Cardiac Mechanics in Patients With Human Immunodeficiency Virus: A Study of Systolic Myocardial Deformation in Children and Young Adults

Human immunodeficiency virus (HIV) infection causes dysfunction of different organ systems. Myocardial diastolic dysfunction has been reported previously in an adult HIV population. Our aim was to study myocardial strain in children and young adults infected by HIV who have apparently normal ejection fraction. Forty HIV-infected patients (mean age 20.6 ± 1.5 years) with normal ejection fraction and 55 matched normal controls (mean age 17 ± 1.5 years) were studied by two-dimensional echocardiogram. The images were stored then exported to velocity vector imaging software for analysis. Measures considered were left-ventricular peak global systolic strain (LV S) and strain rate (LV SR) as well as right-ventricular peak global systolic strain (RV S) and strain rate (RV SR). Circumferential measures of the left ventricle included the following: LV circumferential peak global systolic strain (LV circ S), strain rate (LV circ SR), radial velocity (LV rad vel), and rotational velocity (LV rot vel) at the level of the mitral valve. Statistical significance was set at p < 0.05. The means of all longitudinal deformation parameters were significantly lower in HIV patients compared with normal controls: LV S (?14.15 vs. ?19.31), LV SR (?0.88 vs. ?1.30), RV S (?19.58 vs. ?25.09), and RV SR (?1.34 vs. ?2.13), respectively (p < 0.05). LV rot vel was lower in patients compared with controls (43.23 vs. 51.71, p = 0.025). LV circ S, LV circ SR, and LV rad vel showed no significant difference between the two groups (p ≥ 0.05). HIV infection affects longitudinal systolic cardiac strain and strain rate in children and young adults. Normal ejection fraction might be attributed to preserved circumferential myocardial deformation. Strain and strain rate may help identify HIV patients at high risk for cardiac dysfunction and allow early detection of silent myocardial depression.     

Regional Analysis of Longitudinal Systolic Function of the Right Ventricle After Corrective Surgery of Tetralogy of Fallot Using Myocardial Isovolumetric Acceleration Index

To assess regional longitudinal systolic function of the right ventricle in patients with repaired tetralogy of Fallot (TOF) by tissue Doppler imaging-derived isovolumetric acceleration (IVA) index and determine the effect of right-ventricular (RV) enlargement on regional systolic function. In 30 consecutive TOF patients and 30 age-matched controls, myocardial velocity of the RV ventricular free wall in the basal and middle regions were examined in the apical four-chamber view. Peak myocardial velocity during IVA was recorded on the free RV wall. IVA index was calculated as the difference between baseline and peak velocity divided by their time interval. In 23 of the studied TOF patients, magnetic resonance imaging was performed on the same day to determine global RV volume and ejection fraction. IVA index of the RV lateral free wall was significantly lower in the basal (8.31 ± 6.00 vs. 19.00 ± 10.85 m/s², p = 0.0001) and middle segments (6.56 ± 5.22 vs. 16.17 ± 7.44 m/s², p = 0.0001) in patients than in controls. Among TOF patients, a negative correlation was found between IVA index in the middle segment and RV end-diastolic volume/body surface area (r = ?0.549, p < 0.01). Similar to other longitudinal RV wall parameters, the IVA index showed a decreased value in the RV free wall, which is related to the impaired regional and global longitudinal RV systolic dysfunction. RV enlargement adversely affects regional longitudinal systolic function.     

Decline of Systolic and Diastolic 2D Strain Rate During Follow-Up of HLHS Patients After Fontan Palliation

