Left atrial strain on 2D-STE in pediatric dilated cardiomyopathy

To characterize the left atrial (LA) strain of pediatric dilated cardiomyopathy (DCM) on two-dimensional speckle tracking echocardiography (2D-STE), and elucidate the progression of LA strain with long-term medical therapy in such patients.

Children with DCM who received standardized medical treatment for > 1 year at Children's Hospital of Soochow University between January 2018 - January 2021 were retrospectively reviewed. Age- and sex-matched patients with normal echocardiography were included as controls. Routine echocardiography was performed. 2D-STE was applied to obtain LA strain and tissue mitral annular displacement (TMAD) parameters. Echocardiographic images at baseline, 1-year post-treatment (Period 1), and > 2-year post-treatment (Period 2) were analyzed.

A total of 33 DCM patients were included, among whom 19 had isolated DCM, while 14 had DCM associated with left ventricular (LV) hypertrabeculation. At baseline, the age range of these children was 1 month to 144 months, and significantly lower left ventricular ejection fraction (LVEF) and fractional shortening (LVFS) (P < 0.05) were observed among the patients compared to controls. Among the LA strain parameters, significantly lower reservoir strain (LASr) and conduit strain (LAScd) (P < 0.05) were also demonstrated. And significantly higher LVEF, LVFS, LASr and LAScd and significantly lower IVSd-Z and LVEDd-Z were observed in DCM associated with LV hypertrabeculation patients compared to isolated DCM patients. Between Period 1 and 2, significant increase in LVEF, LVFS, LASr, and LAScd were observed (P < 0.05).

Following long-term standardized medication treatment, children with DCM exhibited significant improvements in left atrial reservoir and conduit functions. LAScd carries the potential as a sensitive imaging modality for LA strain in pediatric DCM.