Assessment of intraventricular time differences in healthy children using two-dimensional speckle-tracking echocardiography

Parameters describing intraventricular time differences are increasingly assessed in both adults and children. However, to appreciate the implications of these parameters in children, knowledge of the applicability of adult techniques in children is essential. Hence, the aim of this study was to assess the applicability of speckle-tracking strain-derived parameters in children, paying special attention to age and heart rate dependency. One hundred eighty-three healthy subjects (aged 0-19 years) were included. Left ventricular global peak strain, time to global peak strain, and parameters describing intraventricular time differences were assessed using speckle-tracking strain imaging in the apical two-chamber, three-chamber, and four-chamber views (longitudinal strain) and the parasternal short-axis view (radial and circumferential strain). Parameters describing intraventricular time differences included the standard deviation of time to peak strain and differences in time to peak strain between two specified segments. Age and heart rate dependency were evaluated using regression analysis, and intraobserver and interobserver variability were tested. Acquisition and analysis of longitudinal six-segment time-strain curves was successful in 94.8% of subjects and radial and circumferential time-strain curves in 89.5%. No clinically significant linear relation was observed between age or heart rate and parameters describing intraventricular time differences. The coefficient of variation of time to global peak strain parameters was 10 for parameters describing intraventricular time differences. The feasibility of speckle-tracking strain analysis in children is relatively good. Furthermore, no linear relation was observed between age or heart rate and parameters describing intraventricular time differences. However, the limited reproducibility of some parameters describing intraventricular time differences will confine their applicability in clinical practic

Relationship between temporal sequence of right ventricular deformation and right ventricular performance in patients with corrected tetralogy of Fallot

Right ventricular (RV) dysfunction is common in patients with corrected tetralogy of Fallot (cToF). Abnormalities in the temporal pattern of RV mechanical activation have been observed in patients with cToF, but the relationship with RV performance remains unclear. This study characterises RV performance and the temporal sequence of RV deformation in patients with cToF and healthy controls. 37 patients with cToF were compared with 18 controls. Using two-dimensional speckle tracking analysis, global RV strain was assessed. In addition, time to peak strain and the time difference between RV inlet and RV outlet (RV time delay) was assessed. The relation between RV performance and RV time delay was assessed with linear regression analysis. Results RV strain was reduced in patients compared with controls (-20.9 ± 4.3% vs -30.7 ± 3.4%, p <0.001). Time to peak strain at the RV inlet showed no differences between patients with cToF and controls (406 ± 55 ms vs 405 ± 67 ms, p=0.429), whereas time to peak strain at the RV outlet was significantly delayed in patients with cToF (339 ± 75 ms vs 262 ± 85 ms, p=0.003). Consequently, RV time delay was significantly shorter in patients with cToF than in controls (66 ± 48 ms vs 143 ± 53 ms, p <0.001). A close relation between RV time delay and RV strain was observed (r=-0.70, p <0.001). In patients with cToF, RV outlet deformation is delayed, causing a reduction in RV time delay which is significantly related to impairment in RV performanc

Scoliosis in children with osteogenesis imperfecta: influence of severity of disease and age of reaching motor milestones

We studied the relationship between the age of reaching motor milestones, especially anti-gravity activities, and the age of development of pathological spinal curvatures in children with osteogenesis imperfecta (OI). We hypothesized that earlier achievement of anti-gravity motor milestones predicts a later development of pathological spinal curvatures. Ninety-six children participated in this retrospective study. The severity of the disease was classified according to Sillence into types I-IV. Spinal radiography was performed annually and spinal deformities were measured according to the Cobb angle. Scoliosis was defined as a Cobb angle exceeding 9 degrees. Pathological thoracic kyphosis was defined as a Cobb angle exceeding 40 degrees. The parents were asked to report the age at which the child achieved motor milestones, and data were checked against health care records. Thirty-seven of 96 children (39%) developed a scoliosis of more than 9 degrees. Nine of 96 children (9%) developed a pathological kyphosis. The age of developing scoliosis was significantly lower than the age of development of the pathological kyphosis (P=0.01). Bone mineral density was measured by dual energy X-ray absorptiometry (DEXA) in 53 children, 28 of whom developed scoliosis, and 25 of whom did not. The mean DEXA Z-score of the 28 children with scoliosis was significantly lower than that of the 25 children without (-5.2, SD 1.3 vs -3.2, SD 1.9; P-value <0.001). Children with OI type IV, but particularly OI type III, reached motor milestones much later than children with OI type I. The motor milestone "supported sitting" showed a significant inverse association with time of the first presence of scoliosis with a Cobb angle greater than 9 degrees (linear regression coefficient: -1.3, 95% confidence interval: -2.6 to -0.03). The age of achieving the motor milestones "lifting the head to 45 degrees in prone position", "rolling", and "supported-" and "unsupported standing" were not significantly associated with age of the first presence of scoliosis with a Cobb angle greater than 9 degrees. However, the directions of associations suggest that here, too, there is a tendency for later development of scoliosis in those who reach milestones at earlier ages. Multivariable analyses showed that the motor milestone "sitting with support" was significantly associated with age of first achieving scoliosis, independent of gender and type of OI (linear regression coefficient: -0.9, 95% confidence interval: -1.3 to -0.5). We conclude that in children with OI, the age of anti-gravity motor milestones was associated with the age of development of pathological spinal curvatures. Earlier achievement of the motor milestone "supported sitting" predicted significantly a later development of pathological spinal curvatures, independent of gender and type of O

