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Age-related variations of left ventricular endocardial and midwall function in healthy infants, children, and
Roberto Crepaz1, Roberto Cemin, Cristina Pedron
1Department of Cardiology, San Maurizio Regional Hospital, Bolzano, Italy. robcrep@hotmail.com
Insights
Pediatric left ventricular systolic function assessment using endocardial measurements can overestimate function in hypertrophy. Midwall measurements reveal reduced contractility and higher afterload sensitivity in infants.
Area of Science:
- Pediatric Cardiology
- Cardiovascular Physiology
- Echocardiography
Background:
- Echocardiographic evaluation of pediatric left ventricular systolic function typically uses endocardial measurements.
- Ventricular hypertrophy can lead to overestimation of systolic function when relying solely on endocardial data.
Purpose of the Study:
- To investigate developmental changes in left ventricular systolic mechanics.
- To compare endocardial and midwall level measurements in normal pediatric subjects.
- To assess the impact of afterload on left ventricular contractility across different age groups.
Main Methods:
- Echocardiographic measurements of left ventricular end-diastolic volume, mass, fractional shortening, and velocity of circumferential shortening were performed.
- Measurements were taken at both endocardial and midwall levels in 239 normal subjects across six age groups.
- Left ventricular afterload was assessed using end-systolic stress, and contractility was evaluated by relating fiber shortening to afterload.
Main Results:
- Left ventricular volume and mass increased with age, while the mass/volume ratio remained stable.
- Endocardial fractional shortening and velocity of circumferential shortening decreased with increasing afterload.
- Midwall fractional shortening and velocity of circumferential shortening were lower in early infancy and did not significantly change within the first year.
Conclusions:
- Left ventricular mass and volume grow with age, with a stable mass/volume ratio and increasing afterload.
- Higher endocardial systolic function indexes in early life are attributed to lower afterload and higher mass/volume ratio.
- The pediatric left ventricular myocardium exhibits greater afterload sensitivity and reduced midwall contractility in the first months of life.
Background:
In pediatric age echocardiographic evaluation of left ventricular systolic function is usually based on indexes obtained by measurements at the endocardial level. In the presence of ventricular hypertrophy this may lead to an overestimation of systolic function. The aim of this study was to assess the developmental changes of left ventricular systolic mechanics measured at the endocardial and midwall levels.
Methods:
In 239 normal subjects divided into six age groups we measured left ventricular end-diastolic volume, mass and mass/volume ratio, fractional shortening, and rate-corrected mean velocity of circumferential shortening at the endocardial and midwall levels. Endocardial meridional end-systolic stress and midwall circumferential end-systolic stress were considered as indexes of afterload. Relations of extent and velocity of fiber shortening to afterload at the endocardial and midwall levels were used to assess left ventricular contractility.
Results:
Blood pressure, left ventricular afterload, volume and mass increased, whereas the mass/volume ratio remained stable during growth. Fractional shortening and mean velocity of circumferential shortening at the endocardial level decreased and showed an inverse relation to afterload. Midwall fractional shortening and rate-corrected mean velocity of circumferential shortening were lower during the first months and did not change during the first year of life.
Conclusions:
Left ventricular volume and mass increase with age, mass/volume ratio remains almost constant while afterload increases. Endocardial systolic function indexes are higher in the first period of life, due to low afterload and increased mass/volume ratio. In the first months of life the left ventricular myocardium shows a greater sensitivity to changes in afterload and a reduced contractility measured at the midwall level.
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