Left Atrial Strain to Identify Diastolic Dysfunction in Children with Cardiomyopathies

Jolanda Sabatino,Manjit Josen,Ciro Indolfi,Valentina Bucciarelli,Nunzia Borrelli,Alain Fraisse,Giovanni Di Salvo,Domenico Sirico,Costantina Prota,Piers E F Daubeney,Josefa Paredes,Sanjay Prasad

doi:10.3390/jcm8081243

Jolanda Sabatino, Manjit Josen + Show 10 more

Open Access

https://doi.org/10.3390/jcm8081243

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Abstract

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.

Highlights

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
It is well known that left ventricular (LV) systolic function is associated with reduced outcomes in childhood cardiomyopathy (CM) [1,2]
Less is known about the role of LV diastolic dysfunction some studies have suggested it may be associated with worse prognosis in childhood [3,4,5,6]

Summary

Introduction

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. 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). 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. Less is known about the role of LV diastolic dysfunction some studies have suggested it may be associated with worse prognosis in childhood [3,4,5,6]. A recent study [8] demonstrated that diastolic parameters derived from adult studies are inadequate and not sufficiently discriminatory in childhood

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