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Pediatric Cardiac Shear Wave Elastography for Quantitative Assessment of Myocardial Stiffness: A Pilot Study in
Pengfei Song1, Xiaojun Bi2, Daniel C Mellema1
1Department of Physiology and Biomedical Engineering, Mayo Clinic College of Medicine, Rochester, Minnesota, USA.
Insights
This pilot study shows cardiac ultrasound shear wave (SW) elastography is feasible for measuring myocardial stiffness in children. It provides crucial control data for assessing chemotherapy-induced cardiotoxicity in pediatric cancer patients.
Area of Science:
- Cardiovascular Imaging
- Pediatric Cardiology
- Biomedical Engineering
Background:
- Chemotherapy can cause cardiotoxicity in pediatric cancer patients.
- Accurate assessment of myocardial stiffness is crucial for early detection.
- Cardiac ultrasound shear wave (SW) elastography offers a non-invasive method to quantify myocardial stiffness.
Purpose of the Study:
- To investigate the feasibility of cardiac SW elastography in children (ages 5-18).
- To establish normative myocardial stiffness control data in healthy pediatric volunteers.
- To lay the groundwork for assessing chemotherapy-induced cardiotoxicity in pediatric cancer patients.
Main Methods:
- Developed a novel cardiac SW elastography sequence combining pulse-inversion harmonic imaging and time-aligned sequential tracking.
- Acquired SW elastography data from the interventricular septum (IVS) in parasternal long-axis (L-A) and short-axis (S-A) views.
- Analyzed SW speed measurements, considering factors like age, gender, and body mass index (BMI).
Main Results:
- Cardiac SW elastography was feasible in pediatric volunteers, with higher success rates in basal and mid IVS views.
- Success rates decreased with increased BMI but were not affected by age or gender.
- Significantly higher SW speed values were observed in S-A views compared to L-A views, indicating myocardial anisotropy.
Conclusions:
- Cardiac SW elastography is a feasible technique for quantitative myocardial stiffness assessment in children.
- Established normative SW speed values provide a baseline for future studies on pediatric cardiotoxicity.
- Myocardial anisotropy must be considered when interpreting SW speed data from different imaging axes.
Abstract:
The long-term goal of this study is to assess chemotherapy-induced cardiotoxicity for pediatric cancer patients using cardiac ultrasound shear wave (SW) elastography. This pilot study aimed to systematically investigate the feasibility of using cardiac SW elastography in children and provide myocardial stiffness control data for cancer patients. Twenty healthy volunteers (ages 5-18) were recruited. A novel cardiac SW elastography sequence with pulse-inversion harmonic imaging and time-aligned sequential tracking was developed for this study. Cardiac SW elastography produces and detects transient SWs propagating in the myocardium in late-diastole, which can be used to quantify myocardial stiffness. The parasternal long-axis (L-A) and short-axis (S-A) views of the interventricular septum (IVS) were feasible for pediatric cardiac SW elastography. The L-A and S-A views of the basal and mid IVS provided better success rates than those of the apical IVS. Success rates decreased with increased body mass index (BMI), but did not differ with age or gender. Two-dimensional SW speed measurements were 1.26, 1.22, 1.71 and 1.67 m/s for L-A base, L-A mid, S-A base and S-A mid IVS, respectively. All S-A SW speed values were significantly higher (p < 0.01) than L-A values due to myocardial anisotropy. No SW speed difference was observed for different ages and genders. This pilot study demonstrated, for the first time, the feasibility of using cardiac SW elastography to measure quantitative myocardial stiffness in children, and established control SW speed values for using SW elastography to assess chemo-induced cardiotoxicity for pediatric cancer patients. The results showed that the myocardial anisotropy needs to be accounted for when comparing SW speed from different imaging axes.
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