Şanlıurfa, Turkey
| | - Mehmet Has
- Deparment of Allergy and Respiratory Diseases, Şanlıurfa Mehmet Akif İnan Training and Research Hospital, Şanlıurfa, Turkey
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Prognostic role of bronchial asthma in patients with heart failure. Heart Vessels 2020; 35:808-816. [PMID: 31970511 DOI: 10.1007/s00380-020-01555-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Accepted: 01/10/2020] [Indexed: 12/25/2022]
Abstract
There are few reports investigating the relationship between bronchial asthma (BA) and heart failure (HF). We hypothesized BA may have impact on prognosis in patients with HF. Among 323 consecutive outpatients with HF, 191 patients without chronic obstructive pulmonary disease were analyzed. Twenty patients had BA, most of whom (80.0%) had preserved left ventricular ejection fraction (LVEF ≥ 50%). The use of β-blockers was less frequent (55.0% vs 83.0%. p = 0.01), systolic blood pressure (133 ± 22 vs 120 ± 17 mmHg, p = 0.003), and heart rate (83 ± 14 vs 74 ± 15 bpm, p = 0.02) were higher in patients with BA than those without BA. During median follow up of 24 months, 45 (23.6%) experienced primary outcome defined as a composite of all-cause death, nonfatal myocardial infarction, nonfatal ischemic stroke, and unexpected hospitalization due to HF. Multivariate Cox regression analysis revealed that the presence of BA was independently associated with the occurrence of primary outcome (hazard ratio 3.08, 95% CI 1.42-6.71, p = 0.004). In the subgroup analysis of patients with preserved LVEF, patients with BA exhibited worse outcomes (p = 0.03 by log-rank). Patients with HF complicated by BA, most of whom had preserved LVEF, exhibited worse outcomes than those without BA.
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Abdelmohsen G, Mohamed H, Mohsen M, Abdelaziz O, Ahmed D, Abdelsalam M, Dohain A. Evaluation of cardiac function in pediatric patients with mild to moderate bronchial asthma in the era of cardiac strain imaging. Pediatr Pulmonol 2019; 54:1905-1913. [PMID: 31424175 DOI: 10.1002/ppul.24485] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2019] [Accepted: 08/05/2019] [Indexed: 12/22/2022]
Abstract
OBJECTIVE Bronchial asthma is a common chronic inflammatory airway disease, which may be associated with pulmonary hypertension and cardiac dysfunction. The aim of this study was to evaluate the ability of 2D-speckle tracking echocardiography (2D-STE) and tissue doppler imaging (TDI) to detect subtle cardiac dysfunction in pediatric patients with mild to moderate bronchial asthma. METHODOLOGY The study included 30 children with mild to moderate bronchial asthma and 27 age-matched healthy controls. Both groups underwent pulmonary function tests, TDI and 2D-STE. Myocardial performance index (MPI), S', E', A' velocities, global strain of left ventricle (LV), right ventricle (RV), and right atrium (RA) were measured. RESULTS RV diastolic function was impaired in the patient group, as the tricuspid E' velocity was significantly lower in the patients when compared with the controls (16 [14-17] vs 16 [17-19] cm/s, P = .044), while the RV-MPI was significantly higher in patients when compared to controls (0.30 [0.27-0.36] vs 0.30 [0.30-0.30], P = .001). The global RV longitudinal strain, RA strain, and LV strain did not show significant differences between the test and the control groups. RV systolic parameters and LV systolic and diastolic parameters did not differ significantly between the two groups. CONCLUSION Pediatric patients with mild to moderate bronchial asthma may have early RV diastolic dysfunction with preserved other cardiac functions.