Accurate assessment of ventricular function is particularly important in children with hypoplastic left heart syndrome (HLHS) after completion of the total cavopulmonary connection (TCPC). For this purpose, two-dimensional speckle tracking (2DST) is a promising technique as it does not depend on the angle of insonation or the geometry of the ventricle. The objective of this study was to assess changes in systolic and diastolic right ventricular (RV) function within a 5-year follow-up period of HLHS patients after TCPC using conventional and 2DST echocardiography. RV fractional area change (RVFAC), tricuspid annular plane systolic excursion (TAPSE), E/A, E/e′ and 2DST parameters [global longitudinal peak systolic strain (GS) and strain rate (GSRs), global strain rate in early (GSRe) and late (GSRa) diastole] of 40 HLHS patients were compared at 1.6 and at 5.1 years after TCPC. RVFAC, E/A, E/e′ and GS did not change, whereas TAPSE (13.7 ± 3.2 vs. 10.5 ± 2.4 mm/m², p < 0.001), GSRs (?1.56 ± 0.28 vs. ?1.35 ± 0.31 1/s, p < 0.001), GSRe (2.22 ± 0.49 vs. 1.96 ± 0.44 1/s, p = 0.004) and GSRa (1.19 ± 0.39 vs. 0.92 ± 0.39 1/s, p < 0.001) decreased significantly. Systolic and diastolic RV function parameters of HLHS patients decreased from 1.6 to 5.1 years after TCPC in our patients. Changes in global strain rate parameters may be signaling early RV dysfunction that is not detectable by traditional echocardiography. Further study is needed to verify this and to determine whether these changes are clinically relevant.     

Assessment of Ventricular Functions by Tissue Doppler Echocardiography in Children with Asthma

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.     

Decreased Right Ventricular Function in Healthy Pediatric Cystic Fibrosis Patients Versus Non-Cystic Fibrosis Patients

Right ventricular (RV) dysfunction may occur in patients with cystic fibrosis (CF). Tissue Doppler imaging (TDI) and strain and strain rate analysis are new echocardiographic tools that can quantitate RV function. This study aimed to compare the RV function between healthy CF patients and non-CF patients to determine whether differences exist. Healthy CF children and age-matched non-CF children were enrolled in the study. In this study, TDI analysis of the RV free wall was performed at the level of the tricuspid valve annulus. Two-dimensional speckle echocardiography was used to measure global strain and strain rates in a six-segment model of the RV. Independent t tests were used to compare the groups. The study enrolled 18 CF patients (age, 7.7 ± 2.0 years) and 15 non-CF patients (age, 6.4 ± 2.5 years). The age difference was not significant. The forced expiratory volume in the first second (FEV₁) for the CF patients was 91 ± 15 %. The systolic annular velocity by TDI was significantly lower in the CF group. The RV strain values in the CF group were significantly lower in four of the six segments (RV free-wall base, RV free-wall mid, RV septal apex, and RV septal mid). The global strain value, the systolic strain rate, and the early diastolic strain rate were significantly lower in the CF group. Decreased systolic and diastolic RV properties were present in young healthy CF patients. Further studies with longitudinal follow-up evaluation are needed to determine the significance of these findings for the pediatric CF population.     

Accuracy of Doppler-Derived Indices in Predicting Pulmonary Vascular Resistance in Children With Pulmonary Hypertension Secondary to Congenital Heart Disease With Left-to-Right Shunting

This study aimed to evaluate the accuracy of Doppler echocardiography-derived indices in children with pulmonary hypertension secondary to congenital heart disease with left-to-right shunting. Doppler-derived indices including the acceleration time corrected (AcTc), deceleration time corrected, deceleration index, peak velocity, heart-rate-corrected inflection time (InTc), and a new index (the acceleration slope [Acc = peak flow velocity/AcTc]) were measured from the pulmonary artery (PA) systolic flow curve before and after 100 % oxygen administration in the main, left, and right PAs of 33 children. The acquired data were compared between low and high pulmonary vascular resistance (PVR) groups and between responders and nonresponders to the vasoreactivity test. The AcTc values differed significantly between the low and high PVR groups before and after oxygen administration in the main (P = 0.032 and <0.001, respectively), right (P = 0.011 and <0.001, respectively), and left (P < 0.001 and <0.001, respectively) PAs. The AcTc cutoff point in the main PA was 3.44 before oxygen administration (81 % sensitivity and 91 % specificity). The InTc in the main PA and its changes differed significantly between the low and high PVR groups before and after oxygen administration and between the responders and nonresponders (P = 0.016, 0.046, and 0.021, respectively). The velocity changes of the PA in the main PA differed significantly between the responders and nonresponders to oxygen administration (P < 0.001). The Acc and its changes differed significantly between the low and high PVR groups after oxygen administration and between the responders and nonresponders to oxygen administration (P = 0.044 and 0.006, respectively). Doppler echocardiographic examination using PA systolic flow indices in addition to PA reactivity testing is a promising technique for assessing PVR in children with congenital heart disease.     

