Optimal noninvasive assessment of initial left ventricular dysfunction in children with ectopic atrial tachycardia

Area of Science:

• Pediatric Cardiology
• Echocardiography
• Cardiac Electrophysiology

Background:

• Tissue Doppler imaging (TDI) is established for detecting cardiac dysfunction in adults.
• Early identification of left ventricular (LV) dysfunction in children with ectopic atrial tachycardia (EAT) is crucial.
• Conventional echocardiography may not always detect subtle early-stage LV dysfunction.

Purpose of the Study:

• To evaluate the utility of TDI in improving the early detection of LV dysfunction in pediatric EAT.
• To correlate TDI-derived parameters with plasma N-terminal pro-brain natriuretic peptide (NT-proBNP) levels.
• To assess the sensitivity of TDI parameters in identifying tachycardia-induced cardiomyopathy (TIC).

Main Methods:

• Seventy children with EAT underwent conventional echocardiography, TDI, and plasma NT-proBNP measurement.
• Key parameters measured included LV ejection fraction (LVEF), mitral inflow velocities (E), and mitral annular velocities (S', E').
• TDI-derived myocardial performance index (TDI-MPI) and the E/E' ratio were calculated and compared with NT-proBNP levels.

Main Results:

• Tachycardia-induced cardiomyopathy (TIC) was present in 18.6% of the children studied.
• TDI-MPI and E/E' demonstrated stronger correlations with elevated NT-proBNP than LVEF.
• Combining TDI-MPI and E/E' with LVEF improved sensitivity to 91.67% for detecting elevated NT-proBNP.

Conclusions:

• TDI-MPI and E/E' are valuable for assessing initial LV dysfunction in pediatric EAT, even with normal LVEF.
• These TDI parameters are associated with elevated NT-proBNP, indicating subclinical cardiac strain.
• TDI offers enhanced diagnostic information for early detection of LV dysfunction in children with EAT.