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Doppler myocardial performance index in assessment of ventricular function in children with single ventricles
Yu-Qi Zhang1, Kun Sun, Shan-Liang Zhu
1Department of Pediatric Cardiology, Shanghai Children's Medical Center, Shanghai Jiaotong University, Shanghai 200127, China. zyq6812@sina.com
Insights
Ventricular function is impaired in children with single ventricles, worsening with age. The Doppler myocardial performance index (MPI) accurately assesses this function before and after total cavopulmonary connection (TCPC) surgery.
Area of Science:
- Pediatric Cardiology
- Echocardiography
- Congenital Heart Disease
Background:
- Assessing ventricular function in single ventricle patients is challenging due to complex geometry.
- The Doppler myocardial performance index (MPI) offers a geometry-independent method for ventricular assessment.
- This study investigates the feasibility of MPI in evaluating ventricular function in single ventricle children pre- and post-total cavopulmonary connection (TCPC).
Purpose of the Study:
- To evaluate the feasibility of using the Doppler myocardial performance index (MPI) for assessing ventricular function in pediatric patients with single ventricles.
- To compare MPI values in single ventricle patients before and after total cavopulmonary connection (TCPC) surgery against healthy controls.
- To determine the relationship between MPI, age, and ventricular pressure changes in children with single ventricles.
Main Methods:
- 161 pediatric patients with single ventricles and 80 healthy children were studied.
- Cardiac catheterization was used to obtain maximum positive rate of ventricular pressure change (Max dp/dt) in 58 patients.
- MPI was calculated from Doppler tracings, comparing values before and after TCPC surgery in 68 patients.
Main Results:
- Children with single ventricles showed significantly higher MPI values (0.54±0.11) compared to normal children (0.30±0.08).
- MPI correlated inversely with Max dp/dt (r=-0.77) and positively with age (r=0.54) in single ventricle patients.
- MPI did not significantly change post-TCPC overall, but decreased in younger children (<6 years), suggesting improved function.
Conclusions:
- Ventricular function is impaired in children with single ventricles and may decline with age.
- The Doppler myocardial performance index (MPI) is a reliable method for assessing ventricular function in single ventricle patients.
- MPI can be effectively used to evaluate ventricular function before and after total cavopulmonary connection (TCPC).
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.
