Quantification of regional left and right ventricular deformation indices in healthy neonates by using strain rate and strain imaging.

Abstract

Color Doppler myocardial imaging (CDMI) allows the calculation of local longitudinal or radial strain rate (SR) and strain (epsilon). The aims of this study were to determine the feasibility and reproducibility of longitudinal and radial SR and epsilon in neonates during the first hours of life and to establish reference values.
Data were obtained from 55 healthy neonates (29 male; mean age, 20 +/- 14 hours; mean birth weight, 3,174 +/- 374 g). Apical and parasternal views quantified regional longitudinal and radial SR and epsilon in differing ventricular wall segments. Values at peak systole, early diastole, and late diastole were calculated from the extracted curves. CDMI data acquired at 300 +/- 50 frames/s were analyzed offline. Three consecutive cardiac cycles were measured during normal respiration. The timing of specific systolic or diastolic regional events was determined. Multiple comparisons between walls and segments were made.
Left ventricular (LV) longitudinal deformation showed basal differences compared with apical segments within one specific wall. Right ventricular (RV) longitudinal deformation was not homogeneous, with significant differences between basal and apical segments. Longitudinal epsilon values were higher in the RV free basal and middle wall segments compared with the left ventricle. In the RV free wall apical segment, longitudinal SR and epsilon were maximal. LV systolic SR and epsilon values were higher radially compared with longitudinally (radial peak systolic SR midportion, 2.9 +/- 0.6 s(-1); radial peak systolic epsilon, 53.8 +/- 19%; longitudinal peak systolic SR midportion, -1.8 +/- 0.5 s(-1); longitudinal peak systolic epsilon, -24.8 +/- 3%; P < .01). Longitudinal systolic epsilon and SR interobserver variability values were 1.2% and 0.7%, respectively.
Ultrasound-based SR and epsilon imaging is a practical and reproducible clinical technique in neonates, allowing the calculation of regional longitudinal and radial deformation in RV and LV segments. These regional SR and epsilon indices represent new, noninvasive parameters that can quantify normal neonate regional cardiac function. Independent from visual interpretation, they can be used as reference values for diagnosis in ill neonates.

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showed a fetal tachycardia with AV dissociation; at the birth it was confirmed the
diagnosis el LQTS and recurrent ventricular tachycardia. In fetal file therapeutical
approach (maternal administration el digoxin, solalol or flecainide lot lotuses with
sustained supraventricular lachycardia) was decided according to the supposed
electrophysiologic al mechanism.
Conclusion: Fetal echocardiography could clarify the electrophysiological mecha-
nism el letal cardiac arrhythmias and guide the therapeutic approach.
430
Objectively measured daily physical activity has a relation with IoN
ventricular seize in young children
M. Dencker 1, O. Thorsson 1, M.K. Karlsson 1, C. Linden 1, j. Svensson 2,
L.B. Andersen 3, p. Wollmer 1. I Maline, Sweden; a lnstitute for Exercise and Sports
Sci, Copenhagen, Denmark; a Sports and Physical Education, Oslo, Norway
Introduction: Training studies in adolescents have revealed that increased expo-
sure to physical activity can give enlargement and a remodelling el the lel! ventri-
cle. This relationship has not been studied on a population-based level in young
children.
Methods: This was a cross-sectional study el 248 children (140 boys and 108
girls) 8 to 11years el age, lrom a population-based cohort. Maturity was evalu-
ated according to Tanner. Echocardiography, 2<limensional guided M-mode, was
pedormed in accordance with ASE-guidelines. Left venlricular end diastolic diam-
eter (LVDD) and lelt ventricular end systolic diameter (LVSD) were measured. All
echocardiography measurements were indexed lor body surlace area (BSA). Phys-
ical activity was assessed by acceleromelers lot 4 days. From acceleromeler data
number el minutes of vigorous activity per day were counted. Blood pressure was
measured in the sitting position.
Results: Acceptable accelerometer measurement was obtained in 229 children
(boys=128, girls=101), this constitutes the final study group. Mean age 9.8±0.6
years (range 7.9-11.1). There were significant (p<0.05) univariate correlations be-
tween number of minutes el vigorous activity per day vs. LVDD (r=0.24) and LVDS
(r=0.19). However, multiple regression analysis with the inclusion el possible co-
founders such as blood pressure, gender, age and Tanner stage revealed thal
independent laclors lot minutes of vigorous activity per day was gender and LVDD.
