Diastolic Function In Children Research Articles

Correlation between HbA1c levels and left ventricular function in children with Type 1 Diabetes Mellitus

Background: Diabetic cardiomyopathy is one of the macrovascular complications in type 1 diabetes mellitus (T1DM). Left ventricular dysfunction primarily reflects diastolic dysfunction which is early sign of diabetic cardiomyopathy. Improved glycemic control can delay the onset and progression of this complication. An important indicator of long-term glycemic control is glycosylated hemoglobin (HbA1c). Objective: The aim of this study is to evaluate the correlation between HbA1c levels with left ventricular diastolic function in children with T1DM. Methods: This study was an observational study with cross-sectional design in children aged 1 month-18 years with T1DM, at Prof Dr. I.G.N.G. Ngoerah Hospital, Denpasar from November 2019–September 2021, using consecutive sampling. Glycosylated hemoglobin (HbA1c) was meassured by blood samping and LV function was assessed by using tissue Doppler imaging (TDI). Statistical analysis was done by Pearson and Spearman correlation test. A p-values of <0.05 was considered statistically significant. Results: A total of 36 subjects were recruited in this study. There was a low positive correlation between HbA1c levels with E/e’ ratio (r=0.284, p=0.047), and MPI (r=0.358, p=0.020). After adjusting body mass index and duration of T1DM as confounding variables, we found a low positive correlation between HbA1c levels and E/e’ ratio (r=0.325, p=0.030), MPI (r = 0.390, p=0.020). Conclusion: HbA1C has a positive correlation with left ventricular diastolic function in children with T1DM.

Left atrial stiffness and strain are novel indices of left ventricular diastolic function in children: validation followed by application in multisystem inflammatory syndrome in children due to COVID-19.

We hypothesized left atrial (LA) stiffness may serve as a surrogate marker in children to differentiate elevated pulmonary capillary wedge pressure (PCWP) from normal and help detect diastolic dysfunction in myocardial injury due to multisystem inflammatory syndrome in children (MIS-C). We validated LA stiffness in 76 patients (median age 10.5 years), 33 had normal PCWP (<12 mmHg) and 43 had elevated PCWP (≥12 mmHg). LA stiffness was applied to 42 MIS-C patients [28 with myocardial injury (+) and 14 without myocardial injury (-)], defined by serum biomarkers. The validation group consisted of a group with and without cardiomyopathies, whose PCWP values ranged from normal to severely elevated. Peak LA strain was measured by speckle-tracking and E/e' from apical four chamber views. Noninvasive LA stiffness was calculated as: LAStiffness=E/e'LAPeakStrain (%-1). Patients with elevated PCWP showed significantly elevated LA stiffness [median 0.71%-1 vs. 0.17%-1, P < 0.001]. Elevated PCWP group showed significantly decreased LA strain (median: 15.0% vs. 38.2%, P < 0.001). Receiver operator characteristic (ROC) curve for LA stiffness yielded an area under the curve (AUC) of 0.88 and cutoff value of 0.27%-1. In MIS-C group, ROC curve yielded an AUC of 0.79 and cutoff value of 0.29%-1 for identifying myocardial injury. In children with elevated PCWP, LA stiffness was significantly increased. When applied to children with MIS-C, LA stiffness classified myocardial injury accurately. LA stiffness and strain may serve as noninvasive markers of diastolic function in the pediatric population.

Longitudinal effect of disease-modifying therapy on left ventricular diastolic function in children with sickle cell anemia.

