Left ventricular systolic function impairment in children after balloon valvuloplasty for congenital aortic stenosis assessed by 2D speckle tracking echocardiography.

Krzysztof Godlewski,Paweł Dryżek,Bożena Werner,Elżbieta Sadurska,Yiru Guo

doi:10.1371/journal.pone.0248862

Abstract

The aim of the study was to evaluate left ventricular (LV) remodeling and systolic function using two-dimensional speckle tracking echocardiographic (2D STE) imaging in children at a long-term (more than 36 months, 107.5±57.8 months) after balloon valvuloplasty for aortic stenosis (BAV). 40 patients (mean age 9,68 years, 75% male) after BAV and 62 control subjects matched to the age and heart rate were prospectively evaluated. The 2D STE assessment of LV longitudinal and circumferential strain and strain rate was performed. Left ventricular eccentric hypertrophy (LVEH) was diagnosed in 75% of patients in the study group. Left ventricular ejection fraction (LVEF) was normal in all patients. In study group, global longitudinal strain (GLS), global longitudinal strain rate (GLSr) were significantly lower compared with the controls: GLS (-19.7±2.22% vs. -22.3±1.5%, P< 0.001), GLSr (-0.89±0.15/s vs. -1.04 ±0.12/s, P < 0.001). Regional (basal, middle and apical segments) strain and strain rate were also lower compared with control group. Global circumferential strain (GCS), global circumferential strain rate (GCSr) as well as regional (basal, middle and apical segments) strain and strain rate were normal. Multivariable logistic regression analysis included: instantaneous peak systolic Doppler gradient across aortic valve (PGmax), grade of aortic regurgitation (AR), left ventricular mass index (LVMI), left ventricular relative wall thickness (LVRWT), left ventricular end-diastolic diameter (LVEDd), peak systolic mitral annular velocity of the septal and lateral corner (S'spt, S'lat), LVEF before BAV and time after BAV and showed that the only predictor of reduced GLS was LV eccentric hypertrophy [odds ratio 6.9; (95% CI: 1.37-12.5), P = 0.045]. Patients at long-term observation after BAV present the subclinical LV systolic impairment, which is associated with the presence of its remodeling. Longitudinal deformation is the most sensitive marker of LV systolic impairment in this group of patients.

Highlights

In many centres, percutaneous balloon aortic valvuloplasty (BAV) is the accepted first-line treatment for congenital aortic stenosis (AS) in the paediatric population
The subgroup of patients with Left ventricular eccentric hypertrophy (LVEH) significantly differed from the non-LVEH subgroup in terms of mean PGmax (P = 0.02), severity of aortic regurgitation (AR) (P = 0.02) and left ventricular end-diastolic diameter (LVEDd) Z-score (P
The presence of LVEH significantly correlated with PGmax (r = 0.36, P = 0.02), severity of AR (r = 0.65, P

Summary

Introduction

Percutaneous balloon aortic valvuloplasty (BAV) is the accepted first-line treatment for congenital aortic stenosis (AS) in the paediatric population. Dilatation of the stenosed valve, quite commonly produces varying degrees of aortic regurgitation (AR). In some of these patients, the clinical problem is the gradual progression of AR, which eventually becomes the main reason for surgical intervention [1,2,3]. The study by Capoulade et al [4] presenting the relationship between a reduced ejection fraction and higher mortality in adult patients with aortic valve stenosis, indicates that decreased EF is a marker of advanced stage of the disease. It is justified to employ more sensitive methods of assessing myocardial function, as these would enable the detection of subclinical changes that reflect incipient abnormalities and would allow to prevent advanced or even irreversible changes from developing. Novel echocardiographic techniques, including two-dimensional speckle-tracking echocardiography (2D STE) for assessing myocardial function, enable early detection of myocardial disease [5,6]

Methods

Results

Discussion

Conclusion