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44. Jahrestagung der Deutschen Gesellschaft für Pädiatrische Kardiologie
– Abstracts –
31
Bildgebung II und Verschiedenes
P28 – P34
Speckle Tracking Echocardiography detects abnormal
regional function in the myocardium in children with P26
Marfan’s syndrome (MS) and preserved LVEF.
Y.P. Mi, H. Abdul-Khaliq; Department of Pediatric Cardiology, Saarland
University Hospital, Homburg/Saar
OBJECTIVES:
In patients with MS, the myocardium might be involved in addition to
the well known morbidities in other organs. The aim of this study was,
therefore, to analyse the regional and global LV deformation using 2-dimensional
speckle tracking (2D-STE).
METHODS:
26 young patients with genetically confirmed diagnosis of MS(with a
mean age of 10.9 years) and 25 aged matched healthy children were studied.
Conventional and 2D-STE were performed. Aortic root was measured
at end-diastole at the standard location. The longitudinal strain (LS),
radial strain (RS) and circumferential strain (CS) were analysed using
2D-STE software from GE in apical 4-chamber view and short axis view.
In each view the LV is divided into 6 standard segments. For each segment
the peak deformation and the time interval from QRS onset to peak
regional strain was assessed.
RESULTS: All MS patients had normal EF (>50%), mild form of mitral
and aortic valve regurgitation. The diameter of sinus of valsava
was significantly enlarged among patients when compared to controls
(27.25±3.93mm vs 21.14±2.88mm, p=0.018), while that of the annulus,
supra-aortic ridge and proximal ascending aorta did not show a significant
difference. Patients had a significantly reduced LS strain of the IVS
(19.54±5.56% vs 23.81±2.63%, p=0.04) and global CS (16.41±1.74% vs
20.21±1.33%, p=0.013).
CONCLUSIONS: In children with MS the new speckle tracking echocardiography
detects abnormal regional contractility and deformation in the
LV, even in those presenting with normal conventional LVEF.
Quantitative Beurteilung der systolischen linkssventrikulären
Deformation mittels der neu entwickelten P28
3D speckle tracking Echokardiographie (3D-STE) bei
EMAH-Patienten mit korrigierter Fallot`scher Tetralogie (TOF).
M. Abd El Rahman , T. Rädle-Hurst, H. Abdul-Khaliq;
Klinik für Pädiatrische Kardiologie. Universitätsklinikum des Saarlandes,
Homburg/Saar
Einleitung: Ziel dieser Studie war die Beurteilung der systolischen
Deformation der linken Kammer (LV) bei jüngeren EMAH Patienten anhand
der 2D und der neuen 3D basierten Strain.
Material und Methoden: Bei 20 Patienten (mittleres Alter 21J) nach TOF-
Korrektur und 20 gesunden Personen desselben Alters wurde die LV
Deformation mit 2D-Strain und der neuen 3D-STE im Vierkammerblick
und in der kurzen Achse untersucht. Das Volumen des LV wurde in den
apikalen 4-Kammerblicken in Atemanhaltetechnik aufgenommen. Zum
Erwerb eines vollen Volumen-Datensatzes des LV wurden sechs Echtzeit-
Subvolumina über 6 Herzzyklen kombiniert. Die durchschnittliche zeitliche
Auflösung betrug 49 BPS. Der longitudinale (LS), zircumferentielle
(CS), und Flächen-Strain (FLS, berechnet aus dem LS und CS, wurde
von allen 16 LV-Segmenten mit einer 3D-STE Software erhoben (GE,
Echopac). Die LV-Auswurffraktion (LVEF) wurde volumetrisch anhand
der gleichen Datensätze errechnet.
Ergebnisse: Die Übereinstimmung des globalen LV Strains zwischen beiden
Methoden (Bland-Altman-Analyse) war beim LS mit einer signifikanten
Korrelation von (r=0,667, p=0,001) besser als beim CS (r=0,448,
p=0,032). Die Intraobserver-Variabilität für die globalen 3D-STE betrug
5%. Im Vergleich zur Kontrollgruppe war der mit 3D-STE bestimmte LS
(p=0,01), CS(p=0,046) und FLS(p=0,021) in der TOF-Gruppe reduziert.
Die aus der 3DE errechnete LVEF korrelierte am besten mit dem FLS
(r=0,758, p=0,0001).
Schlußfolgerung: Die 3D-STE scheint ein sensitives, reproduzierbares
Verfahren zu sein, um die regionale und globale systolische Funktion des
LV zu beurteilen.
The novel speckle tracking method reflects improvement
and remodelling of LV myocardial function rather the P27
conventional echo parameter after aortic valve repair in
pediatric patients. A prospective study in 32 pediatric patients.
Y.P. Mi (1), T. Rädle-Hurst (1), D. Aicher (2), H.J. Schäfers (3), H.
Abdul-Khaliq (3) ; Clinic for Pediatric Cardiology, Clinic for Thoracic
and Cardiovascular Surgery, Saarland University Hospital, Homburg/
Saar
Objectives: To evaluate regional and global left ventricular (LV) function
after aortic valve repair in children with congenital aortic valve disease.
Methods: 32 consecutive patients aged 1.96 years undergoing aortic
valve repair due to valve stenosis (AS group, n=21) or aortic regurgitation
(AR group, n=11) were studied over a follow-up time period of
12 months in regard to change and adaptation of myocardial function
using conventional and novel echocardiographic methods including twodimensional
(2D) strain echo. Conventional and 2D strain echo studies
were performed and analysed off-line using commercially available software
(EchoPac 6.1.0, GE).
Results: The peak aortic valve gradient decreased from 62.04±30.34
mmHg before surgery to 22.80±14.13 mmHg 2 weeks after surgery and
35.73±22.11 mmHg 12 months after surgery (p=0.01). The degree of AR
was decreased significantly to grade 0 in 20 children and grade I in 12. 2D
strain analysis demonstrated that the global peak strain, global systolic
strain rate and global early diastolic strain rate improved significantly for
all the patients during the study period after aortic valve repair (p
+3.00°). In 4 patients, LR changed in the opposite direction after HD. LR
abnormalities were not seen in controls (LR between -2.00° and +2.00°).
Controls showed the highest mean longitudinal strain (patients: − 19.75
± 1.81% vs controls: − 22.60 ± 3.00%, P < 0.0001). Longitudinal strain
decreased significantly after HD (preHD: − 19.75 ± 1.81% vs postHD:
− 17.41 ± 1.68%, P < 0.0001). Mechanical dyssynchrony was more pronounced
in patients (patients: 140.4 ± 90.0 msec vs controls: 106.4 ± 68.9
msec, P < 0.0001), and increased after HD (preHD: 93.1 ± 84.6 msec vs
postHD: 140.4 ± 90.0 msec, P = 0.003).
Conclusions: Patients with ESRF have LR abnormalities, impaired longitudinal
strain and more pronounced dyssynchrony. Preload reduction
acutely changed the direction of LR in 30% patients.