Gearhart Addison, Thatte Nikhil, Bassi Sunakshi, Sperotto Francesca, Nir Reuth, Gauvreau Kimberlee, Emani Sitaram, Rhodes Jonathan, Ghelani Sunil J
Department of Cardiology, Boston Children's Hospital, 300 Longwood Ave, Boston, MA, 02115, USA.
Department of Pediatrics, Harvard Medical School, Boston, MA, USA.
Pediatr Cardiol. 2024 Jul 24. doi: 10.1007/s00246-024-03584-9.
Mean dP/dt is a quantitative measurement of ventricular function that can be obtained noninvasively by echocardiography. In adults with mitral regurgitation (MR), it has been shown to be a more sensitive predictor of postoperative left ventricular ejection fraction (EF). The utility of dP/dt in pediatric congenital heart diseases with MR has been underexplored. Patients (0 to ≤ 19 years) with MR who underwent mitral valve (MV) repair or replacement from 2015 to 2021 were included. Echocardiographically derived mean dP/dt, Tei index, and EF were used to assess and compare ventricular function prior to, shortly after, and late after MV surgery. Study cohort included 61 patients (age 4.5 [IQR 0.14, 18.7] years, 89% MV repair, 11% MV replacement). Median time intervals between surgery and preoperative, early postoperative, and late postoperative echocardiograms were 6 days, 6 days, and 350 days, respectively. Median EF was 62% (z-score - 0.40) preoperatively, 56% (z-score - 1.40) early postoperatively, and 61% (z-score - 0.60) late postoperatively. Median dP/dt was 1393 (IQR 1029, 1775) mmHg/s preoperatively, 1178 (IQR 886, 1946) mmHg/s early postoperatively, and 1270 (IQR 791, 1765) mmHg/s late postoperatively. Preoperative median dP/dt correlated with early and late postoperative EF. Preoperative EF was not significantly correlated with early postoperative EF, but was correlated with late postoperative EF. Mitral valve intervention in pediatric patients is associated with an initial decline but subsequent recovery of systolic function. Non-invasively derived mean dP/dt may offer advantages over other preoperative echocardiographic indices to predict postoperative systolic function.
平均dp/dt是一种心室功能的定量测量指标，可通过超声心动图无创获得。在患有二尖瓣反流（MR）的成人中，它已被证明是术后左心室射血分数（EF）更敏感的预测指标。dp/dt在患有MR的小儿先天性心脏病中的应用尚未得到充分研究。纳入了2015年至2021年接受二尖瓣（MV）修复或置换的MR患者（0至≤19岁）。使用超声心动图得出的平均dp/dt、Tei指数和EF来评估和比较MV手术前、术后不久和术后晚期的心室功能。研究队列包括61例患者（年龄4.5[四分位间距0.14，18.7]岁，89%进行MV修复，11%进行MV置换）。手术与术前、术后早期和术后晚期超声心动图之间的中位时间间隔分别为6天、6天和350天。术前中位EF为62%（z评分-0.40），术后早期为56%（z评分-1.40），术后晚期为61%（z评分-0.60）。术前中位dp/dt与术后早期和晚期EF相关。术前EF与术后早期EF无显著相关性，但与术后晚期EF相关。小儿患者的二尖瓣干预与收缩功能最初下降但随后恢复有关。无创得出的平均dp/dt在预测术后收缩功能方面可能比其他术前超声心动图指标具有优势。