Assessment of Speckle-Tracking Echocardiography-Derived Global Deformation Parameters During Supine Exercise in Children

Exercise echocardiography is an underutilized tool in pediatrics with current applications including detecting segmental wall abnormalities, assessing the utility of global ventricular function, and measuring pulmonary hemodynamics. No prior study has applied speckle-tracking echocardiography (STE) during exercise echocardiography in children. The aim of this study was to determine the feasibility of measuring speckle-tracking-derived peak systolic velocities, global longitudinal and circumferential strain, and global strain rates at various phases of exercise. Ninety-seven healthy children underwent cardiopulmonary exercise testing using supine cycle ergometry. The exercise stress test consisted of baseline pulmonary function testing, monitoring of blood pressure and heart rate responses, electrocardiographic recordings, and oxygen saturations while subjects pedaled against a ramp protocol based on body weight. Echocardiographic measurements and specifically speckle-tracking analysis were performed during exercise at baseline, at a heart rate of 160 beats per minute and at 10 min after exercise. Peak systolic velocity, peak systolic strain, and peak systolic strain rate at these three phases were compared in the subjects in which all measurements were accurately obtained. We were able to complete peak velocity, strain, and strain rate measurements in all three exercise phases for 36 out of the 97 subjects tested. There was no significant difference between the feasibility of measuring circumferential versus longitudinal strain (p = 0.25, B-corrected = 0.75). In the 36 subjects studied, the magnitude of circumferential strain values decreased from ?18.3 ± 4.8 to ?13.7 ± 4.0 % from baseline to HR 160 (p < 0.0001, B-corrected < 0.0001), before returning to ?19.6 ± 4.4 % at recovery (p = 0.19 when compared to baseline). Longitudinal strain did not vary significantly from baseline to HR 160 (from ?17.7 ± 4.4 to ?16.6 ± 4.4 %, p = 0.16); likewise the average recovery strain was no different from those values (?18.4 ± 3.6 %; p = 0.34). Peak circumferential and longitudinal strain rates increased from baseline to HR 160, but neither decreased to baseline levels after 10 min of recovery, which correlated with heart rate variations with exercise. We studied the effects of frame rate on deformation measurements and we observed no difference between measurements taken at lower (<60 frames per second, fps) and higher (≥60 fps) frame rates. This study shows that it is technically difficult to retrospectively measure peak velocities, strain, and strain rate in exercising pediatric subjects with STE. The majority of subjects that were excluded from the study had inadequate echocardiographic images when tachycardic from increased respiratory effort and body movements near peak exercise. Improvements in technique and higher image frame rates could make application of STE to pediatric cardiopulmonary testing more successful in the future.     

Pulmonary Artery Dilation and Right Ventricular Function in Acute Kawasaki Disease

Coronary artery inflammation and aneurysm formation are the most common complications of Kawasaki disease (KD). Valvulitis and myocarditis are also well described and may lead to valvar regurgitation and left ventricular dysfunction. However, functional changes in the right heart have rarely been reported. We noted several acute KD patients with dilated pulmonary arteries (PA) and thus sought to systematically characterize PA size and right-heart function in an unselected cohort of KD patients cared for at a single clinical center. Clinical, laboratory, and echocardiographic data from 143 acute KD subjects were analyzed. PA dilation was documented in 23 subjects (16.1 %); these subjects had higher median right ventricle myocardial performance index (RV MPI), higher ratio of early tricuspid inflow velocity to tricuspid annular early diastolic velocity (TV E/e′), and lower median TV e′ velocity compared to the non-PA dilation group (0.50 vs 0.38 p < 0.01, 4.2 vs 3.6 p < 0.05, and 13.5 vs 15.2 cm/s p < 0.01, respectively). Almost all subjects with PA dilation had improved PA Z-score, RV MPI, and TV E/e′ in the subacute phase (p < 0.01). There were no significant differences in indices of left ventricle function between PA dilation group and non-PA dilation group. In summary, PA dilation was documented in 16 % of acute KD subjects. These subjects were more likely to have echocardiographic indices consistent with isolated RV dysfunction that improved in the subacute phase. The long-term consequence of these findings will require longitudinal studies of this patient population.     