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Affiliation(s)
- Gaser Abdelmohsen
- Pediatric Cardiology Division, Department of Pediatrics, Cairo University, Cairo, Egypt
| | - Hossam Mohamed
- Pediatric Cardiology Division, Department of Pediatrics, Cairo University, Cairo, Egypt
| | - Mona Mohsen
- Pediatric Pulmonology Division, Department of Pediatrics, Cairo University, Cairo, Egypt
| | - Osama Abdelaziz
- Pediatric Cardiology Division, Department of Pediatrics, Cairo University, Cairo, Egypt
| | - Doaa Ahmed
- Pediatric Pulmonology Division, Department of Pediatrics, Cairo University, Cairo, Egypt
| | | | - Ahmed Dohain
- Pediatric Cardiology Division, Department of Pediatrics, Cairo University, Cairo, Egypt
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Elseify MY, Alsharkawy AA, Al-Fahham MM, ElHady MM. Assessment of lateral mitral, septal and tricuspid myocardial performance indices by tissue Doppler imaging in asthmatic children. CLINICAL RESPIRATORY JOURNAL 2019; 12:2676-2682. [PMID: 30471203 DOI: 10.1111/crj.12974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Revised: 10/04/2018] [Accepted: 11/17/2018] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Recurrent hypoxia makes asthmatics at risk for pulmonary hypertension and ventricular dysfunction. Early stages of these cardiovascular diseases cannot be detected by conventional echocardiography. Tissue Doppler imaging has been introduced recently as a more sensitive and more accurate tool for investigating cardiovascular diseases. OBJECTIVE Investigating ventricular functions in asymptomatic asthmatic children using tissue Doppler echocardiography. METHOD Fifty asthmatic children and 50 controls were examined by conventional echocrdiography. Tissue Doppler echocardiography was performed to measure the myocardial performance (Tei) index at the lateral mitral, septal and tricuspid annuli. RESULTS Septal Tei indices among patients and uncontrolled asthmatics were significantly higher than healthy subjects and controlled asthmatics, respectively (P < 0.05). Septal and tricuspid Tei indices were significantly higher among severe asthmatics and patients with concomitant nasal allergy than those with mild asthma and those without concomitant nasal allergy, respectively (P < 0.05). Septal Tei index correlated negatively with daily inhaled corticosteroid dose (r = -0.412, P = 0.003) and forced expiratory volume in the 1st second/forced vital capacity (r = -0.877, P < 0.001). Lateral Tei index correlated positively with the patient age (r = 0.312, P = 0.027) and duration of asthma (r = 0.359, P = 0.011). CONCLUSION Tei index can detect subclinical ventricular dysfunction in asthmatics and is affected by asthma duration, control and severity. It can be used for future scoring of asthma severity. Septal annulus seems to be the best location for assessing Tei index in asthmatics.
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Affiliation(s)
- Magda Yehia Elseify
- Department of Pediatrics, Faculty of Medicine, Ain Shams University, Cairo, Egypt
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Ozde C, Dogru M, Ozde Ş, Kayapinar O, Kaya A, Korkmaz A. Subclinical right ventricular dysfunction in intermittent and persistent mildly asthmatic children on tissue Doppler echocardiography and serum NT-proBNP: Observational study. Pediatr Int 2018; 60:1024-1032. [PMID: 30179288 DOI: 10.1111/ped.13689] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2018] [Revised: 07/26/2018] [Accepted: 08/30/2018] [Indexed: 11/29/2022]
Abstract
BACKGROUND Bronchial asthma may lead to pulmonary hypertension, right ventricular (RV) dysfunction, and cor pulmonale due to elevated afterload on the RV later in life. The aim of this study was to determine whether serum N-terminal pro-B-type natriuretic peptide (NT-proBNP) might serve as a biomarker for detecting subclinical RV dysfunction using echocardiography during the early stages of bronchial asthma. METHODS Sixty-eight pediatric patients with asthma (asthma group) and 69 age- and sex-matched healthy children (control group) were enrolled. The study was conducted in a tertiary woman and child diseases education and research hospital from January 2013 to December 2013. RV function (2-D and tissue-Doppler echocardiography), pulmonary function (spirometry) and serum NT-proBNP concentration were evaluated. RESULTS Mean age was 10.5 ± 2.8 years in the asthma group and 10.2 ± 2.7 years in the control group (P = 0.522). RV diastolic function was significantly decreased in the asthma group (ratio of tricuspid lateral annular early diastolic peak velocity to tricuspid lateral annular late diastolic peak velocity [E'/A'], 1.29 ± 0.68 vs 1.74 ± 0.89, P = 0.001). RV myocardial performance index was significantly higher in the asthma group than in the control group (0.28 ± 0.06 vs 0.24 ± 0.07, respectively; P = 0.003). Finally, serum NT-proBNP concentration was significantly higher in the asthma group than in the control group (292.3 ± 142.2 pg/mL vs 208.2 ± 70.1 pg/mL, respectively; P = 0.003). CONCLUSION Increased serum NT-proBNP is associated with subclinical RV dysfunction in asthmatic children. RV function is significantly affected in children with bronchial asthma.
