Tissue Doppler Imaging In Children Research Articles

Longitudinal Changes in Cardiac Function Based on Serial Tissue Doppler and Doppler Imaging for Patients With Sickle Cell Anemia

Objective: The aim was to evaluate the long-term changes in systolic and diastolic functions with tissue Doppler imaging in children with sickle cell anemia. Materials and Methods: In this study, myocardial performance index of ventricles and mitral and tricuspid valve E/A ratios were calculated. Wall motion velocities of the interventricular septum, right and left ventricles, and mitral and tricuspid annulus were assessed during the systole (Sm), the early diastole (Em), and the late diastole (Am) with pulsed Doppler echocardiography. Results: These diagnostic parameters were obtained from 38 patients (mean 12.5 ± 3.2 years old) who were reached after a mean 6.7 years in long-term follow-up. Left ventricular and septal end-systolic and end-diastolic diameters, and right and left ventricular myocardial performance index were higher in patients ( P < .05 and P = .001, respectively). The Em, Am, and Sm velocities of the right ventricle and septum were significantly lower in the patients at the baseline measures ( P < .05) and all these velocities decreased significantly in patients over time compared with their baseline values ( P < .05). In addition, it was observed that myocardial performance index values of the right and left ventricles increased significantly over time ( P < .05). Conclusion: This is the first study reflecting the age-related changes in global systolic and diastolic functions in sickle cell anemia by serial imaging.

Tissue Doppler echocardiography in children with OSA before and after tonsillectomy and adenoidectomy: A systematic review and meta-analysis

BackgroundWhen to order an echocardiogram in children with obstructive sleep apnea (OSA) is debated. Studies evaluating the utility of pre-operative standard echocardiography are inconsistent. Tissue Doppler imaging (TDI) is an additional technique that quantifies the velocity of myocardial motion to assess cardiac function. The utility of TDI in pediatric OSA remains unclear. MethodsA systematic review and meta-analysis were performed in accordance with PRISMA guidelines using PubMed, Scopus, CINAHL, and Cochrane Library databases. Studies of echocardiographic findings using TDI in children with polysomnogram confirmed OSA before and after tonsillectomy and adenoidectomy (T&A) were included. 1,423 studies were screened, and 4 studies met inclusion criteria. Meta-analysis of echocardiographic findings was performed. ResultsData from 560 children were analyzed. Study groups included pre- and post-T&A children with OSA and non OSA controls. Pre-T&A S′ wave at the tricuspid annulus (S′ RV) was decreased with a mean difference of −1.04 [95% CI -1.57, −0.52, p < 0.001] and E’/A′ ratio at the mitral annulus (E’/A’ LV) was decreased with a mean difference of −0.74 [95% CI -0.85, −0.64, p < 0.001] when compared to controls. These variables were not statistically different when comparing post-T&A to controls. ConclusionsTDI appears to successfully detect subclinical changes in cardiac function in children with OSA. However, echocardiography parameters of post-T&A and non OSA control children were similar. Further prospective studies stratified by OSA severity are needed with both TDI and standard echocardiography to define the utility of pre-operative cardiac imaging.

Evaluation of cardiovascular risk by growth-differentiation factor-15 and tissue Doppler imaging in children with subclinical hypothyroidism.

