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Does chest wall conformation influence myocardial strain parameters in infants with pectus excavatum?
Andrea Sonaglioni1, Gian Luigi Nicolosi2, Marta Braga3
1Department of Cardiology, IRCCS MultiMedica, Milan, Italy.
Insights
Infants with pectus excavatum (PE) show impaired myocardial strain, with severity correlating to chest wall conformation. This suggests compression-induced dyssynchrony, not intrinsic heart dysfunction, affects cardiac function in PE.
Area of Science:
- Cardiology
- Pediatric Cardiology
- Medical Imaging
Background:
- Pectus excavatum (PE) is a congenital chest wall deformity.
- Assessing cardiac function in infants with PE is crucial for understanding potential health impacts.
- Noninvasive methods like echocardiography are vital for evaluating cardiovascular health in neonates.
Purpose of the Study:
- To investigate the influence of chest wall conformation, assessed by the modified Haller index (MHI), on myocardial strain parameters in infants with PE.
- To compare myocardial strain in infants with PE to those with normal chest shapes.
Main Methods:
- A prospective case-control study involving 16 infants with PE (MHI >2.5) and 44 controls (MHI ≤2.5).
- Transthoracic echocardiography with 2D speckle tracking echocardiography (2D-STE) was used to analyze biventricular strain.
- Modified Haller index (MHI) was calculated, and assessments were performed within 3 days and around 40 days of life.
Main Results:
- PE infants had smaller cardiac chambers and significantly reduced biventricular global longitudinal strain (GLS), global circumferential strain (GCS), global radial strain (GRS), and right ventricular free wall longitudinal strain (RVFWLS) compared to controls.
- A strong inverse correlation was found between MHI and all measured strain parameters in PE infants during the perinatal period.
- Similar findings were observed at approximately 40 days of life, indicating progressive impairment.
Conclusions:
- Abnormal chest wall conformation in PE progressively impairs myocardial strain parameters in infants.
- The observed strain reduction is likely due to intraventricular dyssynchrony caused by compressive phenomena, rather than intrinsic myocardial dysfunction.
- Echocardiographic assessment of myocardial strain is valuable in evaluating the cardiac effects of PE in infants.
Purpose:
To investigate the possible influence of chest wall conformation on myocardial strain parameters in a consecutive population of infants with pectus excavatum (PE), noninvasively assessed by modified Haller index (MHI).
Methods:
Sixteen consecutive PE infants (MHI >2.5) and 44 infants with normal chest shape (MHI ≤2.5) entered in this prospective case-control study. All infants underwent evaluation by neonatologist, transthoracic echocardiography implemented with two-dimensional speckle tracking echocardiography (2D-STE) analysis of both ventricles and MHI assessment (ratio of chest transverse diameter over the distance between sternum and spine), at two time points: within 3 days and at about 40 days of life.
Results:
At 2.1 ± 1 days of life, compared to controls (MHI = 2.01 ± 0.2), PE infants (MHI = 2.76 ± 0.2) were diagnosed with significantly smaller cardiac chambers dimensions. Biventricular contractile function and hemodynamics were similar in both groups of infants. Left ventricular (LV) global longitudinal strain (GLS) (-16.0 ± 2.8 vs. -21.7 ± 2.2%), LV-global circumferential strain (GCS) (-16.3 ± 2.7 vs. -24.0 ± 5.2%), LV-global radial strain (GRS) (24.2 ± 3.0 vs. 31.5 ± 6.3%), and right ventricular free wall longitudinal strain (RVFWLS) (-16.0 ± 3.2 vs. -22.3 ± 4.4%) were significantly reduced in PE infants versus controls (all p < 0.001). A strong inverse correlation between MHI and the following parameters: LV-GLS (r = -0.92), LV-GCS (r = -0.88), LV-GRS (r = -0.87), and RVFWLS (r = -0.88), was demonstrated in PE infants, but not in controls, in perinatal period (all p < 0.001). Analogous results were obtained at 36.8 ± 5.2 days after birth.
Conclusions:
Abnormal chest anatomy progressively impairs myocardial strain parameters in PE infants. This impairment might reflect intraventricular dyssynchrony due to compressive phenomena rather than intrinsic myocardial dysfunction.
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