Mechanical Dyssynchrony and Abnormal Regional Strain Promote Erroneous Measurement of Systolic Function in Pediatric Heart Transplantation

Anitha Parthiban, Ling Li, Steven J. Kindel, Girish Shirali, Barbara Roessner, Jennifer Marshall, Andreas Schuster, Berthold Klas, David Alan Danford, Shelby Kutty

Research output: Contribution to journalArticle

3 Citations (Scopus)

Abstract

Background Clinical experience suggests that measurement of left ventricular (LV) ejection fraction (EF) using two-dimensional echocardiography (2DE) is often at variance with results of three-dimensional echocardiography (3DE) in patients who have undergone heart transplantation (HT). The aim of this study was to test the hypothesis that LV mechanical dyssynchrony and abnormal regional strain are present in asymptomatic pediatric HT patients and that they promote errors in the measurement of LV function when 2DE is used. Methods HT subjects and normal volunteer children were prospectively enrolled. All had normal estimated right ventricular systolic pressure and function. LV EF, global and regional strain, and systolic dyssynchrony index (SDI) were quantified using real time 3DE. SDI was determined from volume-time curves of the 16 LV segments and expressed as the standard deviation of the heart rate-corrected time to reach minimal segmental systolic volume. Septal strain was defined as the average of five segments in the interventricular septum. In addition to 3DE, the Teichholz, biplane Simpson, and bullet (5/6 area-length) methods were used to measure EF using 2DE in each subject. Ninety-three examinations were done: 40 in the 40 normal control subjects (mean age, 14.6 ± 10.6 years; 10 male) and 53 in 36 HT subjects (mean age, 10.3 ± 6.2 years; 21 male). Results SDI was greater in HT patients (mean, 6.2 ± 4.3%) than in normal controls (mean, 2.2 ± 1.1%) (P <.0001). Global and septal strain was lower in HT patients than in normal controls. EF divergence (absolute difference between two- and three-dimensional EFs) was greater in HT patients (mean, 3.8 ± 2.2%) than in normal controls (mean, 0.7 ± 0.5%) (P <.0001). EF divergence had a strong positive correlation with SDI (adjusted r 2 = 0.46, P <.001) and negative correlations with all measures of strain (range of adjusted r 2 values, 0.13-0.32). SDI had no particular relation to LV mass or to QRS duration. Conclusions Children after HT have abnormal LV mechanics characterized by greater dyssynchrony and lower strain. These features correlate with, and possibly contribute to differences between measurements by 2DE and 3DE. EF should be calculated using 3DE in this population and others with dyssynchrony and regional strain abnormalities.

Original languageEnglish (US)
Pages (from-to)1161-1170.e2
JournalJournal of the American Society of Echocardiography
Volume28
Issue number10
DOIs
StatePublished - Oct 1 2015

Fingerprint

Heart Transplantation
Pediatrics
Stroke Volume
Three-Dimensional Echocardiography
Ventricular Function
Ventricular Pressure
Mechanics
Left Ventricular Function
Echocardiography
Healthy Volunteers
Heart Rate
Blood Pressure
Population

Keywords

  • Dyssynchrony
  • Heart transplantation
  • Left ventricular function
  • Pediatric
  • Strain
  • Three-dimensional echocardiography

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine

Cite this

Mechanical Dyssynchrony and Abnormal Regional Strain Promote Erroneous Measurement of Systolic Function in Pediatric Heart Transplantation. / Parthiban, Anitha; Li, Ling; Kindel, Steven J.; Shirali, Girish; Roessner, Barbara; Marshall, Jennifer; Schuster, Andreas; Klas, Berthold; Danford, David Alan; Kutty, Shelby.

In: Journal of the American Society of Echocardiography, Vol. 28, No. 10, 01.10.2015, p. 1161-1170.e2.

