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Published on: November 28, 2018
Echocardiographic predictors of early postsurgical myocardial dysfunction in pediatric patients with aortic valve
Alexander Lowenthal1, Theresa A Tacy, Fariborz Behzadian
1Echocardiography Laboratory, Division of Pediatric Cardiology, Department of Pediatrics, Lucile Packard Children's Hospital, Stanford University, 750 Welch Road, Suite # 325, Palo Alto, CA 94304, USA.
Insights
Early detection of left-ventricular dysfunction in pediatric aortic insufficiency is crucial. Global longitudinal strain and strain rate can predict postoperative dysfunction, aiding surgical timing in children with moderate to severe AI.
Area of Science:
- Cardiology
- Pediatric Cardiology
- Echocardiography
Background:
- Chronic aortic insufficiency (AI) can lead to left-ventricular (LV) dysfunction.
- Early detection is vital for timely surgical intervention in pediatric patients.
- The utility of strain and strain rate in pediatric AI remains under-established.
Purpose of the Study:
- To evaluate the effectiveness of strain and strain rate analysis in detecting LV dysfunction in pediatric patients with moderate to severe AI.
- To establish predictive values of preoperative global longitudinal strain (GLS) and strain rate (GLSr) for postoperative LV dysfunction.
Main Methods:
- Retrospective study of 40 pediatric patients with moderate to severe AI.
- Assessment of LV function using conventional echocardiography and strain analysis (GLS, GLSr) pre- and post-surgery.
- Analysis of predictive values for GLS and GLSr in relation to postoperative ejection fraction (EF).
Main Results:
- Preoperative GLS and GLSr values were within normal ranges.
- Postoperative assessment showed significant decreases in EF, shortening, GLS, and GLSr.
- Preoperative GLS ≤ -15.3 and GLSr ≤ -0.79/s predicted early postoperative dysfunction (EF < 50%).
Conclusions:
- Global longitudinal strain and strain rate are valuable tools for assessing LV function in pediatric AI.
- Preoperative GLS and GLSr can predict postoperative ventricular dysfunction.
- These parameters may assist in optimizing surgical timing for pediatric patients with moderate to severe AI.
Abstract:
In chronic aortic insufficiency (AI), left-ventricular (LV) dysfunction must be detected early to allow timely surgery. Strain and strain rate have been used for this purpose in adults, but the value of this method in pediatric AI has not been established. Forty patients with moderate to severe AI were included in this retrospective study. LV function was assessed by strain analysis and conventional echocardiography both before and after surgery. Of the 32 patients with preserved preoperative ejection fraction (EF; >50 %), 8 had postoperative dysfunction (<50 %). Mean conventional indices of global LV systolic performance for the entire cohort of patients with AI were predominantly in the normal range before surgery. Preoperative values for LV global longitudinal strain (GLS) and strain rate (GLSr) were normal. After surgery, there was a significant decrease in shortening and EF. There was a significant decrease from preoperative to postoperative values for both GLS (-16.07 ± 3.82 vs. -11.06 ± 3.88; p < 0.0001) and GLSr (-0.89 ± 0.24 vs. -0.72 ± 0.27; p = 0.0021). A preoperative GLS of -15.3 (AUC = 0.83, CI = 0.69-0.98, p < 0.0001) and a GLSr of -0.79/s (AUC = 0.86, CI = 0.73-0.98, p < 0.0001) were determined to be predictors of early postoperative dysfunction after surgical repair of moderate to severe AI. A preoperative GLS value of ≤-15.3 and GLSr value of -0.79/s or less are predictors of postoperative ventricular dysfunction, which is defined by EF <50 %. GLS and GLSr value determination may be useful as part of the echocardiographic assessment AI and may help determine the optimal timing of surgery in pediatric patient with at least moderate AI.
