Left Ventricular Myocardial Function in Children With Pulmonary Hypertension. (August 2015)

• Record Type: Journal Article
• Authors: Burkett, Dale A.; Slorach, Cameron; Patel, Sonali S.; Redington, Andrew N.; Ivy, D. Dunbar; Mertens, Luc; Younoszai, Adel K.; Friedberg, Mark K.
• Is Part Of: Circulation. Volume 8:Number 8(2015)
• Publication Date: 2015-08
• Subjects: Cardiovascular system -- Imaging -- Periodicals; Heart -- Imaging -- Periodicals; 616.1075405
• DOI: 10.1161/CIRCIMAGING.115.003260
• Languages: English
• ISSNs: 1941-9651

Abstract

<abstract> <title> <x xml:space="preserve">Abstract</x> </title> <sec> <title>Background—</title> <p>Through ventricular interdependence, pulmonary hypertension (PH) induces left ventricular (LV) dysfunction. We hypothesized that LV strain/strain rate, surrogate measures of myocardial contractility, are reduced in pediatric PH and relate to invasive hemodynamics, right ventricular strain, and functional measures of PH.</p> </sec> <sec> <title>Methods and Results—</title> <p>At 2 institutions, echocardiography was prospectively performed in 54 pediatric PH patients during cardiac catheterization, and in 54 matched controls. Patients with PH had reduced LV global longitudinal strain (LS; −18.8 [−17.3 to −20.4]% versus −20.2 [−19.0 to −20.9]%; <italic>P</italic>=0.0046) predominantly because of reduced basal (−12.9 [−10.8 to −16.3]% versus −17.9 [−14.5 to −20.7]%; <italic>P</italic><0.0001) and mid (−17.5 [−15.5 to −19.0]% versus −21.1 [−19.1 to −23.0]%; <italic>P</italic><0.0001) septal strain. Basal global circumferential strain was reduced (−18.7 [−15.7 to −22.1]% versus −20.6 [−19.0 to −22.5]%; <italic>P</italic>=0.0098), as were septal and free-wall segments. Mid circumferential strain was reduced within the free-wall. Strain rates were reduced in similar patterns. Basal septum LS, the combined average LS of basal and mid interventricular septal segments, correlated strongly with degree of PH (<italic>r</italic>=0.66; <italic>P</italic><0.0001), pulmonary vascular resistance (<italic>r</italic>=0.60; <italic>P</italic><0.0001), and right ventricular free-wall LS (<italic>r</italic>=0.64; <italic>P</italic><0.0001). Brain natriuretic peptide levels correlated moderately with septal LS (<italic>r</italic>=0.48; <italic>P</italic>=0.0038). PH functional class correlated moderately with LV free-wall LS (<italic>r</italic>=−0.48; <italic>P</italic>=0.0051). The septum, shared between ventricles and affected by septal shift, was the most affected LV region in PH.</p> </sec> <sec> <title>Conclusions—</title> <p>Pediatric PH patients demonstrate reduced LV strain/strain rate, predominantly within the septum, with relationships to invasive hemodynamics, right ventricular strain, and functional PH measures.</p> </sec> </abstract>