Subclinical right ventricular dysfunction in intermittent and persistent mildly asthmatic children on tissue Doppler echocardiography and serum NT-proBNP: Observational study

Impact of Asthma Phenotypes on Myocardial Performance and Pulmonary Hypertension in Children and Adolescents With Moderate to Severe Persistent Asthma

BACKGROUND

Asthma is characterized by chronic inflammation and remodeling of pulmonary vessels and airway wall resulting in pulmonary hypertension (PH). Increased afterload on right ventricle (RV) myocardium leads to RV diastolic dysfunction (RVDD). Echocardiography is an excellent tool to detect these changes early. Using echocardiography, we assessed the impact of clinical asthma phenotypes on myocardial performance and PH in children with asthma.

MATERIALS AND METHODS

Sixty children with moderate or severe persistent asthma and 60 age and gender-matched healthy controls were enrolled. As per clinical phenotypes, children with asthma were classified into early wheezers (n = 30) and late wheezers (n = 30). Pulmonary function tests (PFT) and echocardiography, both conventional and pulse wave (PW), were performed.

RESULTS

Children with asthma had significant RVDD and higher incidence (33%) of PH. Myocardial performance index (MPI) was poor in asthmatics, 0.41 (0.04) compared to controls, 0.38 (0.03). Measures for PH such as tricuspid regurgitation (TR) gradient, TR velocity, and pulmonary artery pressure (PAP) were significantly higher in cases. Among clinical asthma phenotypes, there was no difference in left ventricular ejection fraction (LVEF) between early 64.3% (4.6) and late wheezers 65.6% (4.4). MPI was better in late wheezers at 0.41 (0.05) than in early wheezers at 0.40 (0.03). TR gradient, TR velocity, and PAP were significantly higher in early wheezers. The odds ratio for the development of PH was 0.74 (CI 0.25 - 2.17), and for the development of RVDD was 3.2 (CI 0.77 - 13.8), both in favor of early wheezers.

CONCLUSION

Children with asthma, particularly early-onset wheezers are at increased risk of developing PH and RVDD. We suggest annual screening by conventional echocardiography and pulse wave Doppler imaging for early diagnosis and timely initiation of management.

Evaluation of cardiac function in asthmatic children by Tissue Doppler Echocardiography

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.

Hidden Comorbidities in Asthma: A Perspective for a Personalized Approach

Bronchial asthma is the most frequent inflammatory non-communicable condition affecting the airways worldwide. It is commonly associated with concomitant conditions, which substantially contribute to its burden, whether they involve the lung or other districts. The present review aims at providing an overview of the recent acquisitions in terms of asthma concomitant systemic conditions, besides the commonly known respiratory comorbidities. The most recent research has highlighted a number of pathobiological interactions between asthma and other organs in the view of a shared immunological background underling different diseases. A bi-univocal relationship between asthma and common conditions, including cardiovascular, metabolic or neurodegenerative diseases, as well as rare disorders such as sickle cell disease, α1-Antitrypsin deficiency and immunologic conditions with hyper-eosinophilia, should be considered and explored, in terms of diagnostic work-up and long-term assessment of asthma patients. The relevance of that acquisition is of utmost importance in the management of asthma patients and paves the way to a new approach in the light of a personalized medicine perspective, besides targeted therapies.

Application of Combined Detection of Echocardiography and Serum NT-ProBNP in the Diagnosis of Diastolic Heart Failure and Its Effect on Left Ventricular Morphology and Diastolic Function

Objective

This study is to assess the application of combined detection of echocardiography and serum N-terminal pro B-type natriuretic peptide (NT-ProBNP) in the diagnosis of diastolic heart failure (DHF) and its effect on left ventricular morphology and diastolic function.

Methods

Thirty patients with DHF with enrolled in our hospital between January 2019 and January 2021 were included in the experimental group, and thirty healthy individuals during the same period were included in the control group. The blood pressure, heart rate (HR), left ventricular morphology, diastolic function, and serum NT-ProBNP levels were compared between the two groups.

Results

DHF was associated with higher levels of diastolic blood pressure (DBP), systolic blood pressure (SBP), HR, left ventricular diameter (LVD), interventricular septum thickness (IVST), left ventricular posterior wall thickness (LVPWT), left atrial volume index (LAVI), left ventricular end-diastolic volume (LVEDV), serum NT-ProBNP, maximum early ventricular filling velocity/early diastolic velocity of the mitral annulus (E/Ea) ratio, and aortic regurgitation (AR) and lower levels of left ventricular ejection fraction (LVEF), flow propagation velocity (VP), and systolic/diastolic (S/D) ratio versus healthy subjects (all at P < 0.05).

Conclusion

The combined detection of echocardiography and serum NT-ProBNP yields a high clinical value in the diagnosis of DHF deficiency, as it can accurately evaluate the patient's left heart morphology and diastolic function, so it is worthy of clinical promotion and application.

Evaluation of cardiac function in pediatric patients with mild to moderate bronchial asthma in the era of cardiac strain imaging

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.

Left Ventricular Dysfunction and Plasmatic NT-proBNP Are Associated with Adverse Evolution in Respiratory Syncytial Virus Bronchiolitis

AIM

To investigate whether the presence of left ventricular myocardial dysfunction (LVMD) assessed by Tei index (LVTX) impacts the outcomes of healthy infants with Respiratory Syncytial Virus Bronchiolitis (RSVB). To explore whether N-terminal pro-B-type natriuretic peptide (NT-proBNP) increases the accuracy of traditional clinical markers in predicting the outcomes.

METHODS

A single-centre, prospective, cohort study including healthy infants aged 1-12 months old admitted for RSVB between 1 October 2016 and 1 April 2017. All patients underwent clinical, laboratory and echocardiographic evaluation within 24 h of admission. Paediatric intensive care unit (PICU) admission was defined as severe disease.

RESULTS

We enrolled 50 cases of RSVB (median age of 2 (1-6.5) months; 40% female) and 50 age-matched controls. We observed higher values of LVTX in infants with RSVB than in controls (0.42 vs. 0.36; p = 0.008). Up to nine (18%) children presented with LVMD (LVTX > 0.5), with a higher incidence of PICU admission (89% vs. 5%; p < 0.001). The diagnostic performance of NT-proBNP in predicting LVMD was high (area under the receiver operator characteristic curve (AUC) 0.95, CI 95% 0.90-1). The diagnostic yield of the predictive model for PICU admission that included NT-proBNP was excellent (AUC 0.945, CI 95% 0.880-1), and significantly higher than the model without NT-proBNP (p = 0.026).

CONCLUSIONS

LVMD could be present in healthy infants with RSVB who develop severe disease. NT-proBNP seems to improve traditional clinical markers for outcomes.