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Affiliation(s)
- Cem Ozde
- Department of Cardiology, Düzce University Faculty of Medicine, Düzce, Turkey
| | - Mahmut Dogru
- Department of Pediatric Allergy İmmunology and Pulmonology, Zeynep Kamil Woman and Child Diseases Education and Research Hospital, Istanbul, Turkey
| | - Şükriye Ozde
- Department of Pediatrics, Çankırı State Hospital, Çankırı, Turkey
| | - Osman Kayapinar
- Department of Cardiology, Düzce University Faculty of Medicine, Düzce, Turkey
| | - Adnan Kaya
- Department of Cardiology, Düzce University Faculty of Medicine, Düzce, Turkey
| | - Ahmet Korkmaz
- Department of Cardiology, Ankara Numune Education and Research Hospital, Ankara, Turkey
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De-Paula CR, Magalhães GS, Jentzsch NS, Botelho CF, Mota CDCC, Murça TM, Ramalho LFC, Tan TC, Capuruço CAB, Rodrigues-Machado MDG. Echocardiographic Assessment of Ventricular Function in Young Patients with Asthma. Arq Bras Cardiol 2018; 110:231-239. [PMID: 29694547 PMCID: PMC5898772 DOI: 10.5935/abc.20180052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2016] [Accepted: 11/16/2017] [Indexed: 11/20/2022] Open
Abstract
Background Despite significant advances in understanding the pathophysiology and
management of asthma, some of systemic effects of asthma are still not well
defined. Objectives To compare heart function, baseline physical activity level, and functional
exercise capacity in young patients with mild-to-moderate asthma and healthy
controls. Methods Eighteen healthy (12.67 ± 0.39 years) and 20 asthmatics (12.0 ±
0.38 years) patients were enrolled in the study. Echocardiography parameters
were evaluated using conventional and tissue Doppler imaging (TDI). Results Although pulmonary acceleration time (PAT) and pulmonary artery systolic
pressure (PASP) were within normal limits, these parameters differed
significantly between the control and asthmatic groups. PAT was lower (p
< 0.0001) and PASP (p < 0.0002) was higher in the asthma group (114.3
± 3.70 ms and 25.40 ± 0.54 mmHg) than the control group
(135.30 ± 2.28 ms and 22.22 ± 0.40 mmHg). The asthmatic group
had significantly lower early diastolic myocardial velocity (E', p = 0.0047)
and lower E' to late (E'/A', p = 0.0017) (13.75 ± 0.53 cm/s and 1.70
± 0.09, respectively) compared with control group (15.71 ±
0.34 cm/s and 2.12 ± 0.08, respectively) at tricuspid valve. In the
lateral mitral valve tissue Doppler, the asthmatic group had lower E'
compared with control group (p = 0.0466; 13.27 ± 0.43 cm/s and 14.32
± 0.25 cm/s, respectively), but there was no statistic difference in
the E'/A' ratio (p = 0.1161). Right isovolumetric relaxation time was higher
(p = 0.0007) in asthmatic (57.15 ± 0.97 ms) than the control group
(52.28 ± 0.87 ms), reflecting global myocardial dysfunction. The
right and left myocardial performance indexes were significantly higher in
the asthmatic (0.43 ± 0.01 and 0.37 ± 0.01, respectively)
compared with control group (0.40 ± 0.01 and 0.34 ± 0.01,
respectively) (p = 0.0383 and p = 0.0059, respectively). Physical activity
level, and distance travelled on the six-minute walk test were similar in
both groups. Conclusion Changes in echocardiographic parameters, evaluated by conventional and TDI,
were observed in mild-to-moderate asthma patients even with normal
functional exercise capacity and baseline physical activity level. Our
results suggest that the echocardiogram may be useful for the early
detection and evoluation of asthma-induced cardiac changes.
