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Niyogi SG, Singh A, Kumar B, Mishra AK, Puri GD. Right Atrial Strain in Pediatric Pulmonary Hypertension-A Prospective Observational Study. Pediatr Cardiol 2024:10.1007/s00246-024-03523-8. [PMID: 38777858 DOI: 10.1007/s00246-024-03523-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Accepted: 05/06/2024] [Indexed: 05/25/2024]
Abstract
Right ventricular (RV) afterload due to elevated pulmonary arterial (PA) pressure in pulmonary hypertension (PH) causes long-term right atrial (RA) remodeling and dysfunction. RA function has been shown to correlate with PA pressures and outcome in both adult and pediatric patients with PH. We studied the role of RA strain in estimating PA pressures in congenital heart disease (CHD)-associated PH. Children below 12 years undergoing elective repair of CHD with left-to-right shunts and echocardiographic evidence of PH were included. RA reservoir, conduit and contractile strain along with conventional measures of RV function and PA pressure were measured using transthoracic echocardiography after induction of anaesthesia. Pre-and post-repair invasive PA pressures were measured after surgical exposure. 51 children with a median age of 24 months (range 4-144 months) were included, most of whom were undergoing VSD closure. Contractile RA strain showed good correlation with pre-repair systolic PA pressure in mmHg (r = 0.59, 95%CI 0.37-0.75) or expressed as a percentage of SBP (r = 0.67, 95%CI 0.49-0.80). It also predicted persistent postoperative PH as well as pre-repair pulmonary artery acceleration time and right ventricular systolic pressure measured from tricuspid regurgitation jet. The trends of correlation observed suggest a possible prognostic role of RA strain in ACHD with PH and potential utility in its echocardiographic assessment. The observed findings merit deeper evaluation in larger cohorts.
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Affiliation(s)
- Subhrashis Guha Niyogi
- Department of Anaesthesia, All India Institute of Medical Sciences, Kalyani, West Bengal, India
| | - Avneet Singh
- Department of Anaesthesia and Intensive Care, Government Medical College and Hospital, Chandigarh, India
| | - Bhupesh Kumar
- Department of Anaesthesia and Intensive Care, Post Graduate Institute of Medical Education and Research, Sector 12, Chandigarh, 160012, India.
| | - Anand Kumar Mishra
- Department of Cardiothoracic and Vascular Surgery, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Goverdhan Dutt Puri
- Department of Anaesthesia and Intensive Care, Post Graduate Institute of Medical Education and Research, Sector 12, Chandigarh, 160012, India
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Ekhomu O, Faerber JA, Wang Y, Huang J, Mai AD, DiLorenzo MP, Bhatt SM, Avitabile CM, Mercer-Rosa L. Right atrial function early after tetralogy of Fallot repair. THE INTERNATIONAL JOURNAL OF CARDIOVASCULAR IMAGING 2022; 38:1961-1972. [PMID: 37726603 DOI: 10.1007/s10554-022-02595-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/21/2021] [Accepted: 03/10/2022] [Indexed: 11/28/2022]
Abstract
Diastolic dysfunction after repair for Tetralogy of Fallot (TOF) is associated with adverse long-term outcomes. Right atrial (RA) mechanics as a proxy of right ventricular (RV) diastolic function in the early post-operative period after surgical repair for TOF has not been reported. We sought to evaluate RA and RV strain prior to hospital discharge after TOF repair and to identify important patient factors associated with strain using a machine learning method. Single center retrospective cohort study of TOF patients undergoing surgical repair, with analysis of RA and RV strain from pre-and post-operative echocardiograms. RA function was assessed by the peak RA strain, systolic RA strain rate, early diastolic RA strain rate and RA emptying fraction. RV systolic function was measured by global longitudinal strain. Pre- and post-operative values were compared using Wilcoxon rank sum test. Gradient boosted machine (GBM) models were used to identify the most important predictors of post-operative strain. In total, 153 patients were enrolled, median age at TOF repair 3.5 months (25th-75th percentile: 2.2- 5.2), mostly male (67%), and White (64.1%). From pre-to post-operative period, there was significant worsening in all RA parameters and in RV strain. GBM models identified patient, anatomic, and surgical factors that were strong predictors of post-operative RA and RV strain. These factors included pulmonary valve and branch pulmonary artery Z scores, birth weight, gestational age and age at surgery, pre-operative RV fractional area change and oxygen saturation, type of outflow tract repair, duration of cardiopulmonary bypass, and early post-operative partial arterial pressure of oxygen. There is significant worsening in RA and RV strain early after TOF repair, indicating early alteration in diastolic and systolic function after surgery. Several patient and operative factors influence post-operative RV function. Most of the factors described are not readily modifiable, however they may inform pre-operative risk-stratification. The clinical application of RA strain and the prognostic implication of these early changes merit further study.
