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Atrioventricular Coupling in Infants and Children Assessed by Three-Dimensional Echocardiography
Katharina Linden1, Florian Otte1, Christian Winkler1
1Department of Pediatric Cardiology, University Hospital of Bonn, Bonn, Germany.
Insights
Atrioventricular (AV) coupling parameters were assessed in children using 3D echocardiography. Conduit volume significantly contributes to left ventricular filling, with coupling varying by heart rate.
Area of Science:
- Cardiovascular Physiology
- Pediatric Cardiology
- Echocardiography
Background:
- Atrioventricular (AV) coupling parameters are crucial for diagnosing diastolic dysfunction in adults.
- Pediatric AV coupling parameters have not been previously evaluated.
- This study investigates AV coupling in healthy infants and children.
Purpose of the Study:
- To evaluate AV coupling parameters in a large cohort of healthy infants and children.
- To investigate the contribution of left atrial (LA) volumes to left ventricular (LV) stroke volume across varying heart rates.
- To establish reference values for AV coupling in pediatric populations.
Main Methods:
- Prospective analysis of 3D echocardiographic data from 332 healthy subjects (0 days to 18.5 years).
- Calculation of conduit volume and establishment of percentiles using the lambda-mu-sigma method.
- Measurement and correlation of LV and LA peak filling/emptying rates (PFR/PER) normalized to R-R interval (PFRt/PERt) with heart rate.
Main Results:
- Conduit volume, contributing most to LV filling (median 57.58%), increased with body surface area.
- LA active emptying contribution to LV filling increased with decreasing heart rate; passive emptying decreased.
- Strong correlations were found between LV PFRt/LA PERt and heart rate (r=0.76/0.73), indicating close diastolic AV coupling.
Conclusions:
- 3D echocardiography enables feasible assessment of conduit volume and AV coupling in pediatric patients.
- Reference values established can aid in investigating AV coupling in pediatric heart diseases.
- Findings provide a basis for understanding diastolic and LA function in children.
Background:
Parameters of the interaction of the left atrium and left ventricle, atrioventricular (AV) coupling, are used in the diagnosis and follow-up of diastolic dysfunction in adults. Pediatric parameters of AV coupling have not been evaluated so far. The aim of this multicenter study was to investigate parameters of AV coupling in a large cohort of healthy infants and children using noninvasive real-time three-dimensional echocardiography. The authors hypothesized that the contribution of the different left atrial (LA) volumes to left ventricular (LV) stroke volume differs over a range of different heart rates.
Methods:
Three-dimensional echocardiographic data sets from 332 subjects (ages 0 days to 18.5 years) were analyzed prospectively. Volume-time curves of the left atrium and left ventricle were generated. Conduit volume was calculated and percentiles were established by the lambda-mu-sigma method of Cole and Green. Contributions of active, passive, and conduit volume to LV filling were measured and related to heart rate by linear regression. LV and LA peak filling rates (PFR) and peak emptying rates (PER) and time to PFR and PER normalized to the R-R interval (PFRt[%] and PERt[%]) were measured and correlated to each other.
Results:
Conduit volume increased with body surface area. The contribution of LA active emptying to LV filling tended to increase with decreasing heart rate, while the contribution of passive emptying decreased. Conduit volume contributed most to LV filling (median, 57.58 %; interquartile range, 12.85%) with a tendency to increase with decreasing heart rate. Close diastolic AV coupling was demonstrated by virtually identical LV PFRt(%) and LA PERt(%) during diastole. LV PERt(%) occurred earlier than LA PFRt(%), showing less coupling during systole. LV PFRt(%) and LA PERt(%) were strongly correlated to heart rate (r = 0.76 and r = 0.73, respectively). Lower heart rate resulted in a prolongation of diastole after LV PFR.
Conclusions:
Assessment of conduit volume and AV coupling by three-dimensional echocardiography is feasible in infants and children. The references of this study can serve as a basis to further investigate the role of parameters of AV coupling in pediatric patients with heart diseases concerning diastolic and LA function.
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