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Respiratory influence on right and left ventricular diastolic function in normal children
1Department of Pediatrics, William Beaumont Hospital, Royal Oak, Michigan 48072.
Insights
Inspiration significantly impacts pediatric heart function, decreasing left ventricular filling while enhancing right ventricular filling. Respiration phase must be standardized when assessing diastolic function in children.
Area of Science:
- Pediatric Cardiology
- Cardiovascular Physiology
- Echocardiography
Background:
- Diastolic function assessment in children is crucial for diagnosing heart conditions.
- Respiratory variations can influence hemodynamic parameters and ventricular filling.
- Understanding these variations is key to accurate interpretation of echocardiographic data.
Purpose of the Study:
- To investigate the effects of respiration on Doppler echocardiographic variables of diastolic function in normal children.
- To determine if respiratory phase influences left ventricular (LV) and right ventricular (RV) filling parameters.
- To establish the need for respiratory standardization in pediatric diastolic function assessment.
Main Methods:
- Doppler echocardiograms of tricuspid and mitral valves were recorded in 20 healthy children (1.5-11 years).
- Electrocardiogram and respiration phase were simultaneously monitored.
- Key diastolic filling variables (peak E velocity, E/A ratio, etc.) were analyzed during inspiration and expiration.
Main Results:
- Inspiration led to significant decreases in early diastolic LV filling variables (peak E velocity, E/A ratio, etc.).
- Inspiration caused significant increases in RV peak E and peak A velocities, indicating enhanced RV filling.
- Late active atrial emptying variables in the LV were unchanged by respiration; RV filling enhancement was consistent across early and late diastole.
Conclusions:
- Inspiration significantly enhances RV venous return and filling, while LV filling decreases due to complex interplay of preload, afterload, and ventricular interdependence.
- Assessment of pediatric RV and LV diastolic function requires standardization for the phase of respiration.
- These findings highlight the importance of considering respiratory variations for accurate interpretation of pediatric echocardiograms.
Abstract:
Doppler echocardiograms of the tricuspid and mitral valves were recorded with electrocardiogram and respirations in 20 normal children aged 1.5 to 11 years. Four variables of early diastolic left ventricular (LV) filling decreased with inspiration: the peak E velocity (mean decrease 8%, p less than 0.0001), the ratio of E/A areas (mean decrease 12%, p less than 0.001), the peak E/A velocity ratio (mean decrease 14%, p less than 0.005) and the 1/3 area fraction (mean decrease 12%, p less than 0.001). Variables of late active atrial emptying (peak A velocity and A/total area ratio) were unchanged with respiration. There was a significant increase in the right ventricular (RV) peak E (mean increase 26%, p less than 0.0001) and peak A velocities (mean increase 18%, p less than 0.0001) and mean heart rate (5% increase) with inspiration. The enhancement of RV filling was similar for early and late diastolic filling, since each of the variables generated from their ratios were not significantly changed with inspiration. Inspiration significantly enhances RV venous return, while the LV response to inspiration is a complex interplay among preload, afterload and ventricular interdependence. Assessment of pediatric RV and LV diastolic function should include standardization for phase of respiration.