Left Atrial Strain to Identify Diastolic Dysfunction in Children with Cardiomyopathies

Q: What are the key findings of this study?

2-D speckle-tracking left atrial peak systolic strain accurately distinguished children with cardiomyopathies from healthy controls and correlated with invasive LVEDP.

Q: What is the clinical evidence from this study?

Study design: Case-Control. Population: Pediatric dilated (DCM), hypertrophic (HCM), and restrictive (RCM) cardiomyopathies (n=136). Intervention: 2-dimensional speckle-tracking left atrial (LA) peak systolic strain and strain rate vs. Healthy controls and standard echo-Doppler diastolic parameters. Primary outcome: Diagnostic discrimination of pediatric cardiomyopathies (diastolic dysfunction) from healthy controls using ROC analysis of LA peak systolic strain (AUC 0.976, p=<0.001).

Q: What does this research mean for the field?

Two-dimensional speckle-tracking left atrial peak systolic strain and strain rate accurately identify and grade diastolic dysfunction in children with cardiomyopathies, distinguishing affected patients from healthy controls. Novelty: ClaimNovelty.NOVEL_FINDING. Consensus alignment: ConsensusAlignment.NEUTRAL.

Q: What question did this study set out to answer?

To evaluate whether two-dimensional left atrial strain and strain rate can identify and classify left ventricular diastolic dysfunction in children with dilated, hypertrophic, and restrictive cardiomyopathies.

Jolanda Sabatino; Giovanni Di Salvo; Costantina Prota; Valentina Bucciarelli; M Josen; Josefa Paredes; Nunzia Borrelli; Domenico Sirico; Sanjay Prasad; Alain Fraisse; Piers E.F. Daubeney

doi:10.3390/jcm8081243

August 17, 2019Journal of Clinical MedicineOpen Access

Left Atrial Strain to Identify Diastolic Dysfunction in Children with Cardiomyopathies

View Full Paper

Ask AI

Bookmark

Share

Key result

LA peak systolic strain accurately identifies pediatric cardiomyopathy with an AUC of ~0.98.

AUC 0.976
P<0.001
n=136

Figures

Why the study?

2-D LA strain accurately categorizes LV diastolic dysfunction in adults, but its role in diagnosing and classifying diastolic dysfunction in children with dilated, hypertrophic, and restrictive cardiomyopathies was unknown.

Does 2-dimensional speckle-tracking left atrial strain and strain rate accurately diagnose and classify diastolic dysfunction in children with dilated, hypertrophic, and restrictive cardiomyopathies compared to conventional echocardiography?

Key Points

To evaluate whether two-dimensional left atrial strain and strain rate can identify and classify left ventricular diastolic dysfunction in children with dilated, hypertrophic, and restrictive cardiomyopathies.
Retrospective evaluation of 136 children (mean age 8.8 ± 6 years): 44 with dilated cardiomyopathy (DCM), 40 with hypertrophic cardiomyopathy (HCM), 7 with restrictive cardiomyopathy (RCM), and 45 healthy controls (CTRL).
Participants underwent standard transthoracic echocardiography and two-dimensional speckle-tracking analyses performed by an experienced pediatric cardiologist blinded to clinical and standard Doppler data.
Conventional diastolic indices including mitral E/A and pulmonary venous S/D ratios showed no significant differences among the four groups, and while E/E' and indexed left atrial volume were significantly higher in CM groups versus CTRL (p < 0.001), they did not differ among CM subtypes.
Peak systolic left atrial strain and strain rate demonstrated a progressive decrease across groups with worsening diastolic dysfunction, yielding ROC area under the curve values of 0.976 (p < 0.001; sensitivity 98%, specificity 99% at cut-off ≥ 40.4%) and 0.946 (p < 0.001; sensitivity 88%, specificity 90% at cut-off ≥ 1.39 1/s), respectively, for distinguishing controls from cardiomyopathies.

Study Design

Type

Case-Control (n=136)

Blinding

Single-blind (2-D speckle-tracking echocardiographic analyses performed by a paediatric cardiologist blinded to clinical and standard echo Doppler data)

Multicenter

No

Structured PICO

Does 2-dimensional speckle-tracking left atrial strain and strain rate accurately diagnose and classify diastolic dysfunction in children with dilated, hypertrophic, and restrictive cardiomyopathies compared to conventional echocardiography?

P

Population

136 children (mean age 8.8 years, range 0-17) including 44 with dilated cardiomyopathy, 40 with hypertrophic cardiomyopathy, 7 with restrictive cardiomyopathy, and 45 healthy controls evaluated at a single UK center.