Serum Markers of Systemic Right Ventricular Function and Exercise Performance

The right ventricle, which faces systemic pressure due to congenital heart disease, often develops premature systolic dysfunction. Cardiac hormones might be useful to identify patients with such systolic dysfunction. This prospective study investigated the relationship of atrial natriuretic peptide (ANP) and brain natriuretic peptide (BNP) levels with right ventricular ejection fraction (RVEF) and exercise performance in patients with a systemic right ventricle. ANP levels were obtained in 24 patients and BNP levels were obtained in 22 patients with systemic right ventricle. Patients underwent exercise study (n = 22) and cardiovascular magnetic resonance imaging (n = 11) or equilibrium radionuclide angiography (n = 13) to determine RVEF. There were 17 patients with complete transposition and 7 patients with corrected transposition. ANP showed an inverse correlation with RVEF (r ² = 0.63, p < 0.001), a weak but statistically significant inverse correlation with exercise duration (r ² = 0.18, p = 0.047) and no relationship with maximal oxygen consumption (peak V′_O2) (r ² = 0.10, p = NS). BNP did not show a relationship with any of the parameters measured. ANP shows a strong inverse correlation with RVEF and a weak correlation with exercise duration in patients with a systemic right ventricle. BNP does not show a significant relationship when compared with either parameter. ANP might be a useful tool for identification of systolic right ventricular dysfunction.     

Evaluation of Left Ventricular Systolic Strain in Children With Kawasaki Disease

The current study aimed to assess left ventricular (LV) longitudinal systolic strains in children with KD using two-dimensional speckle-tracking imaging and to analyze the relationship of LV myocardial deformation to coronary lesions and laboratory markers. The study enrolled 101 children with acute KD. An additional 50 age- and gender-matched normal children were enrolled as control subjects. During different phases of KD, echocardiograms were recorded for 61 children. Two-dimensional strain analysis software was used to track myocardial movement and obtain the strain from each LV segment. The LV longitudinal systolic strain decreased significantly in children with acute KD but increased immediately after intravenous immunoglobulin therapy. At 6–8 weeks after the onset of KD, all LV strains had recovered to normal. The LV systolic strain was not associated with coronary dilation in either acute or convalescent KD. In acute KD, aspartate transaminase, alanine transaminase, erythrocyte sedimentation rate, C-reactive protein (CRP), and hemoglobin (Hb) were found to be associated with coronary dilation, whereas LV systolic strains were found to be correlated with elevated CRP and decreased Hb. Speckle-tracking imaging of LV systolic strain was simple and accurate in evaluating LV function during different phases of KD. No association between LV dysfunction and coronary dilation was observed, but a relationship with CRP and Hb was found. Further studies are recommended to validate the current study results and explore further how these findings can improve clinical practice.     

Doppler myocardial performance index in assessment of ventricular function in children with single ventricles

Background  Quantitative assessment of ventricular function in children with single ventricles is both difficult and subjective because of asymmetric ventricular geometry. The Doppler myocardial performance index (MPI) allows the assessment regardless of ventricular shape. This study was designed to evaluate the feasibility of MPI in assessing ventricular function in children with single ventricles before and after total cavopulmonary connection (TCPC). Methods  Subjects consisted of 161 pediatric patients with single ventricles and 80 normal children without heart disease. The maximum positive rate of ventricular pressure change (Max dp/dt) was obtained in 58 patients by cardiac catheterization. Sixty-eight children with single ventricles received TCPC. MPI was calculated from Doppler tracings of ventricular inflow and outflow, then MPI of single ventricles before and after surgery and normal heart were compared. Results  Normal MPI value was 0.30±0.08 in the left ventricle and 0.26±0.08 in the right ventricle. Compared to normal children, MPI was significantly higher in 161 children with single ventricles (0.54±0.11, P<0.001). MPI correlated inversely with Max (dp/dt) (r=−0.77, P<0.01), and was positively related to age (r=0.54, P<0.01) in patients with single ventricles. MPI did not differ significantly before and after surgery in 68 patients with single ventricles (0.55±0.21 vs 0.51±0.20, P>0.05). However, MPI in 48 patients of <6 years old decreased significantly (0.55±0.21 vs 0.48±0.18, P<0.05), suggesting improved ventricular function. Conclusions  Compared to normal children, ventricular function is impaired in patients with single ventricles and may worsen with age. MPI provides an accurate method for assessing ventricular function in children with single ventricles before and after TCPC.     

