Hope Kyle D, Calderón Anyosa Renzo José Carlos, Wang Yan, Montero Andrea E, Sato Tomoyuki, Hanna Brian D, Banerjee Anirban
Division of Cardiology, The Children's Hospital of Philadelphia, The Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA.
Pulm Circ. 2018 Jan-Mar;8(1):2045893218754852. doi: 10.1177/2045893218754852. Epub 2018 Jan 8.
Right atrial (RA) mechanics have been studied infrequently in children in the past due to technical constraints. With the advent of strain imaging, RA physiology can now be studied in greater detail. The principal aim of this study was to describe functional changes in right heart mechanics of children with idiopathic pulmonary arterial hypertension (PAH), by using new applications of RA strain. In this retrospective study, we evaluated RA mechanics of 20 patients (age range = 3-23 years) with PAH and 18 control patients. RA longitudinal strain (RALS) and longitudinal displacement (LD) were calculated by speckle-tracking echocardiography. RALS was plotted against LD, producing a characteristic strain-displacement (S-D) loop. Standard indices of right heart function and right heart catheterization data were obtained. Patients were clinically subdivided into "compensated" and "decompensated" PAH. A chart review was performed to identify patients who subsequently developed adverse outcomes, including death, awaiting or received lung and/or heart transplantation. RALS was significantly lower in decompensated PAH compared with both controls and compensated PAH. Area enclosed by S-D loops differed significantly between the compensated and decompensated PAH subgroups (5.33 [3.90-9.44] versus 1.83 [1.17-2.36], P < 0.05). S-D loop area and RALS possessed high sensitivity and specificity compared to other parameters for identifying children with PAH who subsequently developed adverse outcomes. In particular, their sensitivities and specificities were greatly superior compared to those of tricuspid annular plane systolic excursion (TAPSE). RALS may represent a useful metric for assessing right ventricular (RV) dysfunction. S-D loops, composed over an entire cardiac cycle, may present useful, composite information regarding both systolic and diastolic right heart function. RA mechanics may serve as useful tools for identifying patients with more severe PAH, who are at risk for future adverse outcomes associated with RV failure.
由于技术限制，过去对儿童右心房（RA）力学的研究较少。随着应变成像技术的出现，现在可以更详细地研究RA生理学。本研究的主要目的是通过使用RA应变的新应用来描述特发性肺动脉高压（PAH）患儿右心力学的功能变化。在这项回顾性研究中，我们评估了20例PAH患儿（年龄范围3 - 23岁）和18例对照患者的RA力学。通过斑点追踪超声心动图计算RA纵向应变（RALS）和纵向位移（LD）。将RALS与LD绘制在一起，生成特征性的应变 - 位移（S - D）环。获取右心功能的标准指标和右心导管检查数据。患者在临床上分为“代偿性”和“失代偿性”PAH。进行图表回顾以确定随后出现不良结局的患者，包括死亡、等待或接受肺和/或心脏移植。与对照组和代偿性PAH相比，失代偿性PAH的RALS显著降低。代偿性和失代偿性PAH亚组之间S - D环所包围的面积差异显著（5.33 [3.90 - 9.44]对1.83 [1.17 - 2.36]，P < 0.05）。与其他用于识别随后出现不良结局的PAH患儿的参数相比，S - D环面积和RALS具有高敏感性和特异性。特别是，它们的敏感性和特异性比三尖瓣环平面收缩期位移（TAPSE）的敏感性和特异性要高得多。RALS可能是评估右心室（RV）功能障碍的有用指标。在整个心动周期中组成的S - D环可能提供有关右心收缩和舒张功能的有用的综合信息。RA力学可能是识别患有更严重PAH且有未来与RV衰竭相关不良结局风险的患者的有用工具。
