Assessment of echocardiographic parameters in children with permanent ventricular pacing

Abstract

BackgroundEchocardiography is important in the follow-up of children with permanent pacemakers due to the risk for cardiomyopathy. However, the value of standard measurements is unclear in the setting of expected dyssynchrony caused by ventricular pacing. ObjectivesThe study sought to assess and compare echocardiographic parameters of ventricular function in children with chronic ventricular pacing. MethodsEchocardiographic studies of patients with normal cardiac anatomy and ventricular pacing for heart block were retrospectively evaluated for routine measurements of systolic and diastolic ventricular function. ResultsIn 60 echocardiograms that were analyzed, fractional shortening (FS) had moderate correlation with ejection fraction (EF; R = 0.64, p < 0.001) while tissue Doppler (TDI) s waves had poor correlation to EF in the assessment of systolic function. When excluding the two patients with clinical cardiomyopathy, EF and FS had near normal mean z-scores (−0.26 ± 1.68 and 0.07 ± 1.65, respectively). For diastolic function, mean left atrial (LA) area measurements were also normal (mean z-score −0.01 ± 0.9). However, TDI measures and E/A wave ratio had poor correlation and appeared to underestimate diastolic function. ConclusionsFS and EF are moderately correlated to each other and may both be appropriate in the evaluation of systolic function in chronically paced children. TDI values may be misleading, measuring low diastolic function despite normal LA area.