Correlations Between Echocardiographic Systolic and Diastolic Function with Cardiac Catheterization in Biventricular Congenital Heart Patients

Newer echocardiographic techniques may allow for more accurate assessment of left ventricular (LV) function. Adult studies have correlated these echocardiographic measurements with invasive data, but minimal data exist in the pediatric congenital heart population. Purpose of this study was to evaluate which echocardiographic measurements correlated best with LV systolic and diastolic catheterization parameters. Patients with two-ventricle physiology who underwent simultaneous echocardiogram and cardiac catheterization were included. Images were obtained in the four-chamber view. LV systolic echocardiographic data included ejection fraction, displacement, tissue Doppler imaging (TDI) s′ wave, global longitudinal strain, and strain rate (SR) s′ wave. Diastolic echocardiographic data included mitral E and A waves, TDI e′ and a′ waves, and SRe′ and SRa′ waves. E/TDI e′, TDI e′/TDI a′, E/SRe′, and SRe′/SRa′ ratios were also calculated. Catheterization dP/dt was used as a marker for systolic function, and LV end-diastolic pressure (EDP) was used as a marker for diastolic function. Correlations of the echocardiographic and catheterization values were performed using Pearson correlation. Twenty-nine patients were included (14 females, 15 males). Median age at catheterization was 3.4 years (0.04–17.4 years). dP/dt was 1258 ± 353 mmHg/s, and LVEDP was 10.8 ± 2.4 mmHg. There were no significant correlations between catheterization dP/dt and systolic echocardiographic parameters. LVEDP correlated significantly with SRe′ (r = ?0.4, p = 0.03), SRa′ (r = ?0.4, p = 0.03), and E/SRe′ (r = 0.5, p = 0.004). In pediatric congenital heart patients, catheterization dP/dt did not correlate with echocardiographic measurements of LV systolic function. Further studies are needed to determine which echocardiographic parameter best describes LV systolic function in this population. Strain rate analysis significantly correlated with LVEDP. Strain rate analysis should be considered as an alternative method to estimate LVEDP in this patient population.     

Ratio of Early Diastolic Tricuspid Inflow to Tricuspid Lateral Annulus Velocity Reflects Pulmonary Regurgitation Severity but Not Right Ventricular Diastolic Function in Children With Repaired Tetralogy of Fallot

The current study assessed relationships between the ratio of early diastolic tricuspid inflow to tricuspid lateral annular velocity (tricuspid E/e′) and right ventricular (RV) function in children after tetralogy of Fallot (TOF) repair. The RV function of 25 asymptomatic children with surgically repaired TOF (age 3.3 ± 2.0 years) was assessed by echocardiography and cardiac catheterization. Right ventricular end-diastolic pressure and volume (RVEDP and RVEDV), systolic pressure, and ejection fraction, as well as mean pulmonary arterial pressure, mean right atrial pressure (RAP), and the severity of both pulmonary regurgitation (PR) and tricuspid regurgitation (TR) were assessed in terms of the contribution to tricuspid E/e′. Univariate analysis discovered a relationship between tricuspid E/e′ and RVEDV (R ² = 0172), pressure half-time of PR (PR-PHT) (R ² = 0.173), and TR grade (R ² = 0.145) (p < 0.01 for each). After multivariate adjustment, PR-PHT was significantly associated with tricuspid E/e′ (β = 0.210; p < 0.001). Tricuspid E/e′ was not significantly associated with RVEDP or RAP. In conclusion, tricuspid E/e′ does not indicate RV diastolic function but reflects the severity of PR in asymptomatic children after TOF repair.     

