Sørensen Kristian, Fadnes Solveig, Mawad Wadi, Henry Matthew, Flade Hans Martin, Østvik Andreas, Myklebust Tor Åge, Kirkeby-Garstad Idar, Løvstakken Lasse, Mertens Luc, Nyrnes Siri Ann
Department of Circulation and Medical Imaging, Norwegian University of Science and Technology (NTNU), Trondheim, Norway, Postboks 8905, 7491 Trondheim, Norway.
Division of Ålesund Hospital, Department of Paediatrics, Møre og Romsdal Hospital Trust, Ålesund Sykehus, 6017 Ålesund, Norway.
Eur Heart J Cardiovasc Imaging. 2025 Jul 31;26(8):1346-1357. doi: 10.1093/ehjci/jeaf149.
Ventricular relaxation creates an intraventricular pressure difference (IVPD) and resultant diastolic suction. Non-invasive estimation by echocardiographic techniques would allow to clinically evaluate IVPD as an important component of diastolic functional assessment. The aims of the current study were to evaluate the accuracy of IVPD estimation based on Blood Speckle Tracking (BST) echocardiography compared with invasive pressure measurements and to clinically apply the method in children with univentricular hearts (UVH) and controls.
The accuracy of BST-based IVPD-estimates was assessed in an open-chest porcine model, comparing BST-based IVPD with simultaneous repeated invasive pressure measurements in six pigs using micromanometer catheters. BST-based IVPD assessment during early diastolic filling was performed in 83 healthy controls and 44 patients with UVH and compared between the groups. The validation in pigs included 103 measurements, demonstrating a mean difference of -0.01 mmHg (P = 0.33) and high correlation (r = 0.95, P value < 0.001) between IVPD from BST (-1.31 ± 0.28 mmHg) and invasive measurements (-1.30 ± 0.31 mmHg). In the paediatric patients, age range 6 months-17.76 years, feasibility was 93.9% in controls and 88.6% in UVH patients. Median IVPD was significantly higher in controls compared with UVH (-1.82 vs. -0.88 mmHg, P < 0.001). Intraclass correlation coefficients for variability of clinical BST-data were 0.99 (interobserver) and 0.98 (intraobserver) respectively.
BST echocardiography provides accurate estimation of IVPD in early diastole. IVPD was significantly lower in children with UVH compared with controls suggesting lower diastolic suction, which can impact overall filling dynamics.
心室舒张产生心室内压力差（IVPD）及由此产生的舒张期抽吸作用。通过超声心动图技术进行无创评估将有助于临床评估IVPD，其作为舒张功能评估的一个重要组成部分。本研究的目的是评估基于血斑追踪（BST）超声心动图的IVPD估计值与有创压力测量相比的准确性，并在单心室心脏（UVH）患儿及对照组中临床应用该方法。
在开胸猪模型中评估基于BST的IVPD估计值的准确性，使用微测压导管对6头猪同时进行重复有创压力测量，并将基于BST的IVPD与之进行比较。对83名健康对照者和44例UVH患者在舒张早期充盈期进行基于BST的IVPD评估，并在两组之间进行比较。在猪身上的验证包括103次测量，结果显示基于BST的IVPD（-1.31±0.28 mmHg）与有创测量的IVPD（-1.30±0.31 mmHg）之间的平均差值为-0.01 mmHg（P = 0.33），且具有高度相关性（r = 0.95，P值<0.001）。在儿科患者中，年龄范围为6个月至17.76岁，对照组的可行性为93.9%，UVH患者为88.6%。与UVH患者相比，对照组的IVPD中位数显著更高（-1.82对-0.88 mmHg，P < 0.001）。临床BST数据变异性的组内相关系数分别为0.99（观察者间）和0.98（观察者内）。
BST超声心动图可准确估计舒张早期的IVPD。与对照组相比，UVH患儿的IVPD显著更低，提示舒张期抽吸作用更低，这可能会影响整体充盈动力学。