Research output: Contribution to journalArticle

Parthiban, Anitha ; Li, Ling ; Kindel, Steven J. ; Shirali, Girish ; Roessner, Barbara ; Marshall, Jennifer ; Schuster, Andreas ; Klas, Berthold ; Danford, David Alan ; Kutty, Shelby. / Mechanical Dyssynchrony and Abnormal Regional Strain Promote Erroneous Measurement of Systolic Function in Pediatric Heart Transplantation. In: Journal of the American Society of Echocardiography. 2015 ; Vol. 28, No. 10. pp. 1161-1170.e2.
@article{ab047faf87f9435f93534d717298163e,
title = "Mechanical Dyssynchrony and Abnormal Regional Strain Promote Erroneous Measurement of Systolic Function in Pediatric Heart Transplantation",
abstract = "Background Clinical experience suggests that measurement of left ventricular (LV) ejection fraction (EF) using two-dimensional echocardiography (2DE) is often at variance with results of three-dimensional echocardiography (3DE) in patients who have undergone heart transplantation (HT). The aim of this study was to test the hypothesis that LV mechanical dyssynchrony and abnormal regional strain are present in asymptomatic pediatric HT patients and that they promote errors in the measurement of LV function when 2DE is used. Methods HT subjects and normal volunteer children were prospectively enrolled. All had normal estimated right ventricular systolic pressure and function. LV EF, global and regional strain, and systolic dyssynchrony index (SDI) were quantified using real time 3DE. SDI was determined from volume-time curves of the 16 LV segments and expressed as the standard deviation of the heart rate-corrected time to reach minimal segmental systolic volume. Septal strain was defined as the average of five segments in the interventricular septum. In addition to 3DE, the Teichholz, biplane Simpson, and bullet (5/6 area-length) methods were used to measure EF using 2DE in each subject. Ninety-three examinations were done: 40 in the 40 normal control subjects (mean age, 14.6 ± 10.6 years; 10 male) and 53 in 36 HT subjects (mean age, 10.3 ± 6.2 years; 21 male). Results SDI was greater in HT patients (mean, 6.2 ± 4.3{\%}) than in normal controls (mean, 2.2 ± 1.1{\%}) (P <.0001). Global and septal strain was lower in HT patients than in normal controls. EF divergence (absolute difference between two- and three-dimensional EFs) was greater in HT patients (mean, 3.8 ± 2.2{\%}) than in normal controls (mean, 0.7 ± 0.5{\%}) (P <.0001). EF divergence had a strong positive correlation with SDI (adjusted r 2 = 0.46, P <.001) and negative correlations with all measures of strain (range of adjusted r 2 values, 0.13-0.32). SDI had no particular relation to LV mass or to QRS duration. Conclusions Children after HT have abnormal LV mechanics characterized by greater dyssynchrony and lower strain. These features correlate with, and possibly contribute to differences between measurements by 2DE and 3DE. EF should be calculated using 3DE in this population and others with dyssynchrony and regional strain abnormalities.",
keywords = "Dyssynchrony, Heart transplantation, Left ventricular function, Pediatric, Strain, Three-dimensional echocardiography",
author = "Anitha Parthiban and Ling Li and Kindel, {Steven J.} and Girish Shirali and Barbara Roessner and Jennifer Marshall and Andreas Schuster and Berthold Klas and Danford, {David Alan} and Shelby Kutty",
year = "2015",
month = "10",
day = "1",
doi = "10.1016/j.echo.2015.05.013",
language = "English (US)",
volume = "28",
pages = "1161--1170.e2",
journal = "Journal of the American Society of Echocardiography",
issn = "0894-7317",
publisher = "Mosby Inc.",
number = "10",

}

TY - JOUR

T1 - Mechanical Dyssynchrony and Abnormal Regional Strain Promote Erroneous Measurement of Systolic Function in Pediatric Heart Transplantation

AU - Parthiban, Anitha

AU - Li, Ling

AU - Kindel, Steven J.

