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Published on: December 22, 2023
Age-related changes in left ventricular vortex and energy loss patterns: from newborns to adults
Kristian C Becker1, Jennifer Cohen1, Jon D Nyce2
1Department of Pediatric Cardiology, Icahn School of Medicine at Mount Sinai, New York, New York, United States.
Insights
Infant heart development shows a transition in left ventricular (LV) vortex patterns. This change in cardiac blood flow efficiency involves increased energy loss (EL) during the first two years of life.
Area of Science:
- Cardiovascular Physiology
- Pediatric Cardiology
- Biomedical Engineering
Background:
- Left ventricular (LV) vortex formation is crucial for efficient blood transport and minimal energy loss (EL).
- LV vortex patterns and associated energy loss in children, particularly infants, are not well-described.
- Understanding these dynamics is key to assessing pediatric cardiac function.
Purpose of the Study:
- To characterize left ventricular (LV) vortex dynamics and energy loss (EL) patterns in healthy children across different age groups.
- To identify age-related transitions in LV vortex formation and cardiac efficiency from infancy to young adulthood.
- To establish normative data for LV vortex parameters in pediatric populations.
Main Methods:
- Prospective cohort study of 66 cardiovascularly normal children (0 days to 22 years).
- Utilized Vector Flow Mapping (VFM) echocardiography to quantify LV vortex number, size, strength, and energy loss (EL) during systole and diastole.
- Compared vortex patterns and EL metrics across distinct pediatric age groups.
Main Results:
- Newborns (≤ 2 months) exhibited one early diastolic (ED) and one late diastolic (LD) vortex.
- Children over 2 months showed a transition to two ED vortices and one LD vortex, with 95% of those over 2 years displaying this pattern.
- Diastolic energy loss (EL) significantly increased between 2 months and 2 years, then decreased in adolescents and young adults.
Conclusions:
- The left ventricular (LV) vortex flow pattern undergoes a significant transition from newborn to adult configurations within the first two years of life.
- This developmental transition is associated with a notable increase in diastolic energy loss (EL) during infancy, reflecting changing cardiac efficiency.
- These findings provide initial insights into dynamic changes in LV flow patterns and cardiac physiology in pediatric patients, establishing a baseline for future studies.
Abstract:
Left ventricular vortex formation optimizes the effective transport of blood volume while minimizing energy loss (EL). Vector flow mapping (VFM)-derived EL patterns have not been described in children, especially in those less than 1 yr of age. A prospective cohort of 66 (0 days-22 yr, 14 patients ≤ 2 mo) cardiovascularly normal children was used to determine left ventricular (LV) vortex number, size (mm2), strength (m2/s), and energy loss (mW/m/m2) in systole and diastole and compared across age groups. One early diastolic (ED) vortex at the anterior mitral leaflet and one late diastolic (LD) vortex at the LV outflow tract (LVOT) were seen in all newborns ≤ 2 mo. At >2 mo, two ED vortices and one LD vortex were seen, with 95% of subjects > 2 yr demonstrating this vortex pattern. Peak and average diastolic EL acutely increased in the same 2 mo-2-yr period and then decreased within the adolescent and young adult age groups. Overall, these findings suggest that the growing heart undergoes a transition to adult vortex flow patterns over the first 2 yr of life with a corresponding acute increase in diastolic EL. These findings offer an initial insight into the dynamic changes of LV flow patterns in pediatric patients and can serve to expand our understanding of cardiac efficiency and physiology in children.NEW & NOTEWORTHY This research article demonstrates, for the first time, echocardiographic evidence of a transition in left ventricular vortex patterns from the newborn to the adult period, with an associated change in cardiac efficiency, marked by increased energy loss, during infancy.
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