E

Exposure

2-dimensional speckle-tracking echocardiography (TomTec 2-D) assessment of left atrial (LA) peak systolic strain and strain rate, and left ventricular longitudinal peak systolic strain (LV LS) from apical four-chamber views.

C

Comparator

45 healthy controls (not on any medication, normal EKG, rest and exercise stress echocardiogram) and conventional echocardiographic Doppler diastolic parameters (mitral E/A ratio, mitral E deceleration time, E/E' ratio, pulmonary venous S/D ratio, indexed left atrial volume [LAVi], and peak tricuspid regurgitation gradient).

O

Outcome

Diagnostic accuracy (area under the ROC curve) of LA peak systolic strain and strain rate to distinguish pediatric cardiomyopathies (diastolic dysfunction) from healthy controls and to classify cardiomyopathy subtypes.surrogate

Main Result

Effect estimate: AUC 0.976

p-value: p=<0.001

Limitations

Single-center retrospective design
DCM group was relatively younger than the other cardiomyopathy groups and patients may have been at different time points in the disease process
Potential confounding from different durations of heart failure medications which could not be ethically stopped
Invasive LV filling pressures were only available in a small subset of 8 patients (9 studies)
Proposed cut-off values require confirmation in larger prospective studies
Single-center retrospective study
DCM group was relatively younger than other groups and patients may have been at different time points in the disease process
Heart failure medications were not stopped for ethical reasons and varying treatment durations may impact diastolic function assessment
Invasive LV filling pressures were only available in 8 patients (9 catheterization studies)
Diagnostic accuracy of proposed cut-off values requires validation in larger prospective studies

Ask about this paper

Answers are grounded in this paper and cite their sources.

Implication

2-D speckle-tracking left atrial strain and strain rate progressively decrease with worsening diastolic dysfunction and strongly correlate with invasive LV end-diastolic pressure in children, offering superior discrimination of pediatric cardiomyopathies compared to conventional echo-Doppler parameters.

Abstract

Background: Left ventricular (LV) diastolic dysfunction (DD) carries worse prognosis in childhood. 2-dimensional (2-D) left atrial (LA) strain accurately categorizes DD in adults but its role in children is unknown. Thus, the aim of this study is to investigate whether LA strain and strain rate could diagnose and classify DD in children with dilated (CMD), hypertrophic (HCM) and restrictive (RCM) cardiomyopathies (CM). Methods and Results: The study includes 136 children (aged 8.8 ± 6 years): 44 with DCM, 40 with HCM, 7 with RCM and 45 healthy controls (CTRL). They underwent standard echocardiographic examination and 2-D speckle-tracking analyses (LV longitudinal peak systolic strain (LS), LA peak systolic strain and strain rate). No significant differences in mitral E/A and pulmonary S/D ratios were observed among the four groups. Although E/E’ and indexed left atrial volumes were found to be significantly higher in HCM, DCM and RCM compared to CTRL (p < 0.001), they showed no significant difference among the three CM groups. LV LS values were significantly reduced in CM vs CTRL (p < 0.001) and in DCM vs HCM (p < 0.01), with no other differences between the remaining groups. LA peak systolic strain and strain rate values showed a steady and significant decrease with worsening of DD. Receiver Operating Characteristics (ROC) curves showed area under the curve of 0.976 (p < 0.001) for LA strain and 0.946 (p < 0.001) for LA strain rate, to distinguish CTRL from CMs. Conclusions: LA strain and strain rate could be a promising tool to better understand and classify DD in children with cardiomyopathies, opening the way to its clinical use.

Discussion

No takes yet. Share an insight, caveat, or question.

Cite This Study

Sabatino et al. (2019) conducted a case-control in Pediatric dilated (DCM), hypertrophic (HCM), and restrictive (RCM) cardiomyopathies (n=136). 2-dimensional speckle-tracking left atrial (LA) peak systolic strain and strain rate vs. Healthy controls and standard echo-Doppler diastolic parameters was evaluated on Diagnostic discrimination of pediatric cardiomyopathies (diastolic dysfunction) from healthy controls using ROC analysis of LA peak systolic strain (AUC 0.976, p=<0.001). 2-D speckle-tracking left atrial peak systolic strain accurately distinguished children with cardiomyopathies from healthy controls and correlated with invasive LVEDP.

synapsesocial.com/papers/6a92a99578b6d4c32c4f3447 https://doi.org/10.3390/jcm8081243

View Full Paper

Ask AI

Bookmark

Share

Left Atrial Strain to Identify Diastolic Dysfunction in Children with Cardiomyopathies

Figures

Key Points

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

Left Atrial Strain to Identify Diastolic Dysfunction in Children with Cardiomyopathies

Figures

Key Points

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

Keep reading

Keep reading