Cardiac abnormalities seen in sickle cell anemia (SCA) include diastolic dysfunction, which has been shown to be associated with high morbidity and early mortality. The effect of disease-modifying therapies (DMT) on diastolic dysfunction is poorly understood. We prospectively evaluated the effects of hydroxyurea and monthly erythrocyte transfusions on diastolic function parameters over 2 years. A total of 204 subjects with HbSS or HbSβ0-thalassemia (mean age 11 ± 3.7 years), unselected for disease severity, had diastolic function assessed with surveillance echocardiograms twice, 2 years apart. During this 2-year observation period, 112 participants received DMTs (hydroxyurea, n=72, monthly erythrocyte transfusions, n=40), 34 initiated hydroxyurea, and 58 did not receive any DMT. The entire cohort showed an increase in left atrial volume index (LAVi) of 3.40 ± 10.86 mL/m2, p=.001 over 2 years. This increase in LAVi was independently associated with anemia, high baseline E/e' or LV dilation. Individuals not exposed to DMT were younger (mean age 8.8 ± 2.9 years), but at baseline their prevalence of abnormal diastolic parameters was similar to that of the DMT-exposed participants who were older (mean age 12 ± 3.8 years). Participants on DMTs saw no improvement in diastolic function over the study period. In fact, participants on hydroxyurea saw a possible worsening in diastolic parameters (14% increase in LAVi and ~5% decrease in septal e') but also a ~9% decrease in fetal hemoglobin (HbF) levels. Further studies are needed to evaluate if exposure to DMT for a longer duration or achieving higher HbF might be beneficial in alleviating diastolic dysfunction.

Assessment of Early Diastolic Intraventricular Pressure Difference in Children by Blood Speckle-Tracking Echocardiography

The lack of reliable echocardiographic techniques to assess diastolic function in children is a major clinical limitation. Our aim was to develop and validate the intraventricular pressure difference (IVPD) calculation using blood speckle-tracking (BST) and investigate the method's potential role in the assessment of diastolic function in children. Blood speckle-tracking allows two-dimensional angle-independent blood flow velocity estimation. Blood speckle-tracking images of left ventricular (LV) inflow from the apical 4-chamber view in 138 controls, 10 patients with dilated cardiomyopathies (DCMs), and 21 patients with hypertrophic cardiomyopathies (HCMs)<18years of age were analyzed to study LV IVPD during early diastole. Reproducibility of the IVPD analysis was assessed, IVPD estimates from BST and color M mode were compared, and the validity of the BST-based IVPD calculations was tested in a computer flow model. Mean IVPD was significantly higher in controls (-2.28±0.62mm Hg) compared with in DCM (-1.21±0.39mm Hg, P<.001) and HCM (-1.57±0.47mm Hg, P<.001) patients. Feasibility was 88.3% in controls, 80% in DCM patients, and 90.4% in HCM patients. The peak relative negative pressure occurred earlier at the apex than at the base and preceded the peak E-wave LV filling velocity, indicating that it represents diastolic suction. Intraclass correlation coefficients for intra- and interobserver variability were 0.908 and 0.702, respectively. There was a nonsignificant mean difference of 0.15mm Hg between IVPD from BST and color M mode. Estimation from two-dimensional velocities revealed a difference in peak IVPD of 0.12mm Hg (6.6%) when simulated in a three-dimensional fluid mechanics model. Intraventricular pressure difference calculation from BST is highly feasible and provides information on diastolic suction and early filling in children with heart disease. Intraventricular pressure difference was significantly reduced in children with DCM and HCM compared with controls, indicating reduced early diastolic suction in these patient groups.

The relationship between left ventricular dilation and right ventricular diastolic function in children with a patent ductus arteriosus.

The impact of a dilated left ventricular (LV) on right ventricular (RV) diastolic function has not been investigated. We hypothesized that in patients with a patent ductus arteriosus (PDA), LV dilation causes elevation of the RV end-diastolic pressure (RVEDP) through ventricular-ventricular interaction. We identified patients' ages 6 months to 18 years who underwent transcatheter PDA closure at our center from 2010 to 2019. One hundred and thirteen patients were included with a median age of 3 years (0.5-18). The median LV end-diastolic dimension (LVEDD) Z-score was 1.6 (-1.4-6.3). RVEDP was positively associated with RV systolic pressure (0.38, P < 0.01), ratio of pulmonary artery/aortic systolic pressure (0.4, P < 0.01), and pulmonary capillary wedge pressure (0.71, P < 0.01). RVEDP was not associated with LVEDD Z-score (0.03, P = 0.74). In children with a PDA, RVEDP was not associated with LV dilation, but was positively associated with RV systolic pressure.

