Reference values for two-dimensional myocardial strain echocardiography of the left ventricle in healthy children

Abstract

BackgroundMyocardial deformation by speckle tracking echocardiography provides additional information on left ventricular function. Values of myocardial deformation (strain and strain rate) depend on the type of ultrasound machine and software that is used. Normative values for QLAB (Philips) are scarce, especially for children. It is important to evaluate the influence of age and body size on myocardial deformation parameters, since anthropometrics strongly influence many standard echocardiographic parameters. The aim of this study was to provide comprehensive normal values for myocardial deformation of the left ventricle using a Philips platform and to evaluate the association with anthropometric and standard echocardiographic parameters.MethodsHealthy children between 1 and 18 years of age were prospectively examined using a standard echocardiographic protocol. Short-axis and apical four-chamber, two-chamber, and three-chamber views were used to measure peak systolic circumferential and longitudinal strain and systolic and early diastolic strain rate of the left ventricle using dedicated software.ResultsA total of 103 children were included with a mean age of 10.8 and inter-quartile range 7.3–14.3 years. Global circumferential strain values (±SD) were −24.2±3.5% at basal, −25.8±3.5% at papillary muscle, and −31.9±6.2% at apex levels. Global left ventricular longitudinal strain values were −20.6±2.6% in apical four-chamber view, −20.9±2.7% in apical two-chamber, and −21.0 ±2.7% in apical three-chamber. Age was associated with longitudinal strain, longitudinal systolic and early diastolic strain rate, but not with circumferential strain.ConclusionsNormal values for left ventricular deformation parameters in children are obtained using a Philips platform. Age partly explains normal variation of strain and strain rate.

Does chest wall conformation influence myocardial strain parameters in infants with pectus excavatum?

“…Main myocardial deformation parameters obtained in the two groups of infants in perinatal period are listed in Table 3. All the investigated indices were significantly impaired in PE infants in comparison to controls and to the normal infant reference ranges 21,22,25 . Nevertheless, the apex‐to‐base gradient of left ventricular regional strain 20,26,27 was preserved in both circumferential and radial directions in PE infants.…”

“…LV global longitudinal strain (GLS) was calculated as the average of the maximal systolic shortening obtained in each of the three apical views (four‐chamber, two‐chamber, and three‐chamber), whereas LV global circumferential strain (GCS) and LV global radial strain (GRS) were measured as the average of the maximal systolic shortening and of the maximal systolic thickening, respectively, obtained from basal, medial, and apical short‐axis views. For each of the LV‐GLS, GCS, and GRS, correspondent early peak diastolic strain rate was measured 20–22 . LV twist was defined as the difference between mean values of peak apical rotation and peak basal rotation 23 .…”

Challenges associated with retrospective analysis of left ventricular function using clinical echocardiograms from a multicenter research study

“…Specific recommendations for the use of strain and strain rate imaging exist for adult cancer patients but not for pediatric patients 9 . Clinical use of strain imaging in pediatric echo laboratories has lagged significantly behind that of adult echo laboratories 25,26 . It is only within the last decade that studies reporting normal values of strain in the pediatric population have emerged 26,27 .…”

LV‐GLS in congenital heart disease, time to go beyond ejection fraction

“…As a consequence, if the calculation of strain rate values and radial and circumferential strain and strain rate values still suffer from a significant variability between different echo machines, the LV‐GLS can now be part of a standard echocardiographic report. Despite age‐ and BSA‐specific normal values for LV‐GLS are now available, 6–8 a cut‐off value of −19% can be used as lower limit of normal values irrespectively of age and sex after the first year of age 8,9 …”