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Affiliation(s)
- Omonigho Ekhomu
- Division of Cardiology, Rush University Children's Hospital, Chicago, IL, USA
| | - Jennifer A Faerber
- Department of Biomedical and Health Informatics, Data Science and Biostatistics Unit, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Yan Wang
- Division of Cardiology, Echocardiography Laboratory, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Jing Huang
- Department of Biomedical and Health Informatics, Data Science and Biostatistics Unit, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Anh Duc Mai
- Division of Cardiology, Echocardiography Laboratory, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Michael P DiLorenzo
- Division of Cardiology, Department of Pediatrics, New York-Presbyterian/Morgan Stanley Children's Hospital, Columbia University Medical Center, New York, NY, USA
| | - Shivani M Bhatt
- Division of Cardiology, Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Catherine M Avitabile
- Division of Cardiology, Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Laura Mercer-Rosa
- Division of Cardiology, Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, Children's Hospital of Philadelphia, Philadelphia, PA, USA.
- Division of Cardiology, Children's Hospital of Philadelphia, 3401 Civic Center Boulevard, Philadelphia, PA, 19104, USA.
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Cau R, Bassareo P, Suri JS, Pontone G, Saba L. The emerging role of atrial strain assessed by cardiac MRI in different cardiovascular settings: an up-to-date review. Eur Radiol 2022; 32:4384-4394. [PMID: 35451607 PMCID: PMC9213357 DOI: 10.1007/s00330-022-08598-6] [Citation(s) in RCA: 33] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Revised: 12/24/2021] [Accepted: 01/15/2022] [Indexed: 11/25/2022]
Abstract
The left atrium (LA) has a crucial function in maintaining left ventricular filling, which is responsible for about one-third of all cardiac filling. A growing body of evidence shows that LA is involved in several cardiovascular diseases from a clinical and prognostic standpoint. LA enlargement has been recognized as a predictor of the outcomes of many diseases. However, LA enlargement itself does not explain the whole LA's function during the cardiac cycle. For this reason, the recently proposed assessment of atrial strain at advanced cardiac magnetic resonance (CMR) enables the usual limitations of the sole LA volumetric measurement to be overcome. Moreover, the left atrial strain impairment might allow several cardiovascular diseases to be detected at an earlier stage. While traditional CMR has a central role in assessing LA volume and, through cine sequences, a marginal role in evaluating LA function, feature tracking at advanced CMR (CMR-FT) has been increasingly confirmed as a feasible and reproducible technique for assessing LA function through strain. In comparison to atrial function evaluations via speckle tracking echocardiography, CMR-FT has a higher spatial resolution, larger field of view, and better reproducibility. In this literature review on atrial strain analysis, we describe the strengths, limitations, recent applications, and promising developments of studying atrial function using CMR-FT in clinical practice. KEY POINTS: • The left atrium has a crucial function in maintaining left ventricular filling; left atrial size has been recognized as a predictor of the outcomes of many diseases. • Left atrial strain has been confirmed as a marker of atrial functional status and demonstrated to be a sensitive tool in the subclinical phase of a disease. • A comprehensive evaluation of the three phases of atrial function by CMR-FT demonstrates an impairment before the onset of atrial enlargement, thus helping clinicians in their decision-making and improving patient outcomes.
