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Left atrial systolic force in children: reference values for normal children and changes in cardiovascular disease
Hideaki Senzaki1, Rie Kumakura, Hirotaka Ishido
1Department of Pediatric Cardiology and Cardiovascular Surgery, Saitama Medical University, Saitama, Japan. hsenzaki@saitama-med.ac.jp
Insights
Left atrial systolic force (LASF) reference values in children are now available. Elevated LASF in pediatric heart conditions like VSD and COA suggests adaptive atrial function, potentially indicating future therapeutic targets.
Area of Science:
- Pediatric Cardiology
- Cardiac Physiology
- Echocardiography
Background:
- Left atrial systolic force (LASF) is a predictor of cardiovascular events in adults.
- Normal LASF values in children and atrial function in pediatric heart disease are not well-established.
- Understanding pediatric atrial function is crucial for managing congenital heart defects.
Purpose of the Study:
- Establish reference values for LASF in healthy children.
- Assess left atrial (LA) pump performance in pediatric patients with heart disease.
- Investigate the relationship between LASF and left ventricular (LV) overload in VSD and COA.
Main Methods:
- LASF was measured using 2D imaging and Doppler echocardiography.
- 185 healthy children and 71 pediatric patients (VSD or COA) were studied.
- LASF was correlated with age, body surface area, stroke volume, and heart rate.
Main Results:
- LASF increased significantly with age in healthy children.
- LASF was elevated in VSD and COA patients, proportional to LV overload.
- LASF normalized post-VSD correction but remained elevated after COA relief.
Conclusions:
- Provides essential reference data for pediatric atrial function assessment.
- Altered LASF in VSD and COA suggests persistent LA overwork with potential pathologic implications.
- LASF may serve as a novel therapeutic target in pediatric cardiac disease.
Background:
Recent studies in adults have indicated that left atrial (LA) systolic force (LASF) provides useful information about LA pump function and can be used to predict cardiovascular events. However, normal values of LASF in children are not available, and little is known about atrial function in pediatric patients with heart disease. The objectives of the present study were to provide reference values for LASF in children and to determine LA pump performance in pediatric patients with heart disease using LASF.
Methods:
LASF was measured using combined two-dimensional imaging and Doppler echocardiography in 185 healthy children and 71 pediatric patients with ventricular septal defects (VSDs; as a representative heart disease with chronic left ventricular [LV] volume overload; n=48) or coarctation of the aorta (COA; as a representative heart disease with chronic LV pressure overload; n=23).
Results:
LASF in children significantly increased with advancing age (P<.005). The major determinants of this change were body surface area, stroke volume, and heart rate, with a linear model fit (r2) of 0.72. In patients with VSD and those with COA, LASF was significantly elevated in proportion to the degree of LV volume or pressure load, suggesting adaptive mechanisms of LA pump function to facilitate LV filling in chronically overloaded hearts. LASF was normalized after anatomic correction of VSDs but remained elevated even after the relief of COA, indicating persistent overwork of the left atrium.
Conclusions:
The present study provides reference data for the evaluation of atrial function in pediatric patients with cardiac disease. In addition, altered LASF in patients with VSDs with even small left-to-right shunts and in those with COA even after anatomic correction may have pathologic implications that could lead to a novel therapeutic target.
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