Subclinical hypothyroidism, defined as increased TSH serum levels and normal serum free T4 concentrations, has been associated with an increased risk of heart disease in adults. But, data in children and adolescents are scanty and treatment of subclinical hypothyroidism is controversial. Growth differentiation factor-15 (GDF-15) is a promising biomarker of cardiac remodeling. This study aimed to evaluate the cardiovascular risk factors in children with subclinical hypothyroidism, measured with tissue Doppler echocardiography (TDE), and conventional echocardiography and GDF-15 level. The study comprised a total of 41 pediatric patients with subclinical hypothyroidism (SH) (mean age 9.6 ± 4.7 years) and 31 healthy children (mean age 11.2 ± 3.4 years) as the control group. Subclinical hypothyroidism was defined as a thyroid-stimulating hormone level higher than 4 mIU/l and a normal free-thyroxine level (0.6-1.8 ng/dl). Tissue Doppler echocardiography was performed to all individuals in the control group and patient group at the beginning of the study. Global systolic function as assessed by left ventricular ejection fraction was compared between groups. The serum GDF-15 level was measured. There were no significant differences in demographic parameters between the SH and control groups. The left ventricular internal diameter end systole, interventricular septal end diastole, left ventricular posterior wall end diastole, and tricuspid annular plane systolic excursion values were significantly different between the SH and control groups (p = 0.038, 0.028, 0.005, and 0.000, respectively). The mean mitral isovolumic relaxation time value of the SH group was 57.2 ± 9.3 ms, compared to 44.5 ± 5.6 ms for the control group (p = 0.000). The mean tricuspid isovolumic contraction time value of the SH group was 58.7 ± 9.4 ms, and that of the control group was 45.1 ± 5.3 ms (p = 0.000). The mean tricuspid isovolumic relaxation time value of the SH group was 58.03 ± 9.5 ms, and that of the control group was 45.1 ± 5.3 ms (p = 0.000). There were no significant differences in the other m-mode or pulse Doppler echocardiography values between two groups. The GDF-15 value of the SH group was 382.6 ± 268.2 pg/mL, and that of the control group was 473.6 ± 337.9 pg/mL; this difference was not significant. Patients with subclinical hypothyroidism versus healthy individuals had some changes in echocardiographic parameters that indicate involvement of diastolic function of the left ventricle. They were significantly different when compared SH group and the control group. This study demonstrated ventricle diastolic dysfunction in pediatric patients with hypothyroidism. The results of our study suggest that cardiac follow-up may be useful in patients with subclinical hypothyroidism and clinical trials are needed to explore therapeutic effects of T4 and T3 administration in this patients.

Evaluation of left ventricular functions by conventional echocardiography and tissue Doppler imaging in children with rheumatic valve disease

Amac: Romatizmal kardit tanisi ile izlenen mitral yetmezlikli cocuklarda sol ventrikul fonksiyonlarini geleneksel ekokardiyografi ve doku Doppler goruntu- leme yontemiyle degerlendirip, sonuclari saglikli kontrol grubu ile karsilastirmayi amacladik. Gerec ve Yontem: Pediatrik kardiyoloji klinigimizde romatizmal kardit sonrasi mitral yetmezlik tanisi ile izlenen 30 hasta ve 5-15 yaslari arasinda 30 saglikli cocuk calismaya dahil edildi. Hasta grubu hafif-orta dereceli mitral yetmezlik ve agir mitral yetmezlik olarak siniflandirildi. Tum ekokardiyografik olcumler ca- lisma grubunun klinik ve laboratuvar sonuclarina kor olan uzman bir pediatrik kardiyolog tarafindan yapildi. Bulgular: Agir mitral yetmezlikli hastalarda sol ventrikul diyastol sonu caplari kontrol grubuna gore anlamli derecede artis gosterdi (4.62±0.82 cm, 3.92±0.39 cm; p=0.008). Yine sol ventrikul sistol sonu caplarinda agir mitral yetmezlikli hastalarda kontrol grubuna gore anlamli olarak artmis bulundu (2.81±0.51, 2.43±0.25, p=0.01). Ejeksiyon fraksiyonu ve fraksiyonel kisalma acisindan gruplar arasinda istatistiksel olarak anlamli fark yoktu (p>0.05). Doku Doppler gorun- tuleme yontemiyle olculen erken diyastolik pik miyokard hizi gruplar arasinda istatistiksel olarak anlamli farklilik gostermedigi halde (p>0.05), atriyal pik sisto- lik hiz, agir mitral yetmezlikli hastalarda, hem kontrol hem de hafif-orta mitral yetmezlikli hastalara gore anlamli derecede yuksek olculdu (sirasiyla p<0.001, p=0.001). Sonuc: Calismamizda, geleneksel ekokardiyografik olcumlerle elde edilen sol ventrikul sistolik ve diyastolik fonksiyonlari acisindan kontrol grubu ile mitral yetmezlikli hasta gruplari arasinda istatistiksel olarak anlamli bir farklilik bulunamamistir. Buna ragmen mitral yetmezlikli hasta grubunda sol ventrikuler fonksiyonlardaki subklinik bozulma doku Doppler goruntuleme yontemiyle saptanmistir.