Assessment of left ventricular diastolic function in children with HIV/AIDS attending a tertiary health Facility in Enugu, Nigeria: a Doppler echocardiographic study

ObjectiveTo determine the prevalence and factors associated with left ventricular diastolic dysfunction in children with HIV/AIDS.MethodEchocardiographic studies were carried out in 90 children/adolescents aged 18 months to 14 years.with HIV/AIDS and a healthy control group of 90 age and gender matched.Results47.8% of the HIV/AIDS patients (subjects) had LVDD. This was more pronounced in the AIDS group (100%). The E/A ratio was 1.9 ± 0.56 in the HIV group, 2.09 ± 0.04 in the AIDS group, and 1.20 ± 0.39 in the control group (p = 0.04). The mean Left ventricular isovolumic relaxation time (IVRT) was 79.4 ± 20.12 in the HIV group, 110.4 ± 10.12 in the AIDS group and 89.22 ± 25.76 in the control group. (p = 0.04). Deceleration time (DT) was also lower in HIV carrier group compared to AIDS group, p = 0.02. A restrictive filling pattern was the most described; with 27 (36.5%) in the HIV group, 16 (100.0%) in the AIDS group and 2 (2.2%) in the control group. (p = 0.02). The impaired relaxation pattern, 3 (4.0%) seen in the HIV group only. Positive correlation exists between body surface area (BSA) and LVDD. Body surface area and younger age were the significant predictors (BSA: r = 0.425, p = 0.038 in HIV and r = 0.827, p = 0.042) of LVDD in the AIDS group.ConclusionThis study showed a high prevalence of LVDD in Nigerian children with HIV and AIDS. This justifies inclusion of echocardiographic studies in the policy care of children with HIV/AIDS in sub-Sahara Africa region.

Systolic and diastolic left ventricular function in children with primary hypertension: a systematic review and meta-analysis.

Evaluation of left ventricular function provides early evidence of target-organ damage in children with primary hypertension. We performed a systematic review and meta-analysis of left ventricular systolic and diastolic function in children and adolescents with primary hypertension. Literature search was performed in PubMed database and out of 718 articles (published between 2000 and 2021) 22 studies providing comparison of left ventricular function parameters between children with primary hypertension and normotensive controls were selected. Overall, 3460 children (5-21 years) with primary hypertension were analyzed. Meta-analysis showed that hypertensive patients when compared with normotensives, had an increased heart rate (mean difference [MD] 5.59; 95% confidence interval [CI] 3.28, 7.89; 10 studies) and increased fractional shortening (MD 1.04; 95% CI 0.48, 1.60; 9 studies) but did not differ in ejection fraction (MD -0.03; 95% CI -1.07, 1.02; 12 studies). Stroke volume was higher in one out of three studies, whereas no differences in cardiac output were found in two studies with available data. Hypertensive children had also lower E/A values (MD -0.21; -0.33, -0.09; 14 studies), greater values of E/e' (MD 0.59; 0.36, 0.82; 8 studies) and greater global longitudinal stress (MD 2.50; 2.03, 2.96; 4 studies) when compared to those with normotension. Our results indicate that hypertensive children and adolescents present with signs of hyperkinetic function of the left ventricle, demonstrate evidence of increased left ventricular strain and impaired diastolic function compared to normotensive controls.

Echocardiographic evaluation of Left ventricular function before and after trans-catheter patent ductus arteriosus closure

Introduction: there are limited available studies on LV hemodynamics alteration after trans-catheter PDA closure particularly diastolic function and most of studies are with 2D echocardiography. Objective: to evaluate the effect of trans-catheter closure of PDA on LV systolic and diastolic function in children and young adults using 2D and 3D echocardiography. Materials and methods: Al-Azhar University hospitals hosted this prospective cohort study, which included 20 patients with isolated PDA who had been referred to Cath lab for trans-catheter PDA closure; LV function evaluated by 2D, 3D echocardiography and TDI before, one day after closure and on follow-up. Results: 45% of patients developed post closure LV systolic dysfunction which improved completely after 3 months of follow up, all studied patients showed significant decrease in LAD, LAD/AoD, LVEDd, LVEDs, LVEDVI and LVESVI after 3 months of trans-catheter PDA closure; (LAD/AoD, LVEDVI, LVESVI, FS and LVEF) can be used as predictors of post closure LV systolic dysfunction, diastolic function was worse in individuals with post closure LV systolic dysfunction.

