Abnormal Two-Dimensional Strain Echocardiography Findings in Children with Congenital Valvar Aortic Stenosis

Zusammenfassung

Ziel: Die angeborene valvuläre Aortenstenose (VAS) verursacht eine linksventikuläre Drucküberlastung. Klinisch wird der Schweregrad der Stenose durch den Druckabfall in der verengten Klappe eingeteilt (Druckgradient). Dieser Marker ist vom hämodynamischen Zustand abhängig und gibt keinen Hinweis auf die Leistung des Myokards. Diese Studie wurde durchgeführt, um die Möglichkeiten der zweidimensionalen Strain-Echokardiografie (2DSTE) zur Entdeckung von Veränderungen der myokardialen Funktion bei Kindern mit angeborener VAS zu untersuchen. Material und Methoden: Insgesamt wurden 86 Patienten (ab Geburt bis zu einem Alter von 18 Jahren) mit isolierter angeborener VAS verschiedenen Schweregrads in diese Studie aufgenommen. Bei keinem der Patienten wurde irgendeine Art von chirurgischer oder Ballon-Intervention durchgeführt. Als Kontrollgruppe dienten 139 gesunde Kinder. Zweidimensionale Cine-loop-Aufnahmen der apikalen Vierkammer, der mittelhöhligen Kurzachsen- und der basalen Kurzachsen-Blicke wurden für die Offline-Analyse digital gespeichert. Sowohl der maximale systolische Längs-, Umfangs- und Radial-Strain, die maximale Strain-Rate-Werte als auch die Zeit bis zum maximalen systolischen Strain (T2P) wurden ermittelt. Mittels 2-facher Varianzanalyse wurde das Verhältnis von VAS-Schweregrad zu 2DSTE-Parametern ermittelt. Ergebnisse: Keiner der Patienten mit normalen echokardiografischen Befunden zeigte eine linksventikuläre systolische Dysfunktion. Alle Strain-Parameter in der Kontrollgruppe unterschieden sich signifikant von denen der VAS-Patienten. Es zeigte sich eine statistisch signifikante umgekehrte Relation zwischen den globalen systolischen Spitzen-Strain-Parametern in alle 3 Richtungen und dem Ausmaß der VAS (p < 0,05). Der lokale maximale systolische Strain im interventrikulären Septum war am meisten betroffen. T 2P zeigte einen signifikanten Anstieg in Zusammenhang mit der Schwere der VAS (p < 0,05). Der Abfall der LV längssystolischen Leistung ging der in anderen Richtungen voraus. Schlussfolgerung: Die 2DSTE ermöglicht die Diagnose von Veränderungen der Myokard-Funktion bei Kindern mit angeborener VAS, bei denen herkömmliche echografische Untersuchungen keinen Hinweis auf eine ventrikuläre systolische Dysfunktion ergeben haben.

Abstract

Purpose: Congenital valvar aortic stenosis (VAS) causes a pressure overload to the left ventricle. In the clinical setting, the severity of stenosis is graded by the pressure drop over the stenotic valve (pressure gradient). This parameter is dependent on the hemodynamic status and does not provide information regarding myocardial performance. This study was undertaken to reveal the potential of two-dimensional strain echocardiography (2DSTE) for the detection of myocardial functional changes due to congenital VAS in children. Materials and Methods: A total of 86 patients (aged from birth to 18 years) with various degrees of isolated congenital VAS were enrolled in this study. None of the patients had undergone any form of surgical or balloon intervention. 139 healthy children served as a control group. Two-dimensional cine-loop recordings of apical 4-chamber, mid-cavity short-axis and basal short-axis views were digitally stored for off-line analysis. Longitudinal, circumferential and radial peak systolic strain and strain rate values were determined as well as the time to peak systolic strain (T2P). Two-way analysis of variance was performed to assess the relationship between VAS severity and 2DSTE parameters. Results: In all patients conventional echocardiographic findings did not indicate systolic left ventricular dysfunction. All strain parameters of the control group were significantly different from those of VAS patients. There was a statistically significant, inverse relationship between global peak systolic strain parameters in all three directions and the degree of VAS (p < 0.05). Local peak systolic strain (rate) in the interventricular septum was most affected. T 2P increased significantly with VAS severity (p < 0.05). The decline in LV longitudinal systolic performance preceded that in other directions. Conclusion: 2DSTE detects alterations in myocardial function in children diagnosed with congenital VAS, whose conventional echocardiographic findings did not indicate ventricular systolic dysfunction.

Key words

child - echocardiography - ultrasound 2D - valvar aortic stenosis - two-dimensional strain echocardiography

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