Center for Congenital Heart Defects, Heart and Diabetes Center Bad Oeynhausen, Ruhr-University Bochum, Bad Oeynhausen, Germany.
Institute of Radiology, Nuclear Medicine and Molecular Imaging, Heart and Diabetes Center Bad Oeynhausen, Ruhr-University Bochum, Bad Oeynhausen, Germany.
J Am Soc Echocardiogr. 2018 Jan;31(1):105-112.e2. doi: 10.1016/j.echo.2017.09.011. Epub 2017 Nov 20.
The generation of velocity-time integrals (VTIs) from Doppler signals is an essential component of standard echocardiographic investigations. The most effective algorithm to compensate for growth in children has, however, not yet been identified. This study was initiated to establish pediatric reference values for VTI and to enhance the interpretability of those values, considering technical and physiological factors.
The echocardiographic data sets of healthy children and adolescents (N = 349; age range, 0-20 years) were recorded in a prospective approach and subsequently analyzed. In a pilot study, aortic and pulmonary VTIs were set in relation to the physiologic parameters of heart size as possible influencing parameters in a subgroup of children with comparable physical characteristics. The ratio with the smallest SD was taken as the base to generate centile curves using the LMS method. The clinical utility of the model was tested by examining patients (n = 80) with shunt lesions such as patent ductus arteriosus and atrial septal defect.
Feasibility was 94.6% for aortic VTI and 92.8% for pulmonary VTI. The pilot study identified ventricular length and heart rate as suitable parameters with the lowest relative SDs and high correlations with VTI. Gender differences were not relevant for children <7 years of age, and with increasing age, SD increased because of higher stroke volume variations. The detection of increased aortic VTI was possible with sensitivity of 73% for patients with patent ductus arteriosus with moderate or large hemodynamically significant ductus arteriosus. Patients with atrial septal defects with enlarged right ventricles could be identified as having increased pulmonary VTI with sensitivity of 84%.
These new reference values for VTI times heart rate as a function of ventricular length may be of specific clinical value to improve the assessment of cardiac function, therapeutic decision making, and follow-up in pediatric patients with heart disease.
从多普勒信号生成速度-时间积分（VTI）是标准超声心动图检查的重要组成部分。然而，尚未确定补偿儿童生长的最有效算法。本研究旨在建立儿科 VTI 的参考值，并考虑技术和生理因素提高这些值的可解释性。
采用前瞻性方法记录健康儿童和青少年（N=349；年龄范围 0-20 岁）的超声心动图数据集，随后进行分析。在一项初步研究中，将主动脉和肺动脉 VTI 与心脏大小的生理参数相关联，作为具有相似身体特征的儿童亚组中的可能影响参数。选择具有最小标准偏差（SD）的比值作为基础，使用 LMS 方法生成百分位数曲线。通过检查具有分流病变（如动脉导管未闭和房间隔缺损）的患者（n=80）来测试该模型的临床实用性。
主动脉 VTI 的可行性为 94.6%，肺动脉 VTI 的可行性为 92.8%。初步研究确定心室长度和心率是最合适的参数，具有最低的相对 SD 和与 VTI 的高度相关性。对于<7 岁的儿童，性别差异并不重要，随着年龄的增长，由于较高的每搏量变化，SD 会增加。对于中度或大分流的动脉导管未闭患者，检测到增加的主动脉 VTI 的敏感性为 73%。对于右心室增大的房间隔缺损患者，检测到增加的肺动脉 VTI 的敏感性为 84%。
这些新的 VTI 参考值是心室长度的函数，与心率相关，可能对改善儿科心脏病患者的心脏功能评估、治疗决策和随访具有特定的临床价值。
