Shedeed Soad A
Department of Pediatrics, Zagazig University Hospital, Zagazig University, Zagazig, Egypt.
Pediatr Cardiol. 2010 Oct;31(7):1008-15. doi: 10.1007/s00246-010-9753-2. Epub 2010 Aug 10.
Asthma is the most common cause of respiratory disability among children. Patients with severe bronchial asthma can experience cor pulmonale later in life, but little is known about the function of the right ventricle early in the disease. This study aimed to investigate the right ventricular function in children with bronchial asthma as detected by tissue Doppler echocardiography. This case-control study compared 60 asthmatic children ages 5 to 15 years between attacks (study group) with 60 apparently healthy children (control group). All the children were subjected to full history-taking, complete physical examination, measurement of peak expiratory flow rate (PEFR), chest x-ray, electrocardiography (ECG), echocardiographic examination, and both conventional and tissue Doppler study. The results of the tissue Doppler study examining the right ventricular diastolic function showed that peak E' velocity (10.08 ± 2.8 cm/s), peak A' velocity (5.7 ± 2.5 cm/s), E'/A' ratio (1.77 ± 0.58 m/s), and isovolumetric relaxation time (IVRT) of the lateral tricuspid annulus (138.9 ± 30.7 m/s) among the asthmatic patients differed significantly from those among the control subjects (12.4 ± 2.3, 7.8 ± 2.1 cm/s; 1.58 ± 0.32, and 91.1 ± 32.6 m/s, respectively). In addition, the E' velocity and IVRT of the lateral tricuspid annulus were significantly different among the mild, moderate, and severe cases (P < 0.001). It is concluded that although the clinical and conventional echocardiographic findings of the asthmatic children were apparently normal, the tissue Doppler echocardiographic study showed right ventricular dysfunction that is positively correlated with the severity of asthma. These findings signify the diagnostic value of tissue Doppler echocardiography for the early detection and monitoring of such deleterious effects among asthmatic patients.
哮喘是儿童呼吸功能障碍的最常见原因。重度支气管哮喘患者在后期可能会出现肺心病，但对于疾病早期右心室的功能了解甚少。本研究旨在通过组织多普勒超声心动图来研究支气管哮喘患儿的右心室功能。这项病例对照研究比较了60名5至15岁发作间期的哮喘儿童（研究组）和60名明显健康的儿童（对照组）。所有儿童均接受了全面的病史采集、完整的体格检查、呼气峰值流速（PEFR）测量、胸部X光检查、心电图（ECG）、超声心动图检查以及传统和组织多普勒研究。组织多普勒研究检查右心室舒张功能的结果显示，哮喘患者三尖瓣环侧壁的E'峰值速度（10.08±2.8 cm/s）、A'峰值速度（5.7±2.5 cm/s）、E'/A'比值（1.77±0.58 m/s）和等容舒张时间（IVRT）（138.9±30.7 m/s）与对照组（分别为12.4±2.3、7.8±2.1 cm/s；1.58±0.32和91.1±32.6 m/s）有显著差异。此外，三尖瓣环侧壁的E'速度和IVRT在轻度、中度和重度病例中也有显著差异（P<0.001）。研究得出结论，尽管哮喘儿童的临床和传统超声心动图检查结果看似正常，但组织多普勒超声心动图研究显示右心室功能障碍，且与哮喘严重程度呈正相关。这些发现表明组织多普勒超声心动图在哮喘患者中早期检测和监测此类有害影响具有诊断价值。
