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Tissue Doppler Imaging Measures Correlate Poorly with Left Ventricular Filling Pressures in Pediatric Cardiomyopathy
David S Ezon1, Shiraz A Maskatia1, Kristen Sexson-Tejtel1
1Section of Pediatric Cardiology, Baylor College of Medicine, Texas Children's Hospital, Houston, Tex, USA.
Insights
Tissue Doppler imaging (TDI) measures are not reliable for assessing pediatric diastolic function. In children with cardiomyopathy, TDI did not accurately correlate with left ventricular filling pressures (LVFPs) or pulmonary artery pressures during catheterization.
Area of Science:
- Pediatric Cardiology
- Echocardiography
- Cardiovascular Physiology
Background:
- Tissue Doppler imaging (TDI) is used in adults with cardiomyopathy to estimate left ventricular filling pressures (LVFPs).
- TDI has been proposed as a non-invasive alternative to cardiac catheterization for assessing diastolic function.
- Validation of TDI for LVFP assessment in pediatric populations is lacking.
Purpose of the Study:
- To evaluate the reliability of TDI-derived diastolic function parameters.
- To assess the correlation between TDI measurements and invasive hemodynamic parameters in children with cardiomyopathy.
- To determine if TDI can serve as a surrogate for catheterization in pediatric patients.
Main Methods:
- Retrospective review of 38 children (≤18 years) with various cardiomyopathies.
- Cardiac catheterization data and echocardiograms obtained within 3 months were analyzed.
- Spearman's correlation coefficients were calculated for LVFP, pulmonary artery pressure, and pulmonary vascular resistance index (PVRi) against mitral inflow E/A, lateral mitral E/E', and septal E/E'.
Main Results:
- No significant correlation was found between LVFP or PVRi and lateral or septal mitral E/E' in pediatric cardiomyopathy patients.
- A positive correlation was observed between LVFP and the mitral inflow E/A ratio (rs = 0.59, P < .01).
- In a subgroup with hypertrophic or restrictive cardiomyopathy, mean pulmonary artery pressure negatively correlated with septal A' (rs = 0.56, P = .02).
Conclusions:
- TDI measures of diastolic function are not reliable surrogates for invasive hemodynamic assessment in children.
- Current TDI parameters do not accurately reflect LVFPs, mean pulmonary artery pressures, or PVRi in pediatric cardiomyopathy.
- Catheterization remains essential for accurate hemodynamic assessment in these patients.
Setting:
In adults with cardiomyopathy, tissue Doppler imaging (TDI) has been shown to correlate with left ventricular filling pressures (LVFPs) and has been advocated as a surrogate to catheterization. However, this has not been validated in children.
Design:
This is a retrospective review of children ≤18 years old with dilated, hypertrophic, restrictive, and left ventricular noncompaction cardiomyopathy who underwent cardiac catheterization within 3 months of an echocardiogram. Spearman's correlation coefficients were calculated to assess a correlation between LVFP and mitral inflow E/A ratio, lateral mitral E/E', and septal E/E'.
Results:
Thirty-eight patients were included in the study; median age was 8.6 years old. The median LVFP was 19 mm Hg, median mean pulmonary artery pressure was 25 mm Hg, and median pulmonary vascular resistance index (PVRi) was 2.4 Wu. There was no significant correlation between LVFP or PVRi with lateral mitral E/E' or septal E/E'. There was a positive correlation between LVFP and mitral inflow E/A ratio (rs = 0.59, P < .01). In a subgroup analysis of patients with hypertrophic or restrictive cardiomyopathy, there was a negative correlation (rs = 0.56, P = .02) between the mean pulmonary artery pressure and septal A'.
Conclusions:
TDI measures of diastolic function are not reliable surrogates for LVFP, mean pulmonary artery pressures, and PVRi at catheterization in children.