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Affiliation(s)
| | | | | | | | | | | | | | - Timothy C Tan
- Westmead Hospital, Faculty of Medicine, University of Sydney, Sidney, Australia
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Akyüz Özkan E, Khosroshahi HE. Evaluation of the left and right ventricular systolic and diastolic function in asthmatic children. BMC Cardiovasc Disord 2016; 16:145. [PMID: 27391475 PMCID: PMC4939042 DOI: 10.1186/s12872-016-0328-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2015] [Accepted: 06/24/2016] [Indexed: 01/20/2023] Open
Abstract
Background Asthma is the most common cause of respiratory disorders among children. We aimed to investigate left (LV) and right (RV) ventricular function in asthmatic children as detected by conventional and tissue Doppler echocardiography. Methods Fifty pediatric patients with asthma and forty healthy children were studied. Pulmonary function tests, electrocardiography and echocardiographic examinations were performed on all children. Results Rate-corrected velocity of circumferential fiber shortening (VCFc) (p = 0.044), the ratio between heights of early and late diastolic flow velocity peaks (E/A) (p = 0.019) and LV end-systolic wall stress (ESWSm) was lower (p = 0.003), RV stroke volume (SV) (p = 0.002), LV SV (p = 0.001), tricuspid annular plane systolic excursion (TAPSE) (p = 0.034), tricuspid annular peak velocity during systole (S’) (p = 0.022), tricuspid and mitral early diastolic velocities (E’) (p = 0.012, p = 0.003 respectively) were lower in asthmatic children than controls. The mitral valve ejection time (ET) was high in asthmatic group (p = 0.027). FEV1 was positively correlated with isovolumetric relaxation time (IVRT) (p = 0.018) (r = 0.382) and mitral ET (p = 0.018) (r = 0.381). PEF was negatively correlated with the RV work index (p = 0.032) (r = -0.348) and LV work index (p = 0.005) (r = -0.457). Conclusion Although cardiac systolic function was found to be impaired in asthmatic patients, contrary to the literature, diastolic dysfunction was not observed in these patients, even by tissue Doppler imaging, and this finding may be attributed to using inhaled corticosteroid
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Affiliation(s)
- Esra Akyüz Özkan
- Department of Pediatrics, Bozok University Medical Faculty, Yozgat, Turkey.
| | - Hashem E Khosroshahi
- Department of Pediatric Cardiology, Bozok University Medical Faculty, Yozgat, Turkey
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Joshi S, Wilson DG, Kotecha S, Pickerd N, Fraser AG, Kotecha S. Cardiovascular function in children who had chronic lung disease of prematurity. Arch Dis Child Fetal Neonatal Ed 2014; 99:F373-9. [PMID: 24928255 DOI: 10.1136/archdischild-2013-305185] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES Although increased pulmonary arterial pressure is common in infancy in preterm infants who develop chronic lung disease of prematurity (CLD), it is unknown if the increase persists into childhood. We, therefore, assessed if 8-12-year-old children with documented CLD in infancy had evidence of right ventricular dysfunction or pulmonary arterial hypertension at rest or in response to acute hypoxia when compared to preterm and term-born controls. METHODS We studied 90 children: 60 born at ≤32 weeks of gestation (28 with CLD and 32 preterm controls), and 30 term-born controls. All had echocardiography including myocardial velocity imaging, at rest and while breathing 15% oxygen and 12% oxygen for 20 min each. RESULTS Baseline oxygen saturation, heart rate, blood pressure and echocardiographic markers of left and right ventricular function were similar in all three groups. While breathing 12% oxygen, the oxygen saturation decreased to 81.9% in the CLD group compared to 85.1% (p<0.05) and 84.7% (p<0.01) in the preterm and term controls, respectively. In response to hypoxia, all three groups showed increases in velocity of tricuspid regurgitation, end-diastolic velocity of pulmonary regurgitation, and right ventricular relaxation time; and decreases in pulmonary arterial acceleration time and the ratio of right ventricular acceleration time to ejection time. However, there were no differences between groups. CONCLUSIONS Childhood survivors of CLD have comparable left and right ventricular function at 8-12 years of age to preterm and term-born children, and no evidence of increased pulmonary arterial pressure even after hypoxic exposure.
