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Two-dimensional right ventricular strain by speckle tracking for assessment of longitudinal right ventricular
Clement Karsenty1, Khaled Hadeed2, Yves Dulac2
1Paediatric Cardiology Unit, Children's Hospital, CHU Toulouse, 31300 Toulouse, France; Intensive Care Unit, Children's Hospital, CHU Toulouse, 31300 Toulouse, France.
Insights
Two-dimensional speckle tracking is a feasible and reproducible method for assessing right ventricular (RV) function in children with congenital heart disease (CHD). This technique effectively captures perioperative changes in RV longitudinal strain, correlating well with conventional markers.
Area of Science:
- Pediatric Cardiology
- Echocardiography
- Cardiac Surgery
Background:
- Right ventricular (RV) function is crucial for prognosis in pediatric cardiac disease.
- Assessing RV longitudinal shortening via speckle tracking is a developing technique.
- Its feasibility in children with congenital heart disease (CHD) remains largely unknown.
Purpose of the Study:
- To evaluate the feasibility and reproducibility of RV two-dimensional (2D) strain using speckle tracking in infants undergoing CHD surgery.
- To compare this novel method with conventional markers of RV function.
Main Methods:
- Prospective study of 37 children undergoing CHD surgery.
- RV peak systolic strain (RV-PSS) measured by 2D speckle tracking pre-surgery, post-surgery, and at discharge.
- Correlation analysis with z scores of tricuspid annular plane systolic excursion (TAPSE) and tricuspid annular systolic velocity (TA Sa).
Main Results:
- Feasibility of RV-PSS analysis was high at 92.9%.
- Intraobserver and interobserver variability were acceptable (9.7% and 15.1%, respectively).
- RV-PSS strongly correlated with TAPSE and TA Sa (r=0.71 and r=0.70, respectively) and showed significant perioperative changes.
Conclusions:
- RV longitudinal strain by speckle tracking is a feasible and reproducible method.
- It effectively assesses the perioperative evolution of RV function in pediatric CHD patients.
Background:
Right ventricular (RV) function is a prognostic marker of cardiac disease in children. Speckle tracking has been developed to assess RV longitudinal shortening, the dominant deformation during systole; little is known about its feasibility in children with congenital heart disease (CHD).
Aims:
To evaluate the feasibility and reproducibility of RV two-dimensional (2D) strain assessed by speckle tracking in infants undergoing CHD surgery compared with conventional markers.
Methods:
In this prospective single-centre study, RV peak systolic strain (RV-PSS) was measured using 2D speckle tracking in 37 consecutive children undergoing CHD surgery. Examinations were performed the day before surgery, a few hours after surgery and before discharge. Relationships with the z score of tricuspid annular plane systolic excursion (TAPSE) and tricuspid annular systolic velocity (TA Sa) were assessed.
Results:
Median (interquartile range) age was 19 months (5-63); median weight was 9.2 kg (5.3-18.0). RV-PSS analysis was feasible in 92.9% (95% confidence interval [CI]: 86.0-97.1) of examinations. The coefficient of variation was 9.7% (95% CI: 7.4-11.9) for intraobserver variability and 15.1% (95% CI: 12.7-17.6) for interobserver variability. Correlations between RV-PSS and z score of TAPSE and TA Sa were strong (r=0.71, P<0.0001 and r=0.70, P<0.0001, respectively). RV-PSS was significantly reduced after surgery compared with baseline (-10.5±2.9% vs. -19.5±4.8%; P<0.0001) and at discharge (-13.5±4.0% vs. -19.5±4.8%; P<0.0001). Similar evolutions were observed with TAPSE and TA Sa (both P<0.0001).
Conclusion:
RV longitudinal strain by speckle tracking is a feasible and reproducible method of assessing perioperative evolution of RV function in children with CHD.