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Affiliation(s)
- Riccardo Cau
- Department of Radiology, Azienda Ospedaliero Universitaria (A.O.U.), di Cagliari - Polo di Monserrato, s.s. 554 Monserrato, 09045, Cagliari, Italy
| | - Pierpaolo Bassareo
- University College of Dublin, Mater Misericordiae University Hospital and Our Lady's Children's Hospital, Crumlin, Dublin, Republic of Ireland
| | - Jasjit S Suri
- Stroke Monitoring and Diagnosis Division, AtheroPoint(tm), Roseville, CA, USA
| | - Gianluca Pontone
- Department of Cardiology, Centro Cardiologico Monzino, IRCCS, Milan, Italy
| | - Luca Saba
- Department of Radiology, Azienda Ospedaliero Universitaria (A.O.U.), di Cagliari - Polo di Monserrato, s.s. 554 Monserrato, 09045, Cagliari, Italy.
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Cau R, Bassareo P, Caredda G, Suri JS, Esposito A, Saba L. Atrial Strain by Feature-Tracking Cardiac Magnetic Resonance Imaging in Takotsubo Cardiomyopathy. Features, Feasibility, and Reproducibility. Can Assoc Radiol J 2021; 73:573-580. [PMID: 34615401 DOI: 10.1177/08465371211042497] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVES The purpose of this study was to investigate whether there may be a bi-atrial dysfunction in Takotsubo syndrome (TS) during the transient course of the disease, using cardiac magnetic resonance imaging feature tracking (CMR-FT) in analyzing bi-atrial strain. METHOD Eighteen TS patients and 13 healthy controls were studied. Reservoir, conduit, and booster bi-atrial functions were analyzed by CMR-FT. The correlation between LA and RA strain parameters was assessed. Intra- and inter-observer reproducibility was evaluated for all strain and strain rate (SR) parameters using intraclass correlation coefficients (ICCs) and Bland-Altman analysis. RESULTS Atrial strain were feasible in all patients and controls. Takotsubo patients showed an impaired LA Reservoir strain (∊s), LA Reservoir strain rate (SRs), LA and RA Conduit strain(∊e), LA and RA conduit strain rate (SRe) in comparison with controls (P < 0.001 for all of them), while no differences were found as to LA and RA booster deformation parameters (∊a and SRa). Analysis of correlation showed that LA ∊s, SRs, ∊e, and SRe were positively correlated with corresponding RA strain measurements (P < 0.001, r = 0.61 and P = 0,03, r = 0,54, respectively). Reproducibility was good to excellent for all atrial strain and strain rate parameters (ICCs ranging from 0,50 to 0,96). CONCLUSION Atrial strain analysis using CMR-FT may be a useful tool to reveal new pathophysiological insights in Takotsubo cardiomyopathy. Additional studies, with a larger number of patients, are needed to confirm the possible role of these advanced CMR tools in characterizing TS patients.
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Affiliation(s)
- Riccardo Cau
- Department of Radiology, Azienda Ospedaliero Universitaria (A.O.U.), Monserrato (Cagliari), Italy
| | - Pierpaolo Bassareo
- University College of Dublin, Mater Misericordiae University Hospital and Our Lady's Children's Hospital, Crumlin, Dublin, Republic of Ireland
| | - Gloria Caredda
- Department of Radiology, Azienda Ospedaliero Universitaria (A.O.U.), Monserrato (Cagliari), Italy
| | - Jasjit S Suri
- Stroke Diagnosis and Monitoring DivisionAtheroPoint, Roseville, CA, USA
| | - Antonio Esposito
- IRCCS San Raffaele Scientific Institute, Milano, Lombardia, Italy
| | - Luca Saba
- Department of Radiology, Azienda Ospedaliero Universitaria (A.O.U.), Monserrato (Cagliari), Italy
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Kiran M, Misra S, Pr S, Babu S, Anand A, Koshy T. Quantification of Right Atrial-Indexed End-Systolic Volumes and Emptying Fraction in Children Undergoing Cardiac Surgery With Two-Dimensional Transesophageal Echocardiography: A Prospective Observational Study. J Cardiothorac Vasc Anesth 2021; 36:202-207. [PMID: 34006468 DOI: 10.1053/j.jvca.2021.04.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Revised: 03/17/2021] [Accepted: 04/10/2021] [Indexed: 11/11/2022]
Abstract