Assessment of the Myocardial Velocity by Tissue Doppler Imaging in Children of Sickle Cell Anemia

Assessment of the Myocardial Velocity by Tissue Doppler Imaging in Children of Sickle Cell Anemia

Impaired longitudinal deformation measured by speckle-tracking echocardiography in children with end-stage renal disease.

BackgroundLeft ventricular dysfunction is an important co-morbidity of end-stage renal disease (ESRD) and is associated with a poor prognosis in the adult population. In pediatric ESRD, left ventricular function is generally well preserved, but limited information is available on early changes in myocardial function. The aim of this study was to investigate myocardial mechanics in pediatric patients with ESRD using speckle-tracking echocardiography (STE).MethodsEchocardiographic studies, including M-mode, tissue Doppler imaging (TDI) and STE, were performed in 19 children on dialysis, 17 transplant patients and 33 age-matched controls. Strain measurements were performed from the apical four-chamber and the short axis view, respectively.ResultsThe interventricular and left ventricular posterior wall thickness was significantly increased in dialysis and transplant patients compared to healthy controls. No significant differences were found in shortening fraction, ejection fraction and systolic tissue Doppler velocities. Dialysis and transplant patients had a decreased mean longitudinal strain compared to healthy controls, with a mean difference of 3.1 [95 % confidence interval (CI) 2.0–4.4] and 2.7 (95 % CI 1.2–4.2), respectively. No differences were found for radial and circumferential strain.ConclusionsSpeckle-tracking echocardiography may reveal early myocardial dysfunction in the absence of systolic dysfunction measured by conventional ultrasound or TDI in children with ESRD.

Prognostic implications of the systolic to diastolic duration ratio in children with idiopathic or familial dilated cardiomyopathy.

Childhood dilated cardiomyopathy (DCM) carries high morbidity and mortality. The echocardiographic systolic to diastolic (S:D) duration ratio, an indicator of global cardiac performance, is elevated in DCM; however, its prognostic implications have not been investigated in this population. We investigated systolic and diastolic durations and the resultant S:D ratio using pulsed tissue Doppler imaging in children with idiopathic or familial DCM. We studied serial echocardiograms from presentation until the last follow-up echo. Results were compared with heart rate-matched controls and between DCM subgroups based on an acute or insidious presentation. The association between S:D ratio and death or need for transplant was analyzed. All analyses were adjusted for repeated measures per patient. We studied 200 serial echocardiograms of 48 children with DCM (7.0±6.0 years) and 25 controls. Adjusted for repeated measures through a compound symmetry covariance structure, the S:D ratio was higher in DCM patients (-0.425 [0.072]; P<0.001) because of shortened diastole. A S:D ratio >1.2 at presentation and on serial evaluation was associated with a hazard ratio of 10.5 (95% confidence interval, 3.9-27.8; P<0.001) for death or transplant. In combined multivariable analysis, a S:D ratio >1.2 remained significantly associated with hazard of death/transplant (hazard ratio, 9.1; P=0.04) after adjustment for ejection fraction (hazard ratio: 2.2 per -10%; P<0.001). A high S:D ratio is associated with increased risk for death or need for transplant in children with DCM across the spectrum of heart rates and may be a useful prognostic index for serial evaluation of children with DCM.

SAT0173 Assessment of Left Ventricular Dyssynchrony in Patients with Familial Mediterranean Fever

BackgroundFamilial Mediterranean fever (FMF) is a disease characterized by recurrent and sustained increased inflammatory activity. Various clinical and subclinical cardiovascular involvements have been reported in FMF patients. However, there is...

