Myocardial performance after coronary re-implantation in pediatric patients assessed with conventional echocardiographic and 2D-speckle tracking analysis: a case-control study
Salma Charfeddine1, Dorra Abid1, Rania Hammami1
1Cardiology Department, Hedi Chaker University Hospital, University of Medicine of Sfax, Sfax, Tunisia.
Insights
Long-term follow-up after arterial switch operation with coronary reimplantation reveals reduced myocardial strain. Two-dimensional speckle-tracking imaging (2D-STI) detected subtle but significant decreases in left ventricular (LV) longitudinal and circumferential strain, despite normal global LV function.
Area of Science:
- Cardiology
- Pediatric Cardiology
- Echocardiography
Background:
- Arterial switch operation (ASO) with coronary reimplantation can lead to reduced exercise capacity and myocardial ischemia.
- Standard echocardiography often shows normal systolic function post-ASO, masking underlying myocardial changes.
- Long-term assessment of myocardial function after ASO is crucial for understanding patient outcomes.
Purpose of the Study:
- To evaluate long-term myocardial function changes after ASO with coronary reimplantation.
- To utilize Doppler and speckle-tracking imaging (STI) for detailed functional assessment.
- To identify subtle myocardial impairments not detected by conventional echocardiography.
Main Methods:
- Observational case-control study including 36 post-ASO patients and 20 healthy controls.
- Patients followed for at least 6 months post-operation.
- Assessment of systolic and diastolic parameters, and left/right ventricular myocardial performance using Doppler and 2D-STI.
Main Results:
- Left ventricular (LV) global longitudinal strain (GLS) was significantly decreased in operated patients compared to controls.
- Patients with coronary reimplantation exhibited the lowest GLS values.
- LV global circumferential strain was also significantly reduced in the ASO group, particularly those with coronary reimplantation.
Conclusions:
- Two-dimensional speckle-tracking imaging (2D-STI) reveals significant, albeit subtle, decreases in LV longitudinal and circumferential strain post-ASO with coronary reimplantation.
- These strain changes occur despite normal global LV function assessed by conventional echocardiographic parameters.
- 2D-STI provides valuable insights into long-term myocardial performance after complex congenital heart surgery.
Introduction:
reduced exercise capacity, coronary artery abnormalities and reversible myocardial ischemia have been demonstrated after arterial switch operation (ASO) and coronary reimplantation. Despite this, indices of systolic function, assessed by standard and Doppler echocardiography, are within the normal range. The aim of this study was to highlight the long-term changes in myocardial function following coronary reimplantation using Doppler and speckle-tracking imaging (STI) echocardiography.
Methods:
this observational case control study included 36 patients and 20 gender and age-matched healthy controls. A group study was performed using patients who were followed for at least 6 months after the operation and who visited the pediatric cardiology outpatient between October 2015 and May 2016. Systolic and diastolic parameters, left ventricle (LV) and right ventricle (RV) myocardial performance were assessed in each group.
Results:
the LV global peak strain parameters revealed a significant decrease in the longitudinal and circumferential strain components. The LV global longitudinal strain (GLS) values were lower in both groups of operated patients than controls (-19.9 ± 2.2% (group 1) versus -20.9 ± 1.6% (group 2) versus -22.9 ± 2.3% (group 3), p<0.001). The patients with coronary reimplantation had the lowest values. The LV global circumferential strain was also decreased in the group 1 patients as compared with the 2 other groups (-16.6 ± 4.1% (group 1) versus -19.4 ± 3.9% (group 2) versus -19.8 ± 4.0% (group 3), p<0.001).
Conclusion:
although global LV function, assessed with conventional echocardiographic parameters, was normal, the 2D-STI analysis showed slight but significant decrease in the global and segmental longitudinal and circumferential LV strain during the long-term follow-up after coronary arteries reimplantation.