OBJECTIVES The primary objective of this study was to establish "normal" right atrial (RA)-indexed end-systolic volumes (ESVs) and emptying fraction (EF) in children undergoing ventricular septal defect (VSD) repair using two-dimensional (2D) transesophageal echocardiography (TEE). Secondary objectives were to obtain RA-indexed ESV and EF in children with RA/right ventricular (RV) volume overload (atrial septal defect [ASD]) and RV pressure overload (tetralogy of Fallot [TOF]) and to determine whether baseline differences existed in these indices among the three lesions. DESIGN A prospective observational study. SETTING Tertiary referral center and a university level teaching hospital. PARTICIPANTS The study comprised 90 children (30 in each cohort) >3 kg and <14 years old admitted for elective repair of either VSD, TOF, or ASD. MEASUREMENTS AND MAIN RESULTS RA ESV and EF were measured in the midesophageal four-chamber view using the area-length and the modified Simpson's methods with 2D TEE in the prebypass period. Mean RA- indexed ESV (area-length method) in the VSD cohort was 24.2 ± 6.7 mL/m2, whereas it was significantly greater in the TOF (31.9 ± 9.8 mL/m2; p = 0.0008) and ASD (52 ± 12.9 mL/m2; p < 0.0001) cohorts. RA EF in the TOF cohort was 48.4% ± 7.6%, which was significantly more than in the VSD (41.5% ± 11.8%; p = 0.0093) and ASD (39.1% ± 12.3%; p = 0.0008) cohorts. CONCLUSIONS This was the first study using 2D TEE to measure RA indices in children with and without right-sided heart dilation undergoing cardiac surgery. In this study, RA, ESV, and EF were considerably different in children with congenital heart disease causing RV pressure or volume overload. Additional studies can examine how these values can be used for risk stratification in this cohort of patients or how they correlate with measures of ventricular performances.
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Affiliation(s)
- Molli Kiran
- Division of Cardiothoracic and Vascular Anaesthesiology, Department of Anesthesia, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala, India
| | - Satyajeet Misra
- Division of Cardiothoracic and Vascular Anaesthesiology, Department of Anesthesia, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala, India
| | - Suneel Pr
- Division of Cardiothoracic and Vascular Anaesthesiology, Department of Anesthesia, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala, India
| | - Saravana Babu
- Division of Cardiothoracic and Vascular Anaesthesiology, Department of Anesthesia, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala, India
| | - Asha Anand
- Division of Cardiothoracic and Vascular Anaesthesiology, Department of Anesthesia, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala, India
| | - Thomas Koshy
- Division of Cardiothoracic and Vascular Anaesthesiology, Department of Anesthesia, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala, India.
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Morhy SS, Barberato SH, Lianza AC, Soares AM, Leal GN, Rivera IR, Barberato MFA, Guerra V, Ribeiro ZVDS, Pignatelli R, Rochitte CE, Vieira MLC. Position Statement on Indications for Echocardiography in Fetal and Pediatric Cardiology and Congenital Heart Disease of the Adult - 2020. Arq Bras Cardiol 2020; 115:987-1005. [PMID: 33295472 PMCID: PMC8452202 DOI: 10.36660/abc.20201122] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Affiliation(s)
| | - Silvio Henrique Barberato
- Cardioeco - Centro de Diagnóstico Cardiovascular, Curitiba, PR - Brasil
- Quanta Diagnóstico e Terapia, Curitiba, PR - Brasil
| | - Alessandro Cavalcanti Lianza
- Hospital Israelita Albert Einstein, São Paulo, SP - Brasil
- Instituto da Criança e do Adolescente do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HC-FMUSP), São Paulo, SP - Brasil
- Hospital do Coração, São Paulo, SP - Brasil
| | - Andressa Mussi Soares
- Hospital Evangélico de Cachoeiro de Itapemirim e Clínica CORImagem, Cachoeiro de Itapemirim, ES - Brasil
| | - Gabriela Nunes Leal
- Hospital Israelita Albert Einstein, São Paulo, SP - Brasil
- Instituto da Criança e do Adolescente do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HC-FMUSP), São Paulo, SP - Brasil
- Hospital do Coração, São Paulo, SP - Brasil
- Hospital e Maternidade São Luiz Itaim, São Paulo, SP - Brasil
| | | | | | - Vitor Guerra
- The Hospital for Sick Children, Toronto - Canadá
| | | | - Ricardo Pignatelli
