Relation between Vascular Endothelial Markers and Right Ventricular Function in the Children with Asthma

Abstract

Objectives: The aim of the study was to evaluate the possible relationship of clinical severity during asthmatic exacerbation with the ventricular functions and the levels of vascular endothelial-related biomarkers endothelin-1 (ET-1) and platelet-derived growth factor-BB (PDGF-BB) in the condensed breathing air in the children with asthma. Methods: The study included a total of 80 children with acute asthmatic episode; of these, 28 had a mild, 26 had a moderate, and 26 had a severe attack. Samples of condensed breathing air were obtained for being analyzed for ET-1 and PDGF-BB levels during the study. All patients were evaluated by echocardiography at the beginning of the study and two weeks after the treatment of asthmatic episode. Results: Before treatment, mPAP in moderate and severe asthma groups was significantly higher than in mild asthma group (21.6 ± 7.3, 30.1 ± 9.8 and 32.7 ± 7.8; P < 0.01, P < 0.001, respectively). After treatment, no significant difference was detected between the asthma groups (P > 0.05). Am and Em waves, and IVRT, IVCT, ET and RV MPI during the asthmatic attack and after treatment did not change significantly between the groups; pre-and post-treatment values of these parameters also did not show significant differences. In exhaled air samples of the group with severe asthma exacerbation ET-1 and PDGF-BB were higher than those in the moderate and mild group (0.80 ± 0.42, 0.58 ± 0.30, 0.50 ± 0.15; P = 0.002 and 281.7 ± 253.2, 167.3 ± 148.1, 135.9 ± 74.9; P = 0.008 respectively). Conclusions: Our study results showed that mPAP in direct proportion with the increased inflammatory cytokines was significantly higher in asthma attacks and levels of ET-1 and PDGF-BB were significantly increased with severity of asthma, indicating a vascular response.

Evaluation of cardiac function in pediatric patients with mild to moderate bronchial asthma in the era of cardiac strain imaging

“…In the present study, preservation of RV systolic function was confirmed by the use of the 2D STE derived RV strain which did not differ significantly between patients and controls. Preservation of RV systolic function was among the parameters reported by previous studies in asthmatic patients . In contrast to our study, Shedeed reported RV systolic dysfunction in asthmatic patients .…”

“…Preservation of RV systolic function was among the parameters reported by previous studies in asthmatic patients. [23][24][25][26] In contrast to our study, Shedeed reported RV systolic dysfunction in asthmatic patients. 28 The discrepancy in the results regarding RV function may be again attributed to differences in the severity and duration of asthma among the studied populations.…”

“…Data regarding the right ventricular dimensions among asthmatic patients varies greatly in the literature. [23][24][25][26][27][28] In our cohort, patients had a greater degree of RV dilatation rather than of hypertrophy, when compared with the controls (Table 2), this may be due to the associated increase of PVR in these patients. Elevation of PVR which is frequently observed in patients with bronchial asthma may also lead to RV hypertrophy.…”

Ventricular Function and Pulmonary Artery Pressure in Children with Mild and Moderate Bronchial Asthma

“…While we can explain diastolic dysfunction in moderate asthma group by pulmonary hypertension, diastolic dysfunction in mild asthma group may be due to cardiac stress during asthma exacerbations resulting from acute increase in pulmonary artery pressure and the concomitant inflammatory response. Released cytokines in such situation was reported as a direct cause of myocardial impairment [27,28] .…”