Clinica La Sagrada Familia, Instituto Medico ENERI, Buenos Aires, Argentina; Consejo Nacional de Investigaciones Cientificas y Tecnicas (CONICET), Argentina.
Fundación Hospitalaria Mother and Child Medical Center, Av. Crámer 4602. Capital Federal, Buenos Aires C1429AKL, Argentina.
J Pediatr Surg. 2022 Oct;57(10):319-324. doi: 10.1016/j.jpedsurg.2021.09.008. Epub 2021 Sep 17.
Systolic dysfunction in pectus excavatum (PEX) is usually very subtle and mainly focused on the right ventricle (RV), leading to normal or unremarkable cardiac imaging findings unless involving exercise stress.
We evaluated systolic function in PEX using longitudinal strain cardiac magnetic resonance (CMR), a validated parameter for the assessment of the systolic deformation of subendocardial fibers.
This prospective registry comprised consecutive patients with PEX who were referred to CMR to define treatment strategies or to establish surgical candidacy. We also included a control group of 15 healthy volunteers without chest wall abnormalities. Using dedicated software, we evaluated the endocardial global longitudinal strain (GLS) of both ventricles and the endocardial global circumferential strain (GCS) of the left ventricle (LV).
A total of 50 patients with PEX comprised the study population, with a mean age of 19.9 ± 8.0 years. The right ventricular ejection fraction (RVEF) of patients with PEX was significantly lower compared to the control group both at end-expiration (59.5 ± 6.8 vs. 64.7 ± 4.7%, p = 0.008) and end-inspiration (56.7 ± 7.2%, vs. 62.7 ± 4.4, p = 0.004); as well as the pulmonary stroke distance (12.6 ± 2.5, vs. 15.0 ± 2.0 cm, p = 0.001). The LV volumetric analysis revealed no differences between PEX and the control group (p > 0.05 for all) regardless of the respiratory cycle, with a mean expiratory LV ejection fraction (LVEF) of 61.4 ± 6.0%. In contrast, the GLS of the LV was significantly lower in PEX compared to controls (-21.2 ± 3.2 vs. -23.7 ± 3.0%, p = 0.010), whereas GCS was similar either at expiration (-28.5 ± 4.0%, vs. -29.5 ± 2.8, p = 0.38) or inspiration (-29.3 ± 4.1%, vs.-28.9 ± 2.3, p = 0.73).
In this study, we demonstrated that longitudinal strain analysis might enable the detection of very subtle left ventricular systolic function abnormalities in patients with PEX, that are commonly overlooked using the conventional assessment.
II.
鸡胸（pectus excavatum，PEX）患者的收缩功能障碍通常非常细微，主要集中在右心室（RV），导致心脏成像检查结果正常或无明显异常，除非涉及运动应激。
我们使用纵向应变心脏磁共振（CMR）评估 PEX 患者的收缩功能，这是一种评估心内膜下纤维收缩变形的验证参数。
这项前瞻性注册研究纳入了因治疗策略或手术候选资格而接受 CMR 检查的 PEX 连续患者，并纳入了 15 名无胸廓异常的健康志愿者作为对照组。使用专用软件评估了两个心室的心内膜整体纵向应变（GLS）和左心室（LV）的心内膜整体圆周应变（GCS）。
共纳入 50 例 PEX 患者，平均年龄 19.9±8.0 岁。与对照组相比，PEX 患者的右心室射血分数（RVEF）在呼气末（59.5±6.8%比 64.7±4.7%，p=0.008）和吸气末（56.7±7.2%比 62.7±4.4%，p=0.004）均显著降低，以及肺动脉射血距离（12.6±2.5cm 比 15.0±2.0cm，p=0.001）。LV 容积分析显示 PEX 与对照组之间无差异（所有呼吸周期 p>0.05），平均呼气末 LV 射血分数（LVEF）为 61.4±6.0%。相反，与对照组相比，PEX 患者的 LV 纵向应变明显降低（-21.2±3.2%比-23.7±3.0%，p=0.010），而在呼气末（-28.5±4.0%比-29.5±2.8%，p=0.38）或吸气末（-29.3±4.1%比-28.9±2.3%，p=0.73）时 GCS 相似。
在这项研究中，我们证明了纵向应变分析可能能够检测到 PEX 患者非常细微的左心室收缩功能异常，而这些异常通常会被常规评估所忽视。
II。