Peak apical recoil rate is a simplified index of left ventricular untwist: validation and application for assessment of diastolic function in children.

The use of untwisting rate as a novel index of LV diastolic function in clinical practice has been limited due to its tedious and time-consuming analysis. Therefore, we simplify the untwist measurement by only measuring the LV apex's recoil rate and validating and applying peak apical recoil rate (PARR) as an index of diastolic dysfunction (DD) in pediatric subjects during increased and decreased lusitropic states. We recruited 153 healthy subjects (mean age 13.8 ± 2.9years), of whom 48 performed straight leg raising exercise and an additional 46 patients (mean 8.4 ± 5.6years) with documented pulmonary capillary wedge pressures (PCWP) (validation cohort). In addition, we studied 16 dilated cardiomyopathy patients (mean age 9.5 ± 6.3years) (application cohort). PARR and isovolumic relaxation time (IVRT) were compared to PCWP. Both PARR and PARR normalized by heart rate (nPARR) were excellent in detecting patients with PCWP ≥ 12mmHg and greatly superior to IVRT in this respect (AUC: 0.98, 95% CI [0.96, 1.0] vs. AUC: 0.7 95%CI [0.54,0.86]). In DCM patients, PARR and nPARR were greatly decreased compared to controls (-38.6 ± 18.6º/s vs -63.1 ± 16.3º /s, p < 0.001) and (-0.43 ± 0.20 º/ s/min vs -0.83 ± 0.28º/s/min, p < 0.0001) but increased with straight leg raising exercise (-59.4 ± 19.4º/s vs -97.8 ± 39.0 º/s, p < 0.01) and -0.85 ± 0.36 vs -1.4 ± 0.62 º/s/min (p < 0.0001) respectively. PARR and nPARR successfully detected increased and decreased lusitropic states and superior to IVRT in correlation with PCWP. This highly reproducible parameter offers incremental value over traditional indices of DD and may potentially serve as a useful index of elevated PCWP in children.

Evaluation of subclinical cardiovascular risk and cardiac function in children with vesicoureteral reflux: a prospective study.

Vesicoureteral reflux is a prominent congenital anomaly of the kidney and the urinary tract. Further, renal scarring is known to be related to chronic inflammation. However, there have been limited studies to date regarding the cardiovascular consequences of vesicoureteral reflux. The aim of this study is to evaluate the possible subclinical atherosclerosis and cardiovascular complications in children with vesicoureteral reflux. Patients with vesicoureteral reflux and age matched healthy controls were prospectively included in this case-control study. Patients were divided into two groups concerning renal scarring status. To assess cardiac functions, carotid artery intima media, epicardial adipose tissue, and periaortic adipose tissue thicknesses were evaluated. There were 50 patients with vesicoureteral reflux; 26 patients without renal scarring and 24 patients with renal scarring, as well as 40 healthy controls. Myocardial performance indexes (Tei indexes) measured by tissue Doppler echocardiography from septum and left ventricle were significantly increased in study group (for all, p < 0.001). Also, intima media, epicardial adipose tissue, and periaortic adipose tissue thicknesses of the study groups were significantly higher than the control group (for all, p < 0.001). However, no statistical difference was observed between renal scarring (-) and renal scarring (+) groups. Results of our study showed early deterioration of cardiac systolic and diastolic functions in children with vesicoureteral reflux regardless of renal scarring. Also, diagnosis of vesicoureteral reflux is an important risk factor for subclinical atherosclerosis, independent of renal scarring, which should be considered in the follow-up of these patients.

The effect of overweight/obesity on diastolic function in children and adolescents: A meta-analysis.