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Affiliation(s)
- Suchita Joshi
- Department of Child Health, Cardiff University, Cardiff, UK
| | - Dirk G Wilson
- Department of Paediatric Cardiology, University Hospital of Wales, Cardiff, UK
| | - Sarah Kotecha
- Department of Child Health, Cardiff University, Cardiff, UK
| | - Nicole Pickerd
- Department of Child Health, Cardiff University, Cardiff, UK
| | - Alan G Fraser
- Wales Heart Research Institute, Cardiff University, Cardiff, UK
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Sobhy K, El-Korashy R, Ahmed M, Fayed F. Right ventricular diastolic dysfunction in asthmatic patients. EGYPTIAN JOURNAL OF CHEST DISEASES AND TUBERCULOSIS 2014. [DOI: 10.1016/j.ejcdt.2013.09.017] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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14
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Ozdemir O, Ceylan Y, Razi CH, Ceylan O, Andiran N. Assessment of ventricular functions by tissue Doppler echocardiography in children with asthma. Pediatr Cardiol 2013; 34:553-9. [PMID: 22965765 DOI: 10.1007/s00246-012-0493-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2012] [Accepted: 08/10/2012] [Indexed: 01/03/2023]
Abstract
Patients with asthma develop pulmonary hypertension due to recurrent hypoxia and chronic inflammation, leading to right heart enlargement with ventricular hypertrophy. Patients with severe asthma can experience cor pulmonale later in life, but little is known about ventricular function during the early stages of the disease. This study aimed to investigate ventricular functions in asymptomatic children with asthma as detected by conventional echocardiography and tissue Doppler echocardiography (TDE). Fifty-one pediatric patients (mean age 10.4 ± 2.2 years) with asthma and 46 age- and sex-matched healthy children (mean age 10.9 ± 2.4 years) were studied. All subjects were examined by conventional echocardiography and TDE, and they had pulmonary function tests on spirometry. The right-ventricular (RV) wall was statistically (p = 0.01) thicker among asthmatic patients (4.7 ± 1.5 mm) compared with healthy children (3.6 ± 0.4 mm). However, conventional pulsed-Doppler indices of both ventricles did not differ significantly between asthmatic patients and healthy children (p > 0.05). The results of TDE examining RV diastolic function showed that annular peak velocity during early diastole (E'), annular peak velocity during late diastole (A') (16.4 ± 1.8 and 5.1 ± 1.4 cm/s, respectively), E'/A' ratio (3.2 ± 0.7), isovolumetric relaxation time (67.7 ± 10.2 ms) and myocardial performance index (48.1 % ± 7.0 %) of the lateral tricuspid annulus among asthmatic patients differed significantly (p = 0.01) from those of healthy children (13.2 ± 2.3, 8.2 ± 2.0 cm/s, 1.6 ± 0.5, 46.2 ± 8.7 ms, and 42.0 % ± 5.7 %, respectively). Only peak expiratory flow (PEF) rate from the pulmonary function tests was negatively correlated with the E'/A' ratio of the tricuspid annulus (r = -0.38, p = 0.01). This study showed that although the findings of clinical and conventional echocardiography were apparently normal in children with asthma, TDE showed subclinical dysfunction of the right ventricle, which is negatively correlated with PEF. These findings signify the diagnostic value of TDE in the early detection and monitoring of such deleterious effects among asthmatic patients.
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Affiliation(s)
- Osman Ozdemir
- Department of Pediatric Cardiology, Kecioren Training and Research Hospital, Ankara, Turkey.
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15
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Koroglu OA, Yalaz M, Levent E, Akisu M, Kültürsay N. Cardiovascular consequences of bronchopulmonary dysplasia in prematurely born preschool children. Neonatology 2013; 104:283-9. [PMID: 24107436 DOI: 10.1159/000354542] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2013] [Accepted: 07/01/2013] [Indexed: 11/19/2022]
Abstract
BACKGROUND A limited number of studies have reported various short-term cardiovascular changes in bronchopulmonary dysplasia (BPD) patients in the postsurfactant era. Little is known about the course of these changes in children with BPD. OBJECTIVES It was the aim of this study to investigate cardiovascular consequences of BPD at preschool ages and to find out possible risk factors related to cardiovascular sequelae. METHODS Prematurely born children with (n = 21) and without BPD (n = 20) were evaluated with conventional and myocardial tissue Doppler echocardiography at the age of 2-4 years. RESULTS BPD patients had a decreased pulmonary artery acceleration time and higher left and right ventricular myocardial performance indexes, consistent with higher pulmonary pressures and impaired biventricular systolic and diastolic functions at preschool ages. Low birth weight, disease severity and postnatal cumulative steroid dose were related to these changes. CONCLUSION Negative effects of BPD on global cardiac performances of both ventricles and pulmonary arterial pressure persist up to preschool ages.
