Abstract 13554: Left Atrial Function in Children by Volume and Strain Analysis: Impact of Congenital Aortic Stenosis

Abstract

Background: Left atrial (LA) function by volume and strain analysis in children has been little studied. LA dysfunction related to aortic stenosis has been reported in adults. Hypotheses: 1. LA volume and strain analysis is feasible and reproducible in normal children. 2. Children with isolated congenital aortic stenosis (AS) as compared to matched controls have higher maximal LA volume (LAV) and lower total longitudinal LA strain. Methods: Retrospective chart review and offline analysis of 2D echocardiogram images for phasic LAVs, volume indices, and longitudinal LA strain (Fig 1) by speckle tracking (TomTec software) in: 1. Healthy children with a normal echocardiogram; and, 2. Children ≥1 years of age with significant (≥ moderate) isolated AS. AS cases were compared with age, gender and BSA-matched normal controls. Results: There were 67 normal subjects [age: 10.5 (1.3-22.1) yrs; 50 males, 17 females; BSA 1.22 (0.44-2.39) m2] studied. No significant inter-observer and intra-observer differences were noted in normal subjects (Fig 2). Between June 2004 and October 2012, there were 41 eligible AS cases [Age: 11.7 (1.6-26.8) yrs; 32 males, 9 females] with median maximal Doppler aortic stenosis gradient of 63 (43-94) mm Hg. Significantly higher phasic indexed LAVs and indexed active LA stroke volume (pump function) and lower strain values for LA reservoir and conduit function were noted in AS cases (Fig 2). Conclusions: LA volume and strain analysis is reproducible and feasible in children. Children with significant AS have abnormal LA function with higher phasic LA volumes, higher LA pump function, and lower strain-derived reservoir and conduit LA function.