SummaryLeft ventricular diastolic function (LVDF) is an important marker of early cardiovascular remodelling, which has not been well summarized in young people with overweight/obesity. Weighted, random‐effects regression was used to determine the strength of associations of both body mass index (BMI) and homeostatic model assessment of insulin resistance (HOMA‐IR) with LVDF measures, adjusting for age and sex. Six databases were searched after PROSPERO registration (CRD42020177470) from inception to July 2020 for studies that compared LVDF between overweight/obesity and control groups aged ≤24 years, yielding 70 studies (9983 individuals). Quality and risk of bias were assessed using NHLBI tools, with scores of good, fair, and poor for 6, 48, and 16 studies, respectively. Increased BMI was associated with worse LVDF in all measures except early mitral inflow deceleration time, with septal early diastolic tissue peak velocity to late diastolic tissue peak velocity ratio having the strongest association (n = 13 studies, 1824 individuals; r = −0.69; P < 0.001). Elevated HOMA‐IR was also associated with worse LVDF. Although we could not determine the causality of reduced LVDF in young people, our findings should aid the development of paediatric guidelines for the assessment of LVDF and support further work to address the longitudinal consequences of childhood obesity and IR on LVDF.

Function Heterogeneity of Different Segments of Left Ventricle in Pediatric Dilated Cardiomyopathy: A Tissue Doppler Study

Function Heterogeneity of Different Segments of Left Ventricle in Pediatric Dilated Cardiomyopathy: A Tissue Doppler Study Background: Dilated cardiomyopathy (DCM) is characterized by impaired systolic function of one or both ventricles. The aim of this study is to assess left ventricular (LV) regional systolic as well as global systolic and diastolic functions in children with DCM using tissue Doppler imaging. Subjects and methods: the study comprised 30 patients with DCM (4.4+3.3 years) and 10 healthy children as a control group. ECG-gated echocardiography was done using m-mode and conventional Doppler as well as Tissue Doppler imaging to obtain modified Tei index, mitral annular wave velocities (S', E' and A') as well as offline analysis of color tissue velocity imaging to obtain the peak systolic velocities of 12 LV points in 4 chamber apical, 2chamber and long axis views. Results: The peak systolic velocities of Mitral anuulus as well as the different LV segments of patients were significantly lower than that of the control group. The E/E' ratio of patients was (11.39+2.4). S' and E' wave of lateral and septal aspects of mitral annulus were correlated. The Tei index of LV of patients (0.568+0.1136) was significantly higher than that of the control group. The averaged mid LV segments showed significantly lower peak systolic velocity (3.018+0.777cm/sec). There was significant difference between different LV segments as regards the peak systolic velocities (P<0.05). Conclusion: In pediatric DCM the diastolic dysfunction lies in the borderline zone, systolic and diastolic dysfunctions are correlated. There is regional heterogeneity of left ventricular systolic velocities being in general lower in mid segments.

Vitamin D and left ventricular dysfunction in pediatric dialysis patients; a tissue doppler study.

Assessment of the left ventricular function in the dialysis children and explore its association with vitamin D level and markers reflecting calcium and phosphate metabolism. In this case-control study, we enrolled forty children on regular hemodialysis and forty healthy controls from July 2019 to March 2020 at the pediatric dialysis unit. Echocardiographic evaluation using both conventional and Tissue Doppler Imaging (TDI) was done for all subjects. Vitamin D and its markers were analyzed to assess its association with ventricular dysfunction. Diastolic function in children on hemodialysis was significantly impaired as evidenced by lower Mitral E/A velocity ratio (E/A), lower early diastolic velocity (E'), and higher E/E' ratio (Ratio of early diastolic mitral inflow velocity (measured by pulsed wave traditional Doppler) to early diastolic mitral annular velocity (measured by Tissue Doppler). in comparison with the controls. Most end stage renal disease (ESRD) participants had vitamin D deficiency. There was an important correlation between left ventricular (LV) dysfunction and both Vitamin D deficiency and hyperparathyroidism. Although our patients had normal systolic function by conventional and Tissue Doppler echocardiographic study, mean values of TDI- MPI (Mean Performance Index) in the haemodialysis group were significantly higher than in the control group, which indicates impaired global cardiac systolic and diastolic function. Tissue Doppler Imaging (TDI) provides a good reflection of the LV diastolic function. As vitamin D deficiency has been substantially associated with worsening of LV dysfunction, we suggest that TDI and Vitamin D might be included in the routine follow-up of pediatric dialysis patients.