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Affiliation(s)
- Ozge Altun Koroglu
- Division of Neonatology, Department of Pediatrics, Ege University Faculty of Medicine, Izmir, Turkey
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16
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Abdalla ME, Azeem HAE. Echocardiographic evaluation of ventricular function in young adults with bronchial asthma. EGYPTIAN JOURNAL OF CHEST DISEASES AND TUBERCULOSIS 2013. [DOI: 10.1016/j.ejcdt.2013.04.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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17
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Zedan M, Alsawah GA, El-Assmy MM, Hasaneen B, Zedan MM, Nasef NA. Clinical asthma phenotypes: is there an impact on myocardial performance? Echocardiography 2012; 29:528-34. [PMID: 22329380 DOI: 10.1111/j.1540-8175.2011.01635.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Asthma is a systemic disease, which affects various body systems. We aimed to assess the impact of clinical asthma phenotypes on myocardial performance in asthmatic children using tissue Doppler imaging (TDI). METHODS We enrolled 58 children with moderate persistent asthma and 62 age- and sex-matched healthy controls. Asthmatic children were classified according to clinical asthma phenotypes into shortness of breath group (n = 26) and wheezy group (n = 32). Pulmonary function tests, and conventional and TDI echocardiography were performed. RESULTS TDI echocardiography assessment of the studied groups showed that asthmatic children as a group had significant left and right ventricular dysfunction when compared with healthy controls. Children in the shortness of breath group had a significant diastolic dysfunction of both ventricles in the form of lower tricuspid and mitral annular early myocardial diastolic velocity (Em), early to late myocardial diastolic velocity (Em/Am) ratio, and prolonged isovolumetric relaxation time when compared with wheezy group (P < 0.001). In the shortness of breath group, TDI-derived myocardial performance index (MPI) of both ventricles was significantly higher when compared with wheezy group (P < 0.001) reflecting global myocardial dysfunction. Conventional echocardiography of both ventricles showed RV diastolic dysfunction in the form of a significantly lower tricuspid E/A ratio in the shortness of breath group when compared with wheezy group. CONCLUSION Clinical asthma phenotypes have an impact on myocardial function especially those presented with shortness of breath. Thus, measurement of MPI by TDI can detect subclinical changes in the cardiac performance in asthmatic children.
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Affiliation(s)
- Magdy Zedan
- Pediatric Allergy and Pulmonology, Children's Hospital, Mansoura University, Mansoura, Egypt
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18
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Cua CL, Feltes TF. Echocardiographic evaluation of the single right ventricle in congenital heart disease: results of new techniques. Circ J 2011; 76:22-31. [PMID: 22139360 DOI: 10.1253/circj.cj-11-1267] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Right ventricular (RV) function is increasingly recognized as having prognostic significance in various disease processes. The current gold standard for noninvasive measurement of RV function is cardiac magnetic resonance imaging; however, because of practical considerations, echocardiography remains the most often used modality for evaluating the RV. In the past, because of its complex morphology, echocardiographic assessment of the RV was usually qualitative in nature. Current advances in echocardiographic techniques have been able to overcome some of the previous limitations and thus quantification of RV function is increasingly being performed. In addition, recent echocardiographic guidelines for evaluating the RV have been published to aid in standardizing practice. The evaluation of RV function almost certainly has no greater importance than in the congenital heart population, especially in those patients that have a single RV acting as the systemic ventricle. As this complex population continues to increase in number, accurate and precise evaluation of RV function will be a major issue in determining clinical care.
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Affiliation(s)
- Clifford L Cua
- Heart Center, Nationwide Children's Hospital, Columbus, OH 43205, USA.
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