Altered Right Ventricular Function in the Long-Term Follow-up Evaluation of Patients After Delayed Aortic Reimplantation of the Anomalous Left Coronary Artery From the Pulmonary Artery

This study aimed to evaluate regional and global ventricular functions in the long term after aortic reimplantation of the anomalous left coronary artery from the pulmonary artery (ALCAPA) and to assess whether the time of surgical repair influences ventricular performance.The study examined 20 patients with a median age of 15 years (range 3–37 years) who had a corrected ALCAPA and 20 age-matched control subjects using echocardiography and tissue Doppler imaging (TDI). The median follow-up period after corrective surgery was 6 years (range 2.6–15 years). Seven patients underwent surgery before the age of 3 years (early-surgery group), whereas 13 patients had surgery after that age (late-surgery group). The TDI-derived myocardial strain of the interventricular septum (IVS), lateral wall of the left ventricle (LV), and lateral wall of the right ventricle (RV) in the basal and mid regions were examined, and a mean was calculated. The pulsed Doppler-derived Tei index was used to assess global left ventricular function. No significant differences were found between the early-surgery group and the control group regarding the regional myocardial strain or the Tei index. Compared with the early-surgery group, the late-surgery group had a significantly higher Tei index (mean 0.37; range 0.31–0.42 vs. mean 0.52; range 0.39–0.69; p < 0.005), a lower strain percentage of the lateral wall of the LV (mean 29; range 17–30 vs. mean 9; range 7–23), IVS (mean 23; range 21–31 vs. mean 19; range 13–25), and lateral wall of the RV (mean 23; range 21–31 vs. mean 19; range 13–25). The age at operation correlated significantly with the Tei index (r = 0.84, p < 0.001) and inversely with the mean strain of the lateral wall of the LV (r = ?0.53, p = 0.028), IVS (r = ?0.68, p = 0.003), and lateral wall of the RV (r = ?0.68, p = 0.003). At the midterm follow-up evaluation after corrective surgery of ALCAPA, not only the left but also the right ventricular function seemed to be affected in patients with delayed diagnosis and late surgical repair but preserved among the younger patients with early diagnosis and corrective surgery.     

Myocardial performance in children with autoimmune hepatitis: Doppler tissue imaging study

Autoimmune hepatitis (AIH) is a member of autoimmune diseases family which can increase risk of cardiovascular morbidity and mortality. This study aimed to assess subclinical impact of AIH on global myocardial performance in affected children using Doppler tissue imaging (DTI) and to correlate it with total serum immunoglobulin-G (IgG). Thirty children with AIH (mean age?=?12.67?±?2.9 years) was included as the study group and 20 age- and sex-matched healthy children (mean age?=?11.93?±?2.66 years) as the control group. Conventional two-dimensional echocardiography was performed to both groups and DTI were used to determine right ventricular (RV) and left ventricular (LV) Tei indexes. Total serum IgG levels at initial diagnosis of AIH were correlated to the cardiac functions of AIH patients. RV and LV Tei indexes were significantly higher in AIH group (mean?±?SD: 0.46?±?0.088 vs. 0.26?±?0.01, P?<?0.0001 and 0.45?±?0.086 vs. 0.31?±?0.02, P?<?0.0001, respectively). Also, total IgG concentrations were correlated positively with the LV Tei index (r?=?0.69, P?<?0.0001) and with the RV Tei index (r?=?0.61, P?<?0.0003) and correlated negatively with the mitral systolic (Sm) velocity (r?=??0.76, P?<?0.0001) and with tricuspid systolic (Sm) velocity (r?=??0.66, P?<?0.0001). On the other hand, fractional shortening did not correlate with serum IgG concentrations (r?=??0.04, P?=?0.821). In conclusion, the DTI technique appears to be more sensitive than conventional echocardiography in the early detection of myocardial dysfunction in AIH children.     

Diffuse myocardial fibrosis following tetralogy of Fallot repair: a T1 mapping cardiac magnetic resonance study

Background

Adverse ventricular remodeling after tetralogy of Fallot (TOF) repair is associated with diffuse myocardial fibrosis.

Objective

The goal of this study was to measure post-contrast myocardial T1 in pediatric patients after TOF repair as surrogates of myocardial fibrosis.