Association between serum uric acid and subclinical cardiac damage in children with primary hypertension

OBJECTIVE To evaluate the condition of subclinical cardiac damage in children with primary hypertension and the association between serum uric acid and subclinical cardiac damage. METHODS A retrospective analysis was performed on the medical data of 55 children who were hospitalized and diagnosed with primary hypertension in the Department of Cardiology, Children's Hospital of Soochow University from January 2015 to June 2020. Forty-five healthy children, matched for age and sex, were enrolled as the control group. The two groups were compared in terms of clinical features, laboratory examination, and parameters for left ventricular structure, systolic function, and diastolic function. The correlation of serum uric acid with the parameters for left ventricular structure, systolic function, and diastolic function in children with primary hypertension was analyzed. RESULTS Compared with the control group, the hypertension group had significantly higher left ventricular mass (LVM), left ventricular mass index (LVMI), and relative wall thickness (RWT) (P < 0.05). Among the children with primary hypertension, 20 (36%) had left ventricular hypertrophy. The hypertension group had significantly larger left atrial diameter and aortic root diameter than the control group (P < 0.05). The hypertension group had a significantly higher ratio of early diastolic mitral inflow velocity to early diastolic mitral annular velocity than the control group (P < 0.05). The correlation analysis showed that in children with primary hypertension, serum uric acid was positively correlated with LVM (r=0.534, P < 0.01), left atrial diameter (r=0.459, P < 0.01), and aortic root diameter (r=0.361, P=0.010). After adjustment for blood pressure, serum uric acid was still positively correlated with the above parameters (P < 0.05). CONCLUSIONS Children with primary hypertension may have subclinical cardiac damage such as left ventricular hypertrophy, left ventricular diastolic dysfunction, left atrial enlargement, and proximal aortic dilation. Elevated serum uric acid is significantly associated with cardiac damage in children with primary hypertension.

Assessment of left ventricular systolic and diastolic functions in severely malnourished children

BackgroundMalnourished children endure many changes in body composition and lose heart and skeletal muscle mass. Diastolic dysfunction is one of the major causes of heart failure with preserved ejection fraction.AimTo assess left ventricular systolic and diastolic functions in children with severe acute malnutrition using tissue Doppler imaging technique and to evaluate the effect of nutritional rehabilitation.Patients and MethodsA follow-up case-control study conducted on 60 severely malnourished children (WHZ < -3SD) and 120 age and sex-matched healthy children as a control group. Tissue Doppler imaging (TDI) was done for all included malnourished children at admission and for control to measure left ventricular systolic and diastolic functions. Nutritional rehabilitation was done according to WHO protocol and tissue doppler was repeated after rehabilitation when (WHZ > -2SD) to detect any changes in systolic or diastolic functions.ResultsSystolic function was normal in malnourished children and control. Grade I diastolic dysfunction was detected in 40% and grade II in 30% of severely malnourished children in comparison to 100% normal diastolic function in control group. No correlations between diastolic dysfunction and either anthropometric measurements, electrolyte disturbances or Hb% in malnourished children before nutritional rehabilitation. Mortality from sepsis with associated ventricular dysfunction grade II documented in 3.3% of malnourished children. After nutritional rehabilitation diastolic function improved significantly as 65.6% of children attained normal diastolic function, 31% grade1 and 3.4% grade II. Positive correlations between diastolic function and WAZ, HAZ, WHZ and MUAC after rehabilitation.ConclusionSevere acute malnutrition affects diastolic function in children which is reversible in most of these cases with rehabilitation. TDI is an easy and practical method for detection and follow-up of ventricular function in malnourished children.