Cardiac resynchronization therapy in paediatric and congenital heart disease patients

The number of patients with congenital heart disease (CHD) has significantly increased over the last decades. The CHD population has a high prevalence of heart failure during late follow-up and this is a major cause of mortality. Cardiac resynchronization therapy (CRT) may be a promising therapy to improve the clinical outcome of CHD and paediatric patients with heart failure. However, the CHD and paediatric population is a highly heterogeneous group with different anatomical substrates that may influence the effects of CRT. Echocardiography is the mainstay imaging modality to evaluate CHD and paediatric patients with heart failure and novel echocardiographic tools permit a comprehensive assessment of cardiac dyssynchrony that may help selecting candidates for CRT. This article reviews the role of CRT in the CHD and paediatric population with heart failure. The current inclusion criteria for CRT as well as the outcomes of different anatomical subgroups are evaluated. Finally, echocardiographic assessment of mechanical dyssynchrony in the CHD and paediatric population and its role in predicting response to CRT is comprehensively discusse

Enhanced characterization of ventricular performance after coarctation repair in neonates and young children

Within the group of patients undergoing coarctectomy today, two subgroups can be identified: neonates with a critical coarctation and nonneonatal patients. We hypothesize that patients who have to undergo repair in the neonatal period will have more persistent impairment of ventricular performance postoperatively. Accordingly, we aimed to characterize biventricular performance after coarctectomy in neonatal and nonneonatal patients. Children (aged 0 to 17 years) undergoing a coarctectomy were prospectively included and classified as neonatal ( <1 month old) or nonneonatal patients. Age-matched controls were included for each measurement occasion. To evaluate left (LV) and right ventricular (RV) performance, fractional shortening, peak systolic (S') and early diastolic (E') tissue Doppler imaging velocities, and E/E' were assessed preoperatively, at discharge, and 1 year postoperatively (11.4 ± 8.3 months). In neonatal (n = 18) and nonneonatal (n = 19) patients LV performance significantly improved within the first postoperative year. Yet 1 year postoperatively, LV S' was still lower in neonatal patients vs controls (4.8 ± 1.1 vs 6.1 ± 1.6 cm/s; p = 0.036), whereas comparable results were observed in nonneonatal patients and controls. One year postoperatively, LV diastolic performance was impaired in neonatal (LV E' 8.7 ± 3.1 vs 13.2 ± 3.9 cm/s, p = 0.005) and nonneonatal patients (LV E' 12.1 ± 3.5 vs 15.1 ± 2.4 cm/s, p = 0.008) vs controls. In RV performance variables, no differences were observed 1 year postoperatively between neonatal and nonneonatal patients and controls. In both subgroups, LV diastolic performance does not recover to normal values within the first postoperative year. However, LV systolic performance remains more persistently impaired in patients who have to undergo repair in the neonatal period vs nonneonatal repai

Tetralogy of fallot: 3D velocity-encoded MR imaging for evaluation of right ventricular valve flow and diastolic function in patients after correction

PURPOSE: To evaluate three-dimensional (3D) velocity-encoded (VE) magnetic resonance (MR) imaging, as compared with two-dimensional (2D) VE MR imaging, for assessment of pulmonary valve (PV) and tricuspid valve (TV) flow, with planimetry as the reference standard, and to evaluate diastolic function in patients with a corrected tetralogy of Fallot (TOF). MATERIALS AND METHODS: Local institutional review board approval was obtained, and patients or their parents gave informed consent. Twenty-five patients with a corrected TOF (12 male, 13 female; mean age, 13.1 years +/- 2.7 [standard deviation]; age range, 8-18 years) and 19 control subjects (12 male, seven female; mean age, 14.1 years +/- 2.4; age range, 8-18 years) underwent planimetric MR imaging, 2D VE MR imaging, and 3D VE MR imaging for TV and PV flow evaluation. For evaluation of diastolic function, PV and TV flow were summated. Data were analyzed by using linear regression analysis, paired and unpaired t testing, and Bland-Altman plots. RESULTS: Strong correlations between the 2D VE MR and 3D VE MR measurements of PV flow (for forward flow: r = 0.87, P < .01; for backward flow: r = 0.97, P < .01) were observed. With PV effective flow as a reference, 3D TV effective flow measurements were more accurate than 2D TV effective flow measurements: In patients, the mean 2D TV effective flow versus 2D PV effective flow difference was 17.6 mL +/- 11 (P < .001), and the mean 3D TV effective flow versus 3D PV effective flow difference was -1.2 mL +/- 4.7 (P = .22). Diastolic functional impairment in patients could be detected at 3D VE MR imaging diastolic assessment. CONCLUSION: Three-dimensional VE MR imaging is accurate for PV flow assessment and is more accurate than 2D VE MR imaging for TV flow evaluation. Assessment of diastolic function with 3D VE MR imaging can facilitate ongoing research of diastolic dysfunction in patients with a corrected TO