Materials and methods

Children after TOF repair who underwent cardiac magnetic resonance imaging with T1 mapping using the modified look-locker inversion recovery (MOLLI) sequence were included. In addition to routine volumetric and flow data, we measured post-contrast T1 values of the basal interventricular septum, the left ventricular (LV) lateral wall, and the inferior and anterior walls of the right ventricle (RV). Results were compared to data from age-matched healthy controls.

Results

The scans of 18 children who had undergone TOF repair and 12 healthy children were included. Post-contrast T1 values of the left ventricular lateral wall (443?±?54 vs. 510?±?77 ms, P?=?0.0168) and of the right ventricular anterior wall (333?±?62 vs. 392?±?72 ms, P?=?0.0423) were significantly shorter in children with TOF repair than in controls, suggesting a higher degree of fibrosis. In children with TOF repair, but not in controls, post-contrast T1 values were shorter in the right ventricle than the left ventricle and shorter in the anterior wall of the right ventricle than in the inferior segments. In the TOF group, post-contrast T1 values of the RV anterior wall correlated with the RV end-systolic volume indexed to body surface area (r?=?0.54; r²?=?0.30; P?=?0.0238).

Conclusion

In children who underwent tetralogy of Fallot repair the myocardium of both ventricles appears to bear an abnormally high fibrosis burden.     

Right- and Left-Ventricular Strain Evaluation in Repaired Pediatric Tetralogy of Fallot Patients Using Magnetic Resonance Tagging

Residual pulmonary insufficiency in post-repair Tetralogy of Fallot (rToF) patients often mediates biventricular dysfunction which is associated with long-term adverse clinical outcomes. The objective of this study was to demonstrate the presence of impaired left ventricle (LV) circumferential strain (CS) in pediatric rToF patients as compared to controls using cardiac magnetic resonance imaging (CMRI). Additionally, bivariate analysis between right ventricle (RV) and LV functional measures in rToF patients was performed to further characterize the interventricular interactions thought to mediate LV dysfunction secondary to RV volume overload. The medical records of 12 rToF patients (mean age 13.3 years) and 9 controls (mean age 10.9 years) were analyzed. LV global CS was significantly decreased in rToF patients versus controls (p = 0.04). This impairment was differentially distributed within the LV, with only the LV anterior and anterior lateral walls significantly decreased versus controls (p = 0.04, p = 0.03). Bivariate analysis revealed a significant correlation between RV mean CS and LV EF (r = 0.71, p = 0.01), RV infundibulum CS and LV EF (r = 0.70, p = 0.01), RV infundibulum CS and LV anterolateral wall CS (r = 0.59, p = 0.04), and RV infundibulum CS and pulmonary regurgitation fraction (r = ?0.63, p = 0.03). These findings support existing research implicating interventricular interactions in the development of LV dysfunction. Furthermore, the segment specific CS impairment in the LV suggests a possible spatial component to these interactions. The success of this study in identifying regional myocardial strain impairment indicates CMRI based techniques may be useful in localizing otherwise undetectable myocardial dysfunction.     

Evaluation of cardiac function by tissue Doppler imaging in children with chronic hepatitis

OBJECTIVES: Pathoanatomic changes in cirrhosis result in impaired ventricular filling and diastolic dysfunction and were named as cirrhotic cardiomyopathy. However, cardiac functions have not been studied in patients with chronic hepatitis. We hypothesized that such patients might have subclinical ventricular dysfunction, detectable by tissue Doppler echocardiography and related to the severity of hepatic inflammation and fibrosis. METHODS: We studied 63 clinically stable patients, 27 patients with mild chronic hepatitis (group 1), 22 patients with moderate chronic hepatitis (group 2) and 14 patients with severe chronic hepatitis (group 3) according to the scoring system of Knodell, and 36 age-matched healthy subjects. RESULTS: Patients with severe chronic hepatitis had impaired right ventricular diastolic function. The early diastolic velocity of the tricuspid valve annulus was lower in patients from group 3 than in healthy subjects (P < 0.001). Patients in group 3 had a greater isovolumic relaxation time (P < 0.001), indicating right ventricular diastolic dysfunction. Comparing group 3 with the healthy subjects, the ratio of peak early myocardial tissue velocity and peak late (or atrial) myocardial tissue velocity was significantly decreased (P < 0.001), at 1.4 (0.7) and 1.9 (0.7), respectively. There was also a slightly lower peak early myocardial tissue velocity and peak late (or atrial) myocardial tissue velocity ratio and a slightly longer isovolumic relaxation time in patients from group 2 than in healthy subjects (P < 0.05). CONCLUSIONS: We detected subclinical dysfunction of the right ventricle in children with chronic hepatitis in whom hepatic inflammation and fibrosis is prominent. Tissue Doppler echocardiography provides a quantifiable indicator useful for detection and monitoring of disease progression.     