Condition of the central hemodynamics in children with false tendons in the left cardiac ventricle

Aim: To study the echomorphometric parameters of the heart in children with false tendons (FT) in the left cardiac ventricle to improve diagnostics of its possible complications.Materials and methods. 64 children with FT, aged from 13 to 17 (15,3±0,2) years old, were examined. Main group of patients consisted of 40 (62,5±6,1%) boys and 24 (37±6,1 %) girls. The control group included 23 almost healthy children of similar age. The study was carried out in Vinnitsa city hospital Center of Mother and a Child. The morphological and functional condition of the heart with hemodynamic parameters was evaluated according to the standard method, recommended by American association of cardiologists in one-dimensional (M-) and two-dimensional (B-) modes, using echocardiography with Doppler effect.Results. Echomorphometric indicators did not significantly differ from the control data. Indicators of ejection (69,4±0,8% vs. 67,8±1,7% – boys and 70,8±1% vs. 69±1,4% – girls) and shortening fraction of the left ventricle (38,6±0,8% vs. 41±2% – boys and 40,8±0,9% vs. 32,5±2,8% - girls) were within normal limits. There was a tendency for decreasing of the end-diastolic index (EDI) in both subgroups (60,3±2,7 ml/m² vs. 62,5±3,9 ml/m² – boys and 56,6±3,3 ml/m² vs. 68,2±5,3 ml/m² – girls). Analysis of diastolic function of the left ventricle (LV) in children of the main group revealed increasing of the E/A parameter in boys (2±0,1 vs. 1,8±0,1, p<0,05) and in girls (2,2±0,1 vs. 2±0,1, p<0,05). The thickness of the left atrium (LA) was not changed. These results reveal the first stages of diastolic dysfunctions of the LV myocardium. The systolic function of the myocardium was normal.Conclusions. Children with FT have normovolemic and eukinetic types of central hemodynamics. Diastolic function in children with FT has initial signs of impairment. These results will help to prevent complication occurrence and progression of diastolic dysfunction of myocardium in adolescents with false tendons by timely providing medical-preventative methods

Age-related changes in diastolic function in children: Echocardiographic association with vortex formation time.

This study aims to understand the age-related changes in vortex formation time (VFT) index in children, and thus, describe the ranges of VFT in different pediatric age groups with the ultimate goal of assessment of diastolic function. Transthoracic echocardiograms in healthy (n=84) subjects from birth to 20years were analyzed to compute VFT and diastolic performance. LV apical and short-axis views were used. Three separate measurements were performed, and the mean was used to derive VFT and other indices. Statistical comparisons were made amongst the groups, stratified by age. Vortex formation times in neonates (median 1.79, interquartile range 1.31-1.92) and infants (1.38, 1.07-1.72) were found to be significantly lower (P<.05) than the older age groups (1-5years 2.47, 1.87-2.94, 5-10years 2.18, 1.89-2.53, 10-20years 2.34, 1.84-2.96). The changes in VFT correlate to the changes in diastolic function in children. Our results show that unlike adults, VFT changes along with the growth-related myocardial adaptations in children, and its range may be used to evaluate diastolic function. The present study is the first to test the significance of the trans-mitral VFT in children by comparing different age groups of healthy subjects.

Impaired Systolic and Diastolic Left Ventricular Function in Children with Chronic Kidney Disease - Results from the 4C Study

Children with chronic kidney disease suffer from excessive cardiovascular mortality and early alterations of the cardiovascular system. Tissue doppler imaging is a validated echocardiographic tool to assess early systolic and diastolic cardiac dysfunction. We hypothesized that tissue Doppler velocities would reveal reduced cardiac function in children with chronic kidney disease compared to healthy children. A standardized echocardiographic exam was performed in 128 patients of the Cardiovascular Comorbidity in Children with Chronic Kidney Disease (4C) Study aged 6–17 years with an estimated glomerular filtration rate (eGFR) below 60 ml/min/1.73 m2. Tissue Doppler measurements included early (E’) and late (A’) diastolic and systolic (S’) velocity at the mitral and septal annulus of the left ventricle. Measured values were normalized to z-scores using published reference data. Predictors of E’/A’, E/E’, S’ and left ventricular mass index (LVMI) were assessed by multiple linear regression analyses. Tissue Doppler E’ was reduced and tissue Doppler A’ increased, resulting in a reduced tissue Doppler E’/A’ ratio (z-score −0.14, p < 0.0001) indicating reduced diastolic function compared to healthy children. Reduced tissue Doppler E’/A’ Z-Scores were independently associated with lower eGFR (p = 0.002) and increased systolic blood pressure (p = 0.02). While E/E’ Z-Scores were increased (Z-score 0.57, p < 0.0001), patients treated with pharmacological RAS blockade but not with other antihypertensive treatments had significantly lower E/E’ and higher E’/A’ Z-Scores. Systolic tissue Doppler velocities were significantly decreased (Z-score −0.24, p = 0.001) and inversely correlated with E/E’ Z-Scores (r = −0.41, p < 0.0001). LVMI was not associated with systolic or diastolic tissue Doppler velocities. Concentric left ventricular hypertrophy showed a tendency to lower S’ in multivariate analysis (p = 0.13) but no association to diastolic function. Concentric left ventricular geometry was significantly associated with lower midwall fractional shortening. In summary, systolic and diastolic function assessed by tissue Doppler is impaired. eGFR, systolic blood pressure and the type of antihypertensive medications are significant predictors of diastolic function in children with CKD. Left ventricular morphology is largely independent of tissue Doppler velocities. Tissue Doppler velocities provide sensitive information about early left ventricular dysfunction in this population.