Diastolic dysfunction measured by tissue Doppler imaging in children with end-stage renal disease: a report of the RICH-Q study

Early detection of cardiovascular disease in children with end-stage renal disease is essential in order to prevent cardiovascular morbidity and mortality in early adulthood. Tissue Doppler imaging has shown to be a promising method to detect and quantify subtle abnormalities in diastolic function. We therefore compared assessment of diastolic function by conventional echocardiography and tissue Doppler imaging. We performed conventional echocardiography and tissue Doppler imaging in 38 children with end-stage renal disease and 76 healthy controls. We compared outcomes on parameters related to diastolic function (E/a ratio for conventional echocardiography and E/E' ratio for tissue Doppler imaging) for both groups using multiple linear regression analysis. Diastolic dysfunction was defined as E/a ratio <1 or E/E' ratio > 95th percentile for age. To assess the intra-observer reproducibility, the coefficient of variation was calculated. Children with end-stage renal disease had on average a lower E/a ratio (p = 0.004) and a higher mitral and septal E/E' ratio (both p < 0.001) compared with controls. In all, two children with end-stage renal disease (5%) had diastolic dysfunction according to the E/a ratio, 11 according to the mitral E/E' ratio (29%), and 16 according to the septal E/E' ratio (42%) compared with none of the controls (p = 0.109, p < 0.001, and p < 0.001, respectively). The coefficients of variation of the mitral (7%) and septal E/E' ratio (4%) were smaller than the coefficient of variation of the E/a ratio (11%). Tissue Doppler imaging is a more sensitive and reliable method to detect diastolic dysfunction than conventional E/a ratio in children with end-stage renal disease.

Correlations between B-type natriuretic peptide levels and nongeometric echocardiographic parameters in pediatric cardiomyopathies

B-type natriuretic peptide is a conventional cardiac biomarker in adult cardiology, however, it is not commonly used in pediatric cases. After introducing B-type natriuretic peptide measurements in pediatric patients for the evaluation of systemic right ventricular function, the authors wanted to evaluate the value of plasma B-type natriuretic peptide and compare the results with systolic and diastolic myocardial parameters obtained with conventional echocardiography and tissue Doppler imaging in children with cardiomyopathy. Between 2007 and 2010, 58 plasma B-type natriuretic peptide measurements were performed in 32 children (dilated cardiomyopathy in 20, hypertrophic cardiomyopathy in 10 and non-compacted cardiomyopathy in 2 cases). The age of the patients was 7.9±6.6 years (mean±SD). Plasma B-type natriuretic peptide was measured using an electrochemiluminescent assay within one day from echocardiographic evaluation. As compared to normal values, children with the 3 types of cardiomyopathies showed significant differences in plasma B-type natriutretic peptide levels (dilated cardiomyopathy vs normal, p<0.001; hypertrophic cardiomyopathy vs. normal, p<0.01; non-compacted cardiomyopathy vs. normal, p<0.001). There was a significant negative correlation (r = -0,63; p<0,01) between B-type natriuretic peptide levels (range, 12-7002 ng/L; mean±SD, 1531±1750 ng/L) and linEF values (range, 4-50%; mean±SD, 22.5±13%). For B-type natriuteric peptide, a cut-off point of 1000 ng/L proved to differentiate significantly decreased linEF values (<17%). B-type natriuretic peptide levels significantly correlated with left ventricular end-diastolic diameter (r = 0.899; p<0.001), with left ventricular anular S wave parameters (r = 0.689; p<0.001) and with E/e ratio (r = 0.43; p<0.05). B-type natriuretic peptide measurements are recommended in all types of cardiomyopathies.

Evaluation of myocardial function using tissue Doppler imaging in children with moderate scorpion envenomation