- Texas Children's Hospital, Baylor College of Medicine, Houston, Texas - EUA
| | - Carlos Eduardo Rochitte
- Instituto do Coração da Faculdade de Medicina da Universidade de São Paulo (InCor, FMUSP), São Paulo, SP - Brasil
| | - Marcelo Luiz Campos Vieira
- Hospital Israelita Albert Einstein, São Paulo, SP - Brasil
- Instituto do Coração da Faculdade de Medicina da Universidade de São Paulo (InCor, FMUSP), São Paulo, SP - Brasil
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Frank BS, Schafer M, Thomas TM, Haxel C, Ivy DD, Jone PN. Right Atrial Conduit Phase Emptying Predicts Risk of Adverse Events in Pediatric Pulmonary Arterial Hypertension. J Am Soc Echocardiogr 2020; 33:1006-1013. [DOI: 10.1016/j.echo.2020.02.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2019] [Revised: 02/18/2020] [Accepted: 02/19/2020] [Indexed: 10/24/2022]
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Truong VT, Palmer C, Young M, Wolking S, Ngo TNM, Sheets B, Hausfeld C, Ornella A, Taylor MD, Zareba KM, Raman SV, Mazur W. Right Atrial Deformation Using Cardiovascular Magnetic Resonance Myocardial Feature Tracking Compared with Two-Dimensional Speckle Tracking Echocardiography in Healthy Volunteers. Sci Rep 2020; 10:5237. [PMID: 32251322 PMCID: PMC7089993 DOI: 10.1038/s41598-020-62105-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Accepted: 03/03/2020] [Indexed: 11/08/2022] Open
Abstract
Speckle tracking echocardiography (STE), and more recently, cardiovascular magnetic resonance myocardial feature tracking (CMR-FT) provides insight into all phases of atrial function. The aim of our study was to compare all phases of RA strain using CMR-FT and STE and also assess the relationship between RA and LA strain. A total of 61 healthy volunteers with mean age of 45 ± 13 years had adequate tracking for analysis on CMR-FT and 2D-STE. Females had larger RA reservoir strain (39 ± 15% vs. 32 ± 13%, p = 0.046) and conduit strain (26 ± 12% vs. 20 ± 9%, p = 0.03) when compared to males, but was not the case with booster strain (14 ± 7% vs. 12 ± 6%, p = 0.45). In comparison with STE derived strain, the RA reservoir and conduit strain were not significantly different between CMR-FT and the three echocardiography gating methods (p > 0.05 for all). Noticeably, there were no significant differences in strain and strain rate between RA and LA function using CMR-FT (p > 0.05 for all). RA strain and strain rate using CMR-FT had fair and good intra- and inter-observer reproducibility and had superior reproducibility compared to STE derived strain.
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Affiliation(s)
- Vien T Truong
- The Christ Hospital Health Network, The Lindner Research Center, Cincinnati, Ohio, USA
- The Sue and Bill Butler Research Fellow, The Lindner Research Center, Cincinnati, Ohio, USA
| | - Cassady Palmer
- The Christ Hospital Health Network, The Lindner Research Center, Cincinnati, Ohio, USA
| | - Michael Young
- The Christ Hospital Health Network, The Lindner Research Center, Cincinnati, Ohio, USA
| | - Sarah Wolking
- The Christ Hospital Health Network, The Lindner Research Center, Cincinnati, Ohio, USA
| | - Tam N M Ngo
- The Christ Hospital Health Network, The Lindner Research Center, Cincinnati, Ohio, USA
| | - Brandy Sheets
- The Christ Hospital Health Network, The Lindner Research Center, Cincinnati, Ohio, USA
| | - Chelsey Hausfeld
- The Christ Hospital Health Network, The Lindner Research Center, Cincinnati, Ohio, USA
| | - Allison Ornella
- The Christ Hospital Health Network, The Lindner Research Center, Cincinnati, Ohio, USA
| | - Michael D Taylor
- Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | | | - Subha V Raman
- Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Wojciech Mazur
- The Christ Hospital Health Network, The Lindner Research Center, Cincinnati, Ohio, USA.
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Hope KD, Wang Y, Banerjee MM, Montero AE, Pandian NG, Banerjee A. Left atrial mechanics in children: insights from new applications of strain imaging. Int J Cardiovasc Imaging 2018; 35:57-65. [DOI: 10.1007/s10554-018-1429-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2018] [Accepted: 07/30/2018] [Indexed: 10/28/2022]
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