Demasking of subclinical left ventricular dysfunction in anemic children
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Updated: Oct 17, 2026
Morphological and Functional Assessment of the Right Ventricle Using 3D Echocardiography
Published on: October 28, 2020
R K Kapoor1, L Singh, S Mehrotra
1Department of Pediatrics, King George's Medical College, Lucknow 226 003, UP, India.
Insights
Exercise echocardiography effectively reveals subclinical left ventricular dysfunction in anemic children, particularly in severe cases. This non-invasive method uncovers subtle cardiac changes not apparent at rest, aiding early diagnosis and management.
Area of Science:
- Pediatric Cardiology
- Cardiovascular Physiology
- Hematology
Background:
- Anemia can impact cardiac function, but subclinical dysfunction may not be evident at rest.
- Early detection of left ventricular dysfunction is crucial for managing pediatric cardiovascular health.
Purpose of the Study:
- To investigate subclinical left ventricular dysfunction in anemic children using exercise echocardiography.
- To assess the role of exercise in unmasking cardiac abnormalities in anemic pediatric patients.
Main Methods:
- Echocardiography (M-mode and Doppler) was performed at rest and post-exercise on 52 anemic children and 20 controls (aged 7-12).
- Standard exercise testing protocols were employed to evaluate left ventricular dimensions, volumes, and function.
- Key echocardiographic parameters including ejection fraction and E/A ratio were analyzed.
Main Results:
- Anemic children showed significant differences in heart rate response and exercise capacity compared to controls.
- Left ventricular dysfunction was detected in all severely anemic children after maximal exercise.
- Reduced left ventricular end-diastolic volume post-exercise indicated diastolic dysfunction in moderate and severe anemia.
Conclusions:
- Exercise echocardiography is a valuable tool for identifying subtle left ventricular dysfunction in anemic children.
- Subtle cardiac impairments in anemic children are often unmasked by exercise stress.
- Prompt identification of exercise-induced cardiac dysfunction can inform clinical management strategies.
Objective:
To study subclinical left ventricular dysfunction in anemic children.
Setting:
Hospital.
Subjects:
The study population consisted of 52 cases of anemia (16 mild, 14 moderate, 22 severe) and 20 normal age and height matched children aged between 7-12 years.
Methods:
These children were subjected to Echocardiography on Ascuson XP model using 3.5 MHz Transducer during rest and immediately after maximum tolerated exercise on Quniton Model Q-5000 treadmill using modified Naughton protocol. Left ventricular end diastolic dimensions, left ventricular systolic dimension, fractional shortening, left ventricular end diastolic volume, systolic volume, stroke volume and ejection fraction were studied on M-mode echocardiography, and E/A ratio on doppler mode.
Results:
Significant differences were observed in resting heart rate, gain in heart rate at peak exercise compared to basal values and double product, total exercise duration and metabolic equivalents at peak exercise in controls and anemic subjects. Left ventricular dysfunction was present in all severely anemic subjects after maximum tolerated exercise on treadmill. The only evidence of left ventricular diastolic dysfunction was in form of decreased left ventricular end diastolic volume after exercise in moderate and severely anemic subjects.
Conclusions:
Exercise is helpful in demasking subtle left ventricular dysfunctions in anemic subjects that are not detected during rest.
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