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Value of tissue Doppler echocardiography in children with pulmonary hypertension
Astrid E Lammers1, Sheila G Haworth, Gillian Riley
1Paediatric Cardiology and the UK Pulmonary Hypertension Service for Children, Great Ormond Street Hospital for Children, London, United Kingdom. astridlammers@gmx.de
Insights
Pulmonary hypertension (PHT) in children impairs left ventricular (LV) systolic performance, even when ejection fraction appears normal. Doppler tissue imaging (DTI) reveals subtle deficits missed by conventional echocardiography.
Area of Science:
- Pediatric Cardiology
- Cardiovascular Imaging
- Pulmonary Hypertension
Background:
- The effects of pulmonary hypertension (PHT) on ventricular function in children are not well understood.
- Echocardiographic data, especially combining conventional and Doppler tissue imaging (DTI), are scarce in pediatric PHT.
Purpose of the Study:
- To evaluate left ventricular (LV) and right ventricular function in children with PHT using conventional echocardiography and DTI.
- To investigate ventricular-ventricular interactions and identify early signs of cardiac dysfunction in pediatric PHT.
Main Methods:
- Conventional echocardiography and DTI were performed on 41 children with PHT and 44 healthy controls.
- Measurements included ventricular dimensions, systolic/diastolic velocities, and pulmonary artery parameters.
Main Results:
- Children with PHT showed enlarged right heart structures and reduced pulmonary acceleration time and tricuspid annular plane systolic excursion.
- DTI revealed significantly lower systolic and diastolic velocities in the tricuspid and septal regions.
- Despite preserved LV ejection fraction, LV systolic velocities were reduced, and LV filling velocities suggested an underloaded or dysfunctional LV.
Conclusions:
- LV systolic performance is impaired in children with PHT, often undetected by conventional echocardiography.
- Quantitative DTI assessment is crucial for understanding ventricular function and interactions in pediatric PHT.
- DTI may guide treatment optimization for heart failure in children with PHT.
Background:
The impact of pulmonary hypertension (PHT) on right ventricular and left ventricular (LV) function in children with PHT is unknown, and echocardiographic data combining conventional and Doppler tissue imaging (DTI) on PHT in children are sparse.
Methods:
Forty-one children (18 male; mean age, 7.9 ± 5.6 years) with PHT and structurally normal hearts (27 with idiopathic PHT, 14 with associated PHT) and 44 age-matched healthy controls were assessed using conventional echocardiography and DTI.
Results:
Children with PHT had enlarged tricuspid valve diameters, right atrial areas, pulmonary artery dimensions, and LV eccentricity indices. In addition, pulmonary acceleration time and tricuspid annular plane systolic excursion were significantly reduced in patients compared with controls. DTI revealed that children with PHT had significantly lower systolic (S) and early diastolic (E) velocities at the tricuspid and septal levels. Despite preserved LV ejection fractions, left lateral free wall systolic velocities were significantly reduced in patients with PHT. Significantly reduced LV rapid filling velocities (E) suggested an underloaded left ventricle or LV diastolic dysfunction in children with PHT compared with controls. Pulmonary acceleration time and tricuspid annular plane systolic excursion correlated best with DTI systolic tricuspid and septal velocities.
Conclusions:
Despite not being evident on conventional two-dimensional echocardiography, LV systolic performance appears to be impaired in children with PHT. Quantitative DTI assessment of ventricular function and ventricular-ventricular interactions in this setting might provide further insights into the mechanisms leading to end-stage PHT and may guide clinicians to optimize antifailure treatment.