Highly active antiretroviral therapy and left ventricular diastolic function in children with human immunodeficiency virus infection

Background In the past, cardiovascular involvement did not seem to be a common complication of HIV, but in recent years it has been described more frequently. With the advent of highly active antiretroviral therapy (HAART), the symptoms of cardiac disease has changed, as the number of HIV-infected patients with abnormal diastolic parameters has increased significantly, often presenting as symptomatic rather than asymptomatic.&#x0D; Objective To analyze for a possible correlation between HAART duration and left ventricular diastolic function in HIV-infected children. &#x0D; Methods This cross-sectional study was conducted from December 2016 to December 2017 at the Cardiology and Allergy-Immunology Division/Department of Child Health, Universitas Udayana Medical School/Sanglah Hospital, Denpasar, Bali. Subjects with HAART were collected using a consecutive sampling method. The following data were recorded for each subject: age, sex, current stage of HIV, CD4+ level, as well as HAART regimen and duration of use. Transthoracic echocardiography was performed for tissue doppler imaging (TDI) of diastolic function. Spearman’s test was used to analyze the strength of correlation based on normality test results.&#x0D; Results This study involved 53 subjects, 21 of whom had impaired diastolic function. There was no correlation between HAART duration and diastolic function in children with HIV infection (r= -0.03; P=0.82).&#x0D; Conclusion Diastolic dysfunction is found in children under HAART treatment, but there is no correlation between HAART treatment duration and diastolic dysfunction.

Echocardiographic Assessment of Diastolic Function in Children with Incident Systemic Lupus Erythematosus.

The timing and etiology of diastolic impairment in pediatric-onset systemic lupus erythematosus (SLE) are poorly understood. We compared echocardiographic metrics of left ventricular diastolic function in children at SLE diagnosis to controls and identified factors associated with diastolic indices. Echocardiograms of children aged 5-18years within 1year of SLE diagnosis and age-/sex-matched controls were retrospectively read by blinded cardiologists. Clinical characteristics were abstracted separately. Z-scores for diastolic indices (E/A, e', E/e', and isovolumetric relaxation time (IVRT)) were calculated using published normative data and study controls, and compared using linear mixed-effects models adjusted for blood pressure. Pericardial effusions and valvular disease were also evaluated. Linear regression was used to identify factors associated with diastolic measures. 85 children with incident SLE had echocardiograms performed a median of 6days after diagnosis (interquartile range (IQR) 1-70). Prior cumulative prednisone exposure was minimal (median 60mg, IQR 0-1652). SLE cases had lower E/A, lower e', higher E/e', and longer IVRT compared to controls. Though none met criteria for Grade I diastolic dysfunction, Z-scores for e', E/e', and IVRT were abnormal in 30%, 25%, and 6% of SLE cases, respectively. Greater disease activity was associated with lower septal e' (p < 0.01), higher E/e' (p = 0.02), and longer IVRT (p < 0.01). Children with incident SLE have worse diastolic indices at diagnosis compared to peers without SLE, independent of blood pressure and prior to significant prednisone exposure. Longitudinal studies will determine whether diastolic dysfunction develops in this population over time.