Context. Scorpion envenomation is an important public health problem. It can cause life-threatening complications such as respiratory, neurological and cardiovascular compromise. Systemic envenoming signs and mortality rates are dramatically higher in children. Objective. The objective of this study was to evaluate myocardial function using pulsed tissue Doppler imaging in patients with moderate scorpion envenomation. Materials and methods. The study was conducted from July to October 2009 in the South-East Anatolia region of Turkey. The study population consisted of 30 children with moderate scorpion envenomation and 30 age- and sex-matched normal controls. Severe and mild envenomations were excluded. In addition to echocardiographic examination, pulsed tissue Doppler imaging was performed. Results. The average age was 7.6 ± 4.3 years in patients and 7.9 ± 3.2 years in controls (p value, 0.77). The mean heart rate was 114 ± 19 beats/min (range, 72–164) in patients and 95 ± 14 beats/min (range, 72–127) in controls (p < 0.01). Sinus tachycardia (> 120 beats/min in children) was detected in ten (33.3%) patients. Myocardial performance index (MPI) was obtained with tissue Doppler imaging. The ejection fraction, the fractional shortening, the MPI of the left ventricle, the MPI of the right ventricle, the left ventricular isovolumetric contraction time (ICT), the left ventricular isovolumetric relaxation time (IRT), the left ventricular ejection time, the right ventricular ICT, the right ventricular IRT and the right ventricular ejection were not statistically different between the patients and the controls (p > 0.05). Discussion. We did not detect any considerable myocardial involvement in the children presenting with moderate scorpion envenomation except for sinus tachycardia. If the patients are treated with antivenom within 4 h, patients with moderate scorpion envenomation may not develop cardiac dysfunction.

Systolic and Diastolic Ventricular Function Assessed by Tissue Doppler Imaging in Children with Chronic Kidney Disease

Chronic kidney disease (CKD) is associated with elevated cardiovascular risk even during childhood. Tissue Doppler is a sensitive technique for the assessment of ventricular dysfunction with relatively little data available in children with CKD. We report a prospective cross-sectional echocardiographic study at a tertiary center. Forty-nine patients with median (range) age 11.2 years (6.9-17.9), weight 39.6 kg (23.6-99.7) and height 146 cm (122-185). Thirty-one patients were male. Median duration of follow-up for CKD was 7.1 years (range 0.13-16.9). Patients were in CKD stage 3 (n = 37) or 4 (n = 12). Mitral valve E-wave, A-wave, and E/A ratio showed mean (SD) z-scores of 0.08 (0.93), 0.12 (0.82) and -0.13 (0.84), respectively. Tissue Doppler imaging (TDI) at the lateral mitral valve annulus showed e', a', s', and E/e' z-scores mean (SD) -1.10 (0.76), -0.29 (0.92), -1.2 (0.7), and 0.86 (1.1), respectively. There was a significant negative correlation of e' and s' z-score with patient age. E/e' ratio correlated positively with patient age. Blood pressure, left ventricular mass, and relative wall thickness did not correlate with tissue Doppler measurements. The e' and s' velocities correlated significantly with each other, suggesting an interaction of systolic and diastolic dysfunction. Children with CKD may have abnormalities of systolic and diastolic ventricular function on TDI, which are not evident on blood pool Doppler. The tissue Doppler results are consistent with worsening ventricular function in older patients.

Assessment of cardiac functions using tissue Doppler imaging in children with familial Mediterranean fever

Familial Mediterranean fever may carry a potential for cardiovascular disorders because of sustained inflammation during its course; however, there has been a limited number of studies investigating the cardiac functions in children. The aim of this study was to assess both ventricular diastolic functions using conventional echocardiography and tissue Doppler imaging in children with familial Mediterranean fever. The study population included 25 patients with familial Mediterranean fever - mean age was 11.8 plus or minus 5.30 years - and 23 healthy patients as controls - mean age was 9.88 plus or minus 3.69 years. Both ventricular functions were measured using echocardiography comprising standard M-mode and conventional Doppler and tissue Doppler imaging during an attack-free period. The conventional echocardiographic parameters with myocardial performance index were in normal ranges and similar in patients with familial Mediterranean fever and controls, with a p-value more than 0.05. However, right ventricular diastolic dysfunction was observed in patients with familial Mediterranean fever documented by tissue Doppler imaging, with a p-value less than 0.05 for E't and A't wave ratio. Using tissue Doppler imaging, we have demonstrated that although left ventricular functions were comparable in the patients and healthy children, right ventricular diastolic function indices were impaired in patients with familial Mediterranean fever during childhood. Impaired right ventricular diastolic function may be an early manifestation of cardiac involvement in children with familial Mediterranean fever.

