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Is torsion a suitable echocardiographic parameter to detect acute changes in left ventricular afterload in children?
Kai Thorsten Laser1, Nikolaus Alexander Haas, Nadine Jansen
1Center of Congenital Heart Disease, Heart and Diabetes Center Northrhine-Westfalia, Ruhr-University of Bochum, Bad Oeynhausen, Germany. tlaser@hdz-nrw.de
Insights
Left ventricular torsion (tor(max)) increases in children with congenital heart defects due to pressure overload. This compensatory mechanism rapidly normalizes after successful interventional treatment, suggesting tor(max) can assess cardiac unloading.
Area of Science:
- Pediatric Cardiology
- Cardiovascular Physiology
- Medical Imaging
Background:
- Congenital heart defects like coarctation and valvular aortic stenosis cause pressure overload in the left ventricle.
- This pressure overload alters myocardial deformation mechanics, impacting heart function.
Purpose of the Study:
- To investigate changes in left ventricular myocardial deformation, specifically maximal torsion (tor(max)), in children with pressure overload due to congenital heart defects.
- To assess the impact of interventional catheterization on tor(max) and its potential as a clinical indicator.
Main Methods:
- Echocardiography with 2-dimensional strain speckle tracking was used in 37 pediatric patients (0-27 years) with coarctation or valvular aortic stenosis.
- Measurements were taken before and after interventional catheterization and compared to 37 healthy controls.
Main Results:
- Interventional treatment significantly reduced pressure gradients in both coarctation and aortic stenosis groups.
- Patients exhibited increased maximal left ventricular torsion (tor(max)) compared to controls, which significantly decreased after therapy.
Conclusions:
- Compensatory elevation of left ventricular tor(max) in children with pressure overload normalizes rapidly after successful interventional treatment.
- tor(max) shows promise as a valuable tool for assessing cardiac unloading and guiding the need for interventional treatment in pediatric cardiovascular conditions.
Background:
Congenital heart defects such as coarctation or valvular aortic stenosis are followed by changes in left ventricular myocardial deformation mechanics induced by pressure overload.
Methods:
Echocardiography was performed in 37 patients (aged 0-27 years, 15 female) with coarctation (27) or valvular aortic stenosis (10) before and after interventional catheterization and compared with 37 body surface area/age-matched healthy children. Deformation was calculated by 2-dimensional strain speckle tracking.
Results:
Stress gradients under provocation with orciprenaline in coarctation decreased from 51.8 +/- 20.0 mm Hg to 6.0 +/- 12.0 mm Hg (P < .0001), and resting gradients in aortic stenoses decreased from 57.5 +/- 18.8 mm Hg to 25.5 +/- 14.0 mm Hg (P < .0001) after intervention. Patients had an increased maximal torsion (tor(max): 16.7 +/- 6.7 deg vs 11.0 +/- 4.7 deg (controls; P < .0001), which decreased significantly after therapy (11.8 +/- 4.9 deg, P < .0001).
Conclusion:
Compensatory elevation of left ventricular tor(max) in children with moderate left ventricular pressure load changes rapidly after successful interventional treatment. tor(max) may be a valuable tool to assess cardiac unloading or indicate the need for interventional treatment.
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