Why the study?
Prognosis of DMD is linked to cardiac dysfunction, and the study aimed to evaluate whether LV dyssynchrony is detectable in DMD children with normal ejection fraction using 2D-STE.
Does two-dimensional speckle tracking echocardiography detect early left ventricular mechanical dyssynchrony in children with Duchenne muscular dystrophy and normal ejection fraction compared to healthy controls?
Does two-dimensional speckle tracking echocardiography detect early left ventricular mechanical dyssynchrony in children with Duchenne muscular dystrophy and normal ejection fraction compared to healthy controls?
Two-dimensional speckle tracking echocardiography can detect early left ventricular mechanical dyssynchrony in children with Duchenne muscular dystrophy before the onset of overt cardiomyopathy or LVEF decline.
May support 2D-STE for early LV dyssynchrony detection in DMD with preserved EF; leaves open prognostic value and clinical utility.
Purpose -Prognosis of Duchenne muscular dystrophy (DMD) is related to cardiac dysfunction. Two dimensional-speckle tracking echocardiography (2D-STE) has recently emerged as a non-invasive functional biomarker for early detection of DMD-related cardiomyopathy. This study aimed to determine, in DMD children, the existence of a left ventricle (LV) dyssynchrony using 2D-STE analysis. Methods -This prospective controlled study enrolled 25 boys with DMD (mean age 11.0±3.5 years) with normal LV ejection fraction and 50 age-matched controls. Three measures were performed to assess LV mechanical dyssynchrony: the opposing-wall delays (longitudinal and radial analyses), the modified Yu index, and the time-to-peak delays of each segment. Feasibility and reproducibility of 2D-STE dyssynchrony were evaluated. Results- All three mechanical dyssynchrony criteria were significantly higher in the DMD group than in healthy subjects: (1) opposing-wall delays in basal inferoseptal to basal anterolateral segments (61.4±45.3 msec vs. 18.3±50.4 msec, P<0.001, respectively) and in mid inferoseptal to mid anterolateral segments (58.6±35.3 msec vs. 42.4±36.4 msec, P<0.05, respectively), (2) modified Yu index (33.3±10.1 msec vs. 28.5±8.1 msec, P<0.05 , respectively), and (3) most of time-to-peak values, especially in basal and mid anterolateral segments. Feasibility was excellent and reliability was moderate to excellent, with ICC values ranging from 0.49 to 0.97. Conclusion -Detection of LV mechanical dyssynchrony using 2D-STE analysis is an easily and reproducible method in pediatrics. The existence of an early LV mechanical dyssynchrony visualized using 2D-STE analysis in children with DMD before the onset of cardiomyopathy represents a perspective for future pediatric drug trials in the DMD-related cardiomyopathy prevention. Clinical Trial Registration - Clinicaltrials.gov NCT02418338. Post-hoc study, registered on April 16, 2015.
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Lanot et al. (2021) studied this question.
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