Conclusions: Preliminary findings from this population-based cohort el young
children show that an independent relationship exists between heart size and
amount of daily physical activity. This suggests that heart muscle remodelling due
to the volume exposure secondary to a high amount of physical activity begins
early in Ilia.
431
Quantification of regional left and right ventricular deformation indices
in normal neonates by using strain rata and strain imaging
J.L.B. Pena 1, M.G. Silva 2 , S.C.C. Faria 2 , V.M.C. Salemi 1, C. Mady 1,
G.R. Sutherland 3 . ~ Heart Institute (InCor) USP, Sac Paulo, Brazil; 2Clinica Baeta
Vianna, Belo Horizonte, Brazil; ~ St.George's Hospital, London, United Kingdom
Background: Color Doppler myocardial imaging (CDMI) allows calculation el ei-
ther local longitudinal (L) or radial (R) Strain Rate (SR) and Strain (e). In this study
we tried to determine the feasibility and reproducibility of L and R SR and e in
neonates at first hours el lile and define normal values.
Methods: Data were obtained in 55 normal neonates, 29 male, (mean 20±14 h el
age), with a mean birth weight el 3174±374g. PDA was present in 67,3% el the
patients. Apical and parasternal views were used to quantily regional L and R SR
and e and from the curves peak values for systole, early diastole and late diastole
were calculated. CDMI data acquired above 250 lps were anlyzed using dedicated
software (Echopac, GE). Three consecutive cardiac cycles were measured during
normal respiration. A paired samples I test was done comparing the 2 groups.
Results: LV L deformation showed dillerences for LV basal, (peak systolic SR:-
1,9±0.6 s -1 , systolic e -26%±5%) when compared to apical (-1,7±0.2 s 1 , systolic
e: -24%±3%) segments (p=O.04, 0,01 ). RV L delormation showed the same pal-
tern, with significant dilferences between basal and apical segments. Longitudinal
e values were higher in the RV basal and mid segments compared to LV and in
the apical wall L SR and e were maximal (peak systolic SR:-2,1±0.5 s 1 systolic
e -32%±5%), (p=O,00). The LV systolic SR and e values were higher in the R di-
rection (basal and mid segments) compared with L direction (R peak systolic SR
mid-portion: 2,9±0.6 s -1 , systolic e: 53,8%±19%; L peak systolic SR mid portion:
-1,8±0.5 s -1 , systolic e: -24,8%:1:3%); p=O,00. The interobserver variability lot L
systolic e and SR was 4,58% and 4,69% and for R systolic e and SR 13,3% and
15,18%, respectively.
Conclusion: Ultrasound-based Strain SR/e imaging is a practical and reproducible
clinical technique in small children. The combination of regional SR/e indices may
be a new important noninvasive parameter to quantilying regional myocardial lunc-
tion in congenital and acquired heart disease in neonates.
432
Myocardial deformation properties in patients with aortic coarctation
after successful repair are influenced by the age at surgical repair
G. Di Salvo 1 , G. Pacileo 3 , M. Verrengia 3 , G. Limongelli 2 , A. Rea 2 ,
A. Imperalore 2 , R Caso 3, R. Calabro 4 . ~Naples, Italy; 2Second University of
Naples, Paediatric Cardiology, Naples, Italy; a Monaldi Hospital, Department of
Cardiology, Naples, Italy; ~ Second University of Naples, Department of
Cardiology, Naples, Italy
Background: Life expectancy remains reduced in patients with repaired aortic
coarctation (AC) because el the increased risk of hypertension and cardiovascular
disease despite successlul repair. We studied the myocardial delormation prop-
erties in a large sample i:>1 patients after (>1 year) successlul aortic coarctation
repair and their relation to age at surgical repair.
Methods: In all we studied 140 subjects: 100 AC patients (moan age 12±4 years,
median age at repair: 4 months) late alter successful repair el AC (<3.5 m/see
velocity and or <20 mmHg pressure gradient at continuous wave Doppler in the
aortic arch and without the presence el diastolic tail); 40 ago sex comparable sub-
jecls as control group. Moreover, AC patients were divided in 2 groups based on
the ago at surgical repair (Group I within 6 months[n=63, mean age12±4 years],
and Group II >6 months [n--37, mean age 11±3 years). All the studied sample un-
derwent standard echocardiography, 24h-ABPM, and strain rate immaging study.
