Key result
Still's murmur linked to a ~15% lower ventriculo-arterial coupling ratio in healthy children versus controls.
Why the study?
Does ventriculo-arterial coupling differ between healthy children with Still's murmur and those without?
Case-Control (n=85)
No
Does ventriculo-arterial coupling differ between healthy children with Still's murmur and those without?
Still's murmur in healthy children is associated with a lower ventriculo-arterial coupling ratio, higher ejection fraction, and larger stroke volume, suggesting it is caused by a more active interplay between the heart and aorta.
Answers are grounded in this paper and cite their sources.
Still's murmur assessment unchanged in healthy children; hypothesis-generating for ventriculo-arterial coupling differences.
Still's murmur is the most common innocent heart murmur in children and considered flow related; however, so far the cause of the murmur has not yet been fully explained. Assessment of the hemodynamic ventriculo-arterial interaction and the proportional anatomical dimensions of the left ventricle and the aortic root were the objective for this study. This case-control study was conducted at the Division of Pediatric Cardiology, Vienna Medical University, including healthy children with and without Still's murmur. To assess ventriculo-arterial interaction, the model of ventriculo-arterial coupling (VAC) was applied. The model describes the interaction between the left ventricle (left ventricular contractility, ELV) and the arterial system (effective arterial elastance, EA) by the VAC ratio EA/ELV. The parameters EA and ELV can be derived from M-mode echocardiography thereby allowing a noninvasive pressure-volume analysis. Outcomes comprised VAC ratio and diameters of both the aortic root (AOD) and the left ventricle in end diastole (LVED) and end systole (LVES) as well as their relative proportions, ejection fraction (EF), stroke volume (SV), blood pressure (BP), and heart rate (HR). Forty-three healthy children with Still's murmur (mean age 5.2 years) and 42 healthy children without murmur (mean age 5.8 years) participated in this study. Children with Still's murmur had a significantly lower VAC ratio EA/ELV (0.5 ± 0.13 vs. 0.59 ± 0.15; P < 0.005), a significantly higher EF% (67.1 ± 5.8 vs. 63.3 ± 5.6; P < 0.005, P < 0.01), and a larger SV per kg bodyweight (1.84 ± 0.33 vs. 1.68 ± 0.38; P < 0.05) than controls. BP, HR, and diameters of AOD, LVED, and LVES as well as their relative anatomic proportions did not differ between children with Still's murmur and controls. Still's murmur seems to be generated by a subtle alteration in ventriculo-arterial coupling in healthy children. This result can be translated to parents, as they may be informed that their child's innocent murmur is caused by a more "lively interplay between the heart and the aorta."
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Engel et al. (2014) conducted a case-control in Still's murmur (n=85). Still's murmur vs. Healthy children without murmur was evaluated on Ventriculo-arterial coupling (VAC) ratio EA/ELV (p=<0.005). Still's murmur in healthy children was associated with a lower ventriculo-arterial coupling ratio compared to controls without a murmur.
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