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Transthoracic Speckle Tracking Echocardiography for the Quantitative Assessment of Left Ventricular Myocardial Deformation
Published on: October 20, 2016
Impaired longitudinal deformation measured by speckle-tracking echocardiography in children with end-stage renal
Maike van Huis1, Nikki J Schoenmaker2, Jaap W Groothoff2
1Department of Pediatric Nephrology, Emma Children's Hospital, Academic Medical Center (AMC) Amsterdam/University of Amsterdam, Amsterdam, The Netherlands. maikevanhuis@gmail.com.
Insights
Speckle-tracking echocardiography detected early heart muscle changes in pediatric end-stage renal disease (ESRD) patients. This technique reveals myocardial dysfunction before conventional methods, aiding in early intervention for children with ESRD.
Area of Science:
- Pediatric Cardiology
- Nephrology
- Cardiovascular Imaging
Background:
- Left ventricular dysfunction is a significant comorbidity in adult end-stage renal disease (ESRD), impacting prognosis.
- In pediatric ESRD, left ventricular function is typically preserved, but early myocardial changes are not well understood.
Purpose of the Study:
- To investigate myocardial mechanics in pediatric patients with ESRD.
- To utilize speckle-tracking echocardiography (STE) for assessing early changes in myocardial function.
Main Methods:
- Echocardiography (M-mode, TDI, STE) was performed on 19 pediatric dialysis patients, 17 transplant patients, and 33 controls.
- Strain measurements (longitudinal, radial, circumferential) were obtained from standard echocardiographic views.
Main Results:
- Dialysis and transplant patients showed increased interventricular and left ventricular posterior wall thickness compared to controls.
- No significant differences were observed in ejection fraction, shortening fraction, or systolic tissue Doppler velocities.
- Pediatric ESRD patients exhibited decreased mean longitudinal strain, indicating early myocardial impairment not detected by conventional measures.
Conclusions:
- Speckle-tracking echocardiography can identify subclinical myocardial dysfunction in pediatric ESRD patients.
- STE offers a sensitive method for detecting early cardiac changes in pediatric ESRD, even when conventional echocardiography appears normal.
Background:
Left ventricular dysfunction is an important co-morbidity of end-stage renal disease (ESRD) and is associated with a poor prognosis in the adult population. In pediatric ESRD, left ventricular function is generally well preserved, but limited information is available on early changes in myocardial function. The aim of this study was to investigate myocardial mechanics in pediatric patients with ESRD using speckle-tracking echocardiography (STE).
Methods:
Echocardiographic studies, including M-mode, tissue Doppler imaging (TDI) and STE, were performed in 19 children on dialysis, 17 transplant patients and 33 age-matched controls. Strain measurements were performed from the apical four-chamber and the short axis view, respectively.
Results:
The interventricular and left ventricular posterior wall thickness was significantly increased in dialysis and transplant patients compared to healthy controls. No significant differences were found in shortening fraction, ejection fraction and systolic tissue Doppler velocities. Dialysis and transplant patients had a decreased mean longitudinal strain compared to healthy controls, with a mean difference of 3.1 [95 % confidence interval (CI) 2.0-4.4] and 2.7 (95 % CI 1.2-4.2), respectively. No differences were found for radial and circumferential strain.
Conclusions:
Speckle-tracking echocardiography may reveal early myocardial dysfunction in the absence of systolic dysfunction measured by conventional ultrasound or TDI in children with ESRD.
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