Peak systolic Strain (%) and Strain rate (1/see) lot both regional longitudinal and
radial function were ess~ed.
Results: Regional myocardial deformation properties were significantly reduced
lor both radial (SR: 2.2±0.6 vs 3.8±1) and longitudinal (SR: -1 2±0.9 vs -1.9±0.7,
p<0.05) in AC patients compared to controls. Group I patients were similar (p=NS)
to Group II patients lot age (12±4 vs 11±3), 24h systolic (126±10 vs 126±18)
and diastolic blood pressure (60±9 vs 58±12), LVMI (92±36 vs 104±2.9), and lelt
venlricular ejection lraclion (73±8 vs 73±15). Longitudinal deformation properties
were significantly higher in Group I patients (SR: -1.4±1) when compared to Group
II patients (-1 .t ±0.7).
Conclusions: Despite the presence of a successlul repair lor AC, both radial and
longitudinal deformation properties are significantly impaired. Moreover, longitudi-
nal delormalion properties are more compromised in patients operated on later.
This is probably due to the prolonged increase in the alterload leading to a more
severe dammage on the subendocardial layer, which is the main determinant of
the longitudinal function.
433
A reduced myocardial acceleration during isovolumic contraction and
systolic deformation are seen in children late ater low dose
anthracycline treatment
J. Ganame 1, I~ Claus 2 , A. Uyltebroeck 3, M. Renard s, j. D,hooge 2 ' B. Bijnees 2 ,
M. Gewillig 1, L. Merlens 1. r University Hospital Gasthuisberg, Pediatric
Cardiology, L euven, Belgium; 2 Universitary Hospital Gasthuisberg, Cardiology
Department, Leuven, Belgium; 3 University Hospital Gasthuisberg, Pediatric
Department, Leuven, Belgium
Background: The occurrence i:>1 anlhracycline (Ant) c ardioloxicity is still a concern
alter treatment el childhood cancer. This has led oncologists to lower the cumula-
live dose. However, these lower doses might as well affect cardiac lunction in the
long-term although often conventional echocardiographic data are completely nor-
mal. There may well be a discrete cardiac dyslunction which remains undetected
using these conventional techniques. Myocardial velocity imaging, a new echocar-
diographic technique, which allows measuring: (i) the myocardial acceleration dur-
ing isovolumic conlraclion (IVA) and (ii) the systolic deformation (strain tale {SR}
and strain {S}); is potentially uselul in this regard.
Aim: To determine whether IVA, SR and S could detect abnormalities in cardiac
lunclion in pls late allot a low Ant dose treatment.
Methods: We examined 56 pls aged 12.7±4.8 years. They had all previously re-
ceived an Ant dose lower than 300 mg/m s (median: 240 mg/mS). Data were com-
pared to 32 age-matched normal controls. Both, standard echocardiographic mea-
surements as well as myocardial velocity imaging data were obtained. The IVA was
measured at the LV basal lateral and RV basal lree wall. Peak systolic SR and S
were estimated both in the radial, from the infero-lateral wall, and in the longitudinal
direction Item the LV lateral wall and inlervenlricular septum
Resulls: See table. Additionally, end-systolic wall stress was higher; isovolumic
relaxation lime was prolonged; LV annular motion and pulmonary vein systolic flow
were reduced in pls compared to controls. All other standard indices el LV function
were not different between pls and controls.
IVA (cm/s 2)
Ant
Strain Rate (s -I )
Ant
3.94-1 1 # 5.04-1 0 54.14-18.0# 67.64-11.9
Strain (%)
Ant Controls Controls Controls
Radial LV
Longitudinal LV 9844-52.2" 121.54-31.2 -1.94-06" -2.24-07 -20.34-82 *
Longitudinal RV 17244-54.3 17704- 42.9 -2.94-13 -3.14-10 -3614-157
#p < 0.01 vs Controls; *p < 0.05 vs; C0ntr013
-2774-7.7
-43.04-14.2
Conclusions: By measuring the IVA and systolic delormalion indices (SR and S),
it can be shown that both, radial and longitudinal function appear to be affected in
pls late alter a low Ant dose. IVA and delormation indices could potentially be used
to monitor cardiac lunclion since they detect abnormalities at an early subclinical
stage.
Eur J Echocardiography Abstracts Supplement, December 2005
by guest on January 5, 2012
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