Strain measurement by cardiovascular magnetic resonance in pediatric cancer survivors: validation of feature tracking against harmonic phase imaging

Background

Left ventricular strain may be a more sensitive marker of left ventricular dysfunction than ejection fraction in pediatric cancer survivors after anthracycline therapy, but there is limited validation of strain measurement by feature tracking on cardiovascular magnetic resonance (MR) images.

Objective

To compare left ventricular circumferential and radial strain by feature tracking vs. harmonic phase imaging analysis (HARP) in pediatric cancer survivors.

Materials and methods

Twenty-six patients (20.2?±?5.6 years old) underwent cardiovascular MR at least 5 years after completing anthracycline therapy. Circumferential and radial strain were measured at the base, midventricle and apex from short-axis myocardial tagged images by HARP, and from steady-state free precession images by feature tracking.

Results

Left ventricular ejection fraction more closely correlated with global circumferential strain by feature tracking (r?=??0.63, P?=?0.0005) than by HARP (r?=??0.39, P?=?0.05). Midventricular circumferential strain did not significantly differ by feature tracking or HARP (?20.8?±?3.4 vs. ?19.5?±?2.5, P?=?0.07), with acceptable limits of agreement. Midventricular circumferential strain by feature tracking strongly correlated with global circumferential strain by feature tracking (r?=?0.87, P?HARP, particularly at higher values of radial strain. Intraobserver and interobserver reproducibility was excellent for feature tracking circumferential strain, but reproducibility was poor for feature tracking radial strain.

Conclusion

Midventricular circumferential strain by feature tracking is a reliable and reproducible measure of myocardial deformation in patients status post anthracycline therapy, while radial strain measurements are unreliable. Further studies are necessary to evaluate potential relation to long-term outcomes.     

Subclinical Vascular Endothelial Dysfunctions and Myocardial Changes With Type 1 Diabetes Mellitus in Children and Adolescents

Vascular endothelial dysfunction, accelerated thickening of arterial intima, and changes in ventricular functions contribute to increased cardiovascular morbidity in type 1 diabetes mellitus (T1DM). This study aimed to investigate the functional-structural changes in the arteries and myocardium together with affection of highly sensitive C-reactive protein (hsCRP), circulating endothelial cells (CECs), and vitamin C levels in children with T1DM. Also, to test the association with early atherosclerotic changes. The study included 30 children with a diagnosis of T1DM and 30 healthy subjects matched by sex, age, and body mass index. Serum lipids, HbA1c, hsCRP, vitamin C, and CECs were detected. Corrected QT interval (QTc), cardiac dimensions, and left ventricular (LV) functions were assessed using conventional echocardiography. Noninvasive ultrasound was used to measure brachial artery flow-mediated dilation (FMD) responses and carotid intima-media thickness (IMT). The QTc interval was significantly higher in the diabetic patients than in the control subjects (P < 0.001). The findings showed LV diastolic dysfunction as reflected by significantly lower early peak flow velocity, decreased E/A ratio, increased early filling deceleration time (DcT), and prolonged isovolumic relaxation time (IVRT) (P < 0.001 for each). The children with diabetes had a significantly lower FMD response, increased IMT, lower vitamin C level, higher hsCRP, and higher CEC compared with the control subjects (P < 0.001 for each). A positive correlation between CEC and HbA1c was found (P = 0.004). An alteration in myocardial function and endothelial dysfunction may begin early with the association of early atherosclerotic changes. These changes are accelerated when glycemic control is poor. The authors recommend early and close observation of children with diabetes for any alterations in cardiac and vascular endothelial function. Vitamin C supplementation may reduce the risk of complications.