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Diastolic ventricular function in children: a Doppler echocardiographic study establishing normal values and
P W O'Leary1, K Durongpisitkul, T M Cordes
1Section of Pediatric Cardiology, Mayo Clinic, Rochester, MN 55905, USA.
Insights
This study establishes normal Doppler echocardiographic values for pediatric diastolic cardiac function. These findings enable accurate noninvasive assessment of ventricular end-diastolic pressure (EDP) in children.
Area of Science:
- Pediatric Cardiology
- Echocardiography
- Diastolic Function Assessment
Background:
- Noninvasive assessment of diastolic cardiac function is crucial for pediatric cardiology.
- Existing Doppler echocardiography techniques require age-specific normal values for children.
Purpose of the Study:
- To establish age-appropriate normal diastolic Doppler echocardiographic data for children and adolescents.
- To determine the utility of these Doppler techniques in identifying pediatric patients with increased ventricular end-diastolic pressure (EDP).
Main Methods:
- Two-phase study involving 223 normal children and 24 children with elevated EDP.
- Doppler echocardiography focused on diastolic ventricular function variables.
- Analysis of Doppler data for age, heart rate, and gender dependency, and comparison between normal and elevated EDP groups.
Main Results:
- Normal Doppler values for diastolic function vary significantly with age and heart rate in children.
- The ratio and difference between pulmonary vein atrial reversal and mitral A wave durations effectively distinguished children with increased EDP.
- Specific thresholds (ratio ≥1.2 or difference ≥29 ms) demonstrated high sensitivity (88-90%) and specificity (86%) for identifying elevated EDP.
Conclusions:
- The study provides essential normal data for pediatric diastolic function assessment using Doppler echocardiography.
- These validated Doppler techniques allow for confident, noninvasive evaluation of diastolic function in pediatric patients, similar to adults.
Objective:
To extend noninvasive assessment of diastolic cardiac function into the pediatric age-group.
Design:
This study was divided into two phases, the first of which was designed to provide an age-appropriate set of normal diastolic Doppler echocardiographic data for children and adolescents and the second of which was to determine whether these Doppler techniques could be used to identify children with increased ventricular end-diastolic pressure (EDP).
Material And Methods:
Complete echocardiographic studies focusing on Doppler variables of diastolic ventricular function were performed on 223 normal children. Values observed were analyzed for dependence on age, heart rate, and gender. Results from the normal group were then compared with Doppler values observed in a group of 24 children with catheterization-substantiated increases in ventricular EDP.
Results:
Normal values for the Doppler factors studied vary with both age and heart rate. The variables that most confidently distinguished children with increased EDP from normal subjects were the ratio of and the difference between the durations of pulmonary vein atrial reversal and the mitral A wave. A ratio of 1.2 or more or a difference of 29 ms or more identified those children with increased EDP with sensitivities of 88 and 90% and specificities of 86 and 86%, respectively.
Conclusion:
Use of the normal data and the Doppler techniques described in this study will allow confident assessment of diastolic function in children as well as in adults.