AbdelMassih Antoine Fakhry, Emam Soha, Mabrouk Aliaa Ibrahim, AbdelHameed Manal
Department of Pediatrics, Pediatric Cardiology Division, Faculty of Medicine, Specialized Pediatric Hospital, Cairo University, Cairo University Children Hospital, Kasr Al Ainy Street, Cairo, 12411, Egypt.
Pediatrics' Master of Science training program, Faculty of Medicine, Cairo University Children Hospital, Cairo University, Cairo, Egypt.
BMC Cardiovasc Disord. 2025 Jul 21;25(1):532. doi: 10.1186/s12872-025-04984-2.
Dilated Cardiomyopathy (DCM) is an important cause of significant cardiac functional impairment in pediatric patients. There is to date debate on which echocardiographic variable correlates better with the functional status of the patient.
28 DCM patients (NYHA class II and III), and 30 controls were enrolled in the study, where advanced echocardiographic examination was used to assess LV (Left ventricular) function. Tissue Doppler, 2D speckle tracking for PSI (post-systolic strain index calculation), and blood speckle tracking for the timing of LV vortex formation were implemented.
Intriguingly, none of LV GLS and GAS (Global longitudinal and area strain), or EF (Ejection fraction, were able to differentiate NYHA II and III subgroups of cases. In contrast, PSI, and systolic vortex formation were significantly different between subgroups of cases; systolic vortex was seen in 33% of NYHA II patients compared to 77% of NYHA III patients, a PSI median value of 5% was seen in NYHA III cases, and a cut-off >4% was 92% sensitive in predicting worse manifestations.
Dyssynchrony; seems to play a significant role in orchestrating symptoms of heart failure. In this context, blood speckle tracking study seems a promising bedside method, in its assessment. A large room for improvement and systemization of its assessment is still needed to objectivize its use.
扩张型心肌病（DCM）是小儿患者心脏功能严重受损的重要原因。迄今为止，关于哪种超声心动图变量与患者功能状态的相关性更好仍存在争议。
本研究纳入了28例DCM患者（纽约心脏协会心功能分级II级和III级）和30例对照，采用先进的超声心动图检查评估左心室（LV）功能。实施了组织多普勒、用于计算收缩后应变指数（PSI）的二维斑点追踪以及用于左心室涡旋形成时间的血流斑点追踪。
有趣的是，左心室整体纵向应变（GLS）和整体面积应变（GAS）或射血分数（EF）均无法区分NYHA II级和III级病例亚组。相比之下，PSI和收缩期涡旋形成在病例亚组之间存在显著差异；NYHA II级患者中33%出现收缩期涡旋，而NYHA III级患者中这一比例为77%，NYHA III级病例的PSI中位数为5%，截断值>4%对预测更严重表现的敏感性为92%。
不同步似乎在协调心力衰竭症状方面发挥着重要作用。在这种情况下，血流斑点追踪研究在其评估中似乎是一种有前景的床边方法。仍需要大幅改进和规范其评估，以使其使用客观化。