AU - Shirali, Girish

AU - Roessner, Barbara

AU - Marshall, Jennifer

AU - Schuster, Andreas

AU - Klas, Berthold

AU - Danford, David Alan

AU - Kutty, Shelby

PY - 2015/10/1

Y1 - 2015/10/1

N2 - Background Clinical experience suggests that measurement of left ventricular (LV) ejection fraction (EF) using two-dimensional echocardiography (2DE) is often at variance with results of three-dimensional echocardiography (3DE) in patients who have undergone heart transplantation (HT). The aim of this study was to test the hypothesis that LV mechanical dyssynchrony and abnormal regional strain are present in asymptomatic pediatric HT patients and that they promote errors in the measurement of LV function when 2DE is used. Methods HT subjects and normal volunteer children were prospectively enrolled. All had normal estimated right ventricular systolic pressure and function. LV EF, global and regional strain, and systolic dyssynchrony index (SDI) were quantified using real time 3DE. SDI was determined from volume-time curves of the 16 LV segments and expressed as the standard deviation of the heart rate-corrected time to reach minimal segmental systolic volume. Septal strain was defined as the average of five segments in the interventricular septum. In addition to 3DE, the Teichholz, biplane Simpson, and bullet (5/6 area-length) methods were used to measure EF using 2DE in each subject. Ninety-three examinations were done: 40 in the 40 normal control subjects (mean age, 14.6 ± 10.6 years; 10 male) and 53 in 36 HT subjects (mean age, 10.3 ± 6.2 years; 21 male). Results SDI was greater in HT patients (mean, 6.2 ± 4.3%) than in normal controls (mean, 2.2 ± 1.1%) (P <.0001). Global and septal strain was lower in HT patients than in normal controls. EF divergence (absolute difference between two- and three-dimensional EFs) was greater in HT patients (mean, 3.8 ± 2.2%) than in normal controls (mean, 0.7 ± 0.5%) (P <.0001). EF divergence had a strong positive correlation with SDI (adjusted r 2 = 0.46, P <.001) and negative correlations with all measures of strain (range of adjusted r 2 values, 0.13-0.32). SDI had no particular relation to LV mass or to QRS duration. Conclusions Children after HT have abnormal LV mechanics characterized by greater dyssynchrony and lower strain. These features correlate with, and possibly contribute to differences between measurements by 2DE and 3DE. EF should be calculated using 3DE in this population and others with dyssynchrony and regional strain abnormalities.

AB - Background Clinical experience suggests that measurement of left ventricular (LV) ejection fraction (EF) using two-dimensional echocardiography (2DE) is often at variance with results of three-dimensional echocardiography (3DE) in patients who have undergone heart transplantation (HT). The aim of this study was to test the hypothesis that LV mechanical dyssynchrony and abnormal regional strain are present in asymptomatic pediatric HT patients and that they promote errors in the measurement of LV function when 2DE is used. Methods HT subjects and normal volunteer children were prospectively enrolled. All had normal estimated right ventricular systolic pressure and function. LV EF, global and regional strain, and systolic dyssynchrony index (SDI) were quantified using real time 3DE. SDI was determined from volume-time curves of the 16 LV segments and expressed as the standard deviation of the heart rate-corrected time to reach minimal segmental systolic volume. Septal strain was defined as the average of five segments in the interventricular septum. In addition to 3DE, the Teichholz, biplane Simpson, and bullet (5/6 area-length) methods were used to measure EF using 2DE in each subject. Ninety-three examinations were done: 40 in the 40 normal control subjects (mean age, 14.6 ± 10.6 years; 10 male) and 53 in 36 HT subjects (mean age, 10.3 ± 6.2 years; 21 male). Results SDI was greater in HT patients (mean, 6.2 ± 4.3%) than in normal controls (mean, 2.2 ± 1.1%) (P <.0001). Global and septal strain was lower in HT patients than in normal controls. EF divergence (absolute difference between two- and three-dimensional EFs) was greater in HT patients (mean, 3.8 ± 2.2%) than in normal controls (mean, 0.7 ± 0.5%) (P <.0001). EF divergence had a strong positive correlation with SDI (adjusted r 2 = 0.46, P <.001) and negative correlations with all measures of strain (range of adjusted r 2 values, 0.13-0.32). SDI had no particular relation to LV mass or to QRS duration. Conclusions Children after HT have abnormal LV mechanics characterized by greater dyssynchrony and lower strain. These features correlate with, and possibly contribute to differences between measurements by 2DE and 3DE. EF should be calculated using 3DE in this population and others with dyssynchrony and regional strain abnormalities.

KW - Dyssynchrony

KW - Heart transplantation

KW - Left ventricular function

KW - Pediatric

KW - Strain

KW - Three-dimensional echocardiography

UR - http://www.scopus.com/inward/record.url?scp=84944168350&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84944168350&partnerID=8YFLogxK

U2 - 10.1016/j.echo.2015.05.013

DO - 10.1016/j.echo.2015.05.013

M3 - Article

VL - 28

SP - 1161-1170.e2

JO - Journal of the American Society of Echocardiography

JF - Journal of the American Society of Echocardiography

SN - 0894-7317

IS - 10

ER -