Assessment of left ventricular systolic function using tissue Doppler imaging in children after successful repair of aortic coarctation

SUMMARY AIM: Assessment of left ventricular systolic function in children after the successful repair of aortic coarctation using tissue Doppler imaging (TDI). The study group consisted of 32 patients (mean age 12.0 +/- 4.2 years) after the aortic coarctation repair. The TDI parameters and the conventional echocardiographic endocardial and midwall indices of the left ventricular systolic function were analysed and compared with the results obtained from 34 healthy children. The systolic mitral annulus motion velocity, systolic myocardial velocity of the medial segment of the left ventricular septal wall, left ventricular strain and Strain Rate (SR) in the study group were significantly higher than in the control group, respectively: 6.92 +/- 0.75 cm s(-1) versus 6.45 +/- 0.83 cm s(-1); 5.82 +/- 1.03 cm s(-1) versus 5.08 +/- 1.11 cm s(-1); -28.67 +/- 6.04% versus -22.53 +/- 6.44% and -3.20 +/- 0.76 s(-1) versus -2.39 +/- 0.49 s(-1). Except midwall shortening fraction the conventional endocardial and midwall echocardiographic indices in the study group were significantly higher in comparison to the healthy controls. The left ventricular systolic meridional fibre stress and end-systolic circumferential wall stress did not differ between the examined groups. There were no differences of the TDI or conventional parameters between hypertensive and normotensive patients. Left ventricular systolic performance in children after the surgical repair of aortic coarctation reveals tendency to rise in late follow-up despite a satisfactory result after surgery. Higher systolic strain and SR in children treated due to coarctation of the aorta may suggest the increased preserved left ventricular performance despite normalization of afterload.

Clinical applications of tissue Doppler imaging in children with cardiovascular disease

组织多普勒成像通过多普勒频移来定量描述局部心肌的运动,在二维超声图像不佳时也可以获得心肌运动的信息,具有更高的时间和空间分辨率,并可同步定量多个节段心肌的运动速度.目前组织多普勒成像能对心肌功能障碍的性质和程度做出判断和定量分析,已显示出重要的临床应用价值.该文对组织多普勒成像的概念、技术原理以及其在小儿心血管疾病中的临床应用现状和潜在的发展作一综述。

Variation of parameters according to cardiac cycle length, evaluated by TDI in children

Purpose : This study aimed to determine the variation in parameters according to cardiac cycle length (CL; time interval between the QRS peaks on ECG) in children by using the conventional pulsed Doppler and tissue Doppler imaging echocardiography. Methods : Eighteen children with an anatomically normal heart were enrolled for the study. All children were examined by conventional and pulsed Doppler echocardiography at Gangneung Asan hospital between July 2006 and June 2007. We measured the CLs, mitral inflow velocities (E,A) and tissue Doppler imaging (TDI) parameters (s', e', a') from apical 4-chamber view. The TDI parameters were measured at the lateral (Lat) and septal (Sep) part of the mitral valve. All parameters were measured at 6 to 18 consecutive beats from each child. We then evaluated the linear correlation between CL and each parameter. Results : The mean age was 3.60.5 years (M:F=8:10). There were significantly negative linear correlations between CL and A, Lat s', Lat a', Sep s', Sep e', Sep a' (P

Left ventricular diastolic function evaluated with tissue Doppler imaging in children with familial Mediterranean fever

