Segmental and global longitudinal strain differences between Kawasaki disease and multi-system inflammatory syndrome in children

Multi-system inflammatory syndrome in children and Kawasaki disease have overlapping clinical features but comparative echocardiographic studies are lacking

Echocardiographic Normal Reference Ranges for Non-invasive Myocardial Work Parameters in Pediatric Age: Results From an International Multi-Center Study

This international multi-center study aimed to demonstrate the feasibility and reliability of non-invasive myocardial work (MW) parameters in the pediatric population, and to provide normal reference ranges for this useful echocardiographic tool in this specific subset of patients

Blood speckle imaging: A new echocardiographic approach to study fluid dynamics in congenital heart disease

Introduction: Blood speckle imaging (BSI) is a new speckle-tracking-based technique for blood flow study. Flows assessment is particularly challenging in Congenital heart diseases (CHDs), where a profound distortion in cardiac anatomy gives reason of alteration in fluid mechanics. Up until now doppler methods were the only ones used for the analysis of fluid. Overcoming standard Doppler limits, BSI is becoming a promising new approach for the study of fluid dynamics.The aim of the study was to assess fluid-dynamics of different CHDs by using BSI. Methods and results: Ten children (7 with suspected CHDs and 3 controls) were enrolled for the purpose between January and June 2019. All of them underwent a complete 2D and Doppler echocardiographic assessment plus a further BSI study. We studied: one complex transposition of great arteries, one coarctation of aorta, one tetralogy of Fallot, one complete atrio-ventricular septal defect, one suspicious flow in pulmonary artery, one aortic stenosis, one hypertrophic cardiomyopathy and three normal controls. Conclusion: Compared to conventional Doppler methods, BSI was able to better describe fluid dynamics and hemodynamics of these CHDs by showing laminar and turbulent flows and vortices. In our experience, it helped to define the diagnosis and, in some cases, drove the management

Echocardiography and cardiac magnetic resonance in children with repaired tetralogy of Fallot: New insights in cardiac mechanics and exercise capacity

Background: Pulmonary regurgitation (PR) and right ventricular (RV) dilatation and disfunction are common in patients with repaired Tetralogy of Fallot (r-TOF).Aims: To compare Echo datawith the gold standard CMR in a paediatric population of r-TOFwith significant PR, to assess the reliability of standard and advanced echo parameters. In addition, to evaluate their correlation with peak oxygen consumption (VO2).Methods and results: All patients underwent standard echo-Doppler study, speckle tracking analysis, and CMR to assess PR and RV size and function. Thirty-six patients underwent also cardiopulmonary exercise test. Fourty-six patients (aged 13.7 +/- 3.0) were included. Echo derived RV areas correlated with CMR RV volumes (p = 150 ml/m(2). RVEF was preserved in all patients, while TAPSE was reduced in 78.2% and RVGLS in 60.8%. Flow-reversal in pulmonary branches showed a sensitivity of 95.8% and a specificity of 59.1% to identify CMRpulmonary regurgitant fraction (RF) = 35%. None of the CMRparameters correlated with peak VO2. Among the Echo data only right atrial strain (RAS) correlated with peak VO2.Conclusion: In children, flow-reversal in pulmonary branches identifies hemodynamically significant RF with a good sensitivity but poor specificity. RV area by echocardiogramis a valid first-line parameter to screen RV dilation. RV longitudinal systolic dysfunction coexistswith a still preserved EF. RAS correlates stronglywith peak VO2 and should be added in their follow up. (C) 2020 Elsevier B.V. All rights reserved

Echocardiography and cardiac magnetic resonance in children with repaired tetralogy of Fallot: New insights in cardiac mechanics and exercise capacity

Background: Pulmonary regurgitation (PR) and right ventricular (RV) dilatation and disfunction are common in patients with repaired Tetralogy of Fallot (r-TOF).Aims: To compare Echo datawith the gold standard CMR in a paediatric population of r-TOFwith significant PR, to assess the reliability of standard and advanced echo parameters. In addition, to evaluate their correlation with peak oxygen consumption (VO2).Methods and results: All patients underwent standard echo-Doppler study, speckle tracking analysis, and CMR to assess PR and RV size and function. Thirty-six patients underwent also cardiopulmonary exercise test. Fourty-six patients (aged 13.7 +/- 3.0) were included. Echo derived RV areas correlated with CMR RV volumes (p = 150 ml/m(2). RVEF was preserved in all patients, while TAPSE was reduced in 78.2% and RVGLS in 60.8%. Flow-reversal in pulmonary branches showed a sensitivity of 95.8% and a specificity of 59.1% to identify CMRpulmonary regurgitant fraction (RF) = 35%. None of the CMRparameters correlated with peak VO2. Among the Echo data only right atrial strain (RAS) correlated with peak VO2.Conclusion: In children, flow-reversal in pulmonary branches identifies hemodynamically significant RF with a good sensitivity but poor specificity. RV area by echocardiogramis a valid first-line parameter to screen RV dilation. RV longitudinal systolic dysfunction coexistswith a still preserved EF. RAS correlates stronglywith peak VO2 and should be added in their follow up. (C) 2020 Elsevier B.V. All rights reserved

Left Atrial Strain to Identify Diastolic Dysfunction in Children with Cardiomyopathies

Background: Left ventricular (LV) diastolic dysfunction (DD) carries worse prognosis in childhood. 2-dimensional (2-D) left atrial (LA) strain accurately categorizes DD in adults but its role in children is unknown. Thus, the aim of this study is to investigate whether LA strain and strain rate could diagnose and classify DD in children with dilated (CMD), hypertrophic (HCM) and restrictive (RCM) cardiomyopathies (CM). Methods and Results: The study includes 136 children (aged 8.8 ± 6 years): 44 with DCM, 40 with HCM, 7 with RCM and 45 healthy controls (CTRL). They underwent standard echocardiographic examination and 2-D speckle-tracking analyses (LV longitudinal peak systolic strain (LS), LA peak systolic strain and strain rate). No significant differences in mitral E/A and pulmonary S/D ratios were observed among the four groups. Although E/E’ and indexed left atrial volumes were found to be significantly higher in HCM, DCM and RCM compared to CTRL (p < 0.001), they showed no significant difference among the three CM groups. LV LS values were significantly reduced in CM vs CTRL (p < 0.001) and in DCM vs HCM (p < 0.01), with no other differences between the remaining groups. LA peak systolic strain and strain rate values showed a steady and significant decrease with worsening of DD. Receiver Operating Characteristics (ROC) curves showed area under the curve of 0.976 (p < 0.001) for LA strain and 0.946 (p < 0.001) for LA strain rate, to distinguish CTRL from CMs. Conclusions: LA strain and strain rate could be a promising tool to better understand and classify DD in children with cardiomyopathies, opening the way to its clinical use