Impact of Ventricular Geometric Characteristics on Myocardial Stiffness Assessment Using Shear-Wave Velocity in Healthy Children and Young Adults

Abstract

Diastolic myocardial stiffness (MS) can serve as a key diagnostic parameter for congenital or acquired heart diseases. Using shear modulus and shear-wave velocity (SWV), shear-wave elastography (SWE) is an emerging ultrasound-based technique that can allow noninvasive assessment of MS. However, MS extrinsic parameters such as left ventricular geometric characteristics could affect shear-wave propagation. The aims of this study were to determine a range of normal values of MS using SWE in age groups of healthy children and young adults and to explore the impact of left ventricular geometric characteristics on SWE. Sixty healthy volunteers were recruited in the study and divided into 2 groups: neonates (0-1 months old, n=15) and >1month old (1month to 45years of age, n=45). SWE was performed using the Verasonics Vantage systems with a phased-array ultrasound probe. The anteroseptal basal segment was assessed in two views. SWE was electrocardiographically triggered during the end-diastolic phase. Conventional echocardiography was performed to assess ventricular function and anatomy. Results are presented as stiffness values along with mean velocity measurements and SDs. Simple and multivariate linear regression analyses were performed. For neonates, mean MS was 1.87±0.79kPa (range, 0.59-2.91kPa; mean SWV, 1.37±0.57m/sec), with high variability and no correlation with age (P=.239). For this age group, no statistically significant correlation was found between MS and any demographic or echocardiographic parameters (P>.05). For the >1month old group, a mean MS value of 1.67±0.53kPa was observed (range, 0.6-3kPa; mean SWV, 1.29±0.49m/sec) for healthy volunteers. When paired for age, no sex-related difference was observed (P=.55). In univariate linear regression analysis, age (r=0.83, P<.01), diastolic interventricular septal thickness (r=0.72, P<.01), and left ventricular end-diastolic diameter (r=0.67, P<.01) were the parameters with the highest correlation coefficients with MS. In a multiple linear regression analysis incorporating these three parameters as cofounding factors, age was the only statistically significant parameters (r=0.81, P=.02). Diastolic MS increases linearly in children and young adults. Diastolic MS correlates more robustly with age than with myocardial and left ventricular geometric characteristics. However, the geometry affects SWV, implying the need to determine well-established boundaries in future studies for the clinical application of SWE.