The aim of this study was to assess the left ventricular diastolic function using conventional echocardiography and tissue Doppler imaging in children with familial Mediterranean fever. This study included 29 (13 males and 16 females) patients and 30 healthy subjects as controls. Body mass index was calculated and arterial blood pressure was monitored. After an overnight fast, venous blood samples were taken and serum amyloid A protein, C-reactive protein, serum-fasting glucose, total cholesterol, triglycerides, high-density lipoprotein cholesterol, very low density lipoprotein cholesterol, and serum low-density lipoprotein cholesterol levels were measured. A complete 2-dimensional, M-mode, pulse wave Doppler, and pulse wave tissue Doppler echocardiographic examination was performed. There were no significant differences between the groups regarding age, body mass index values, systolic and diastolic blood pressures, heart rates, serum-fasting glucose, total cholesterol, triglycerides, high-density lipoprotein cholesterol, very low density lipoprotein cholesterol, and serum low-density lipoprotein cholesterol. Serum levels of inflammatory markers were higher in patients' group (C-reactive protein and serum amyloid A protein levels were 10.84 mg/dl, 22.32 mg/l in patients' group, respectively, and 4.11 mg/dl, 3.65 mg/l, respectively, in the healthy controls.) Peak mitral A wave, E and A wave ratio differed significantly in both groups. There were statistically significant differences regarding parameters observed by tissue Doppler imaging such as E'm, A'm, E'm, and A'm ratio between patients' group and controls. Tissue Doppler imaging provided additional information on left ventricular diastolic function. While systolic functions were in normal range, some of the diastolic function parameters were impaired in patients with familial Mediterranean fever during childhood.

Evaluation of Cardiac Function by Tissue Doppler Imaging in Children With Chronic Hepatitis

Pathoanatomic changes in cirrhosis result in impaired ventricular filling and diastolic dysfunction and were named as cirrhotic cardiomyopathy. However, cardiac functions have not been studied in patients with chronic hepatitis. We hypothesized that such patients might have subclinical ventricular dysfunction, detectable by tissue Doppler echocardiography and related to the severity of hepatic inflammation and fibrosis. We studied 63 clinically stable patients, 27 patients with mild chronic hepatitis (group 1), 22 patients with moderate chronic hepatitis (group 2) and 14 patients with severe chronic hepatitis (group 3) according to the scoring system of Knodell, and 36 age-matched healthy subjects. Patients with severe chronic hepatitis had impaired right ventricular diastolic function. The early diastolic velocity of the tricuspid valve annulus was lower in patients from group 3 than in healthy subjects (P < 0.001). Patients in group 3 had a greater isovolumic relaxation time (P < 0.001), indicating right ventricular diastolic dysfunction. Comparing group 3 with the healthy subjects, the ratio of peak early myocardial tissue velocity and peak late (or atrial) myocardial tissue velocity was significantly decreased (P < 0.001), at 1.4 (0.7) and 1.9 (0.7), respectively. There was also a slightly lower peak early myocardial tissue velocity and peak late (or atrial) myocardial tissue velocity ratio and a slightly longer isovolumic relaxation time in patients from group 2 than in healthy subjects (P < 0.05). We detected subclinical dysfunction of the right ventricle in children with chronic hepatitis in whom hepatic inflammation and fibrosis is prominent. Tissue Doppler echocardiography provides a quantifiable indicator useful for detection and monitoring of disease progression.

Evaluation of cardiac function by tissue Doppler imaging in children with cancer

Purpose:The objectives of this study were to assess ventricular function by tissue Doppler imaging in children who were receiving chemotherapy or who had received chemotherapy, and to apply repeated tissue Doppler imaging to make an early assessment in cardiac toxicity studies. Methods:This study was conducted on 23 oncology patients on-treatment or off-treatment from April 2005 to July 2005 at Dongsan Medical Center, Keimyung University. All patients(group 1) were divided into two groups, fractional shortening(FS) over 29 percent(group 2) and FS under 28 percent (group 3) in the first category. These same patients were also divided into the following groups:group treated with anthracyclin(group 4) and group treated without anthracyclin(group 5). Deceleration time(DT), isovolumic relaxation time(IVRT), FS, peak early diastolic(E), and peak late diastolic (A) velocity of transmitral flow were measured by M-mode and pulsed wave Doppler. Systolic(Sm), peak early diastolic(Em), and peak late diastolic(Am) velocity in apical 4-chamber and 2-chamber views were measured by tissue Doppler imaging. The author calculated a modified Tei index, E/A, E/Em ratio by using measured values. Results:Twenty three patients were enrolled:12 boys and 11 girls. The average age of patients was 8 years and 4 months. Thirteen out of 23 patients were in the group treated with anthracyclin (group 4) and 6 had FS under 28 percent(group 3). E/Em ratio showed a significant difference between group 1 and control group(6.46±1.85 vs 7.06±1.64, P