- Email: [email protected]
Echocardiographic right ventricular function reference values in pediatrics: Which is the best mathematical model to define Z-Scores?
52
03-Echocardiography and imaging
assessment in the clinical work-up of these patients could improve the evaluation of cardiovascular risk and may be helpful in the clinical-decision making process. Disclosure of interest The authors declare that they have no competing interest. https://doi.org/10.1016/j.acvdsp.2017.11.310 236
Clinical significance of right ventricular longitudinal function parameters after aortic valve replacement A. Coisne 1,2,∗ , T. Modine 3 , F. Outteryck 1 , S. Mouton 1 , R. Pilato 1 , H. Ridon 1 , M. Richardson 1 , A. Duva Pentiah 1 , B. Boutie 1 , M. Jacquelinet 1 , S. Ninni 1,2 , S. Ortmans 1 , M. Koussa 3 , P. Lancellotti 4 , D. Montaigne 1,2 1 Department of clinical physiology and echocardiography, heart valve clinic, Institut Cœur Poumon, CHRU de Lille, Lille, France 2 European genomic institute for diabetes (E.G.I.D), Inserm UMR 1011, Institut Pasteur de Lille, Lille university hospital, Lille, France 3 Department of cardiovascular surgery, CHRU de Lille, Lille, France 4 University of Liège hospital, GIGA cardiovascular sciences, departments of cardiology, heart valve clinic, CHU Sart Tilman, Liège, Belgium ∗ Corresponding author. E-mail address: [email protected] (A. Coisne) Background Parameters of longitudinal systolic function, i.e. tricuspid annular plane systolic excursion (TAPSE) and peak systolic velocity (PSV) of tricuspid annulus, are used to quantify RV function in daily practice. Changes in TAPSE and PSV after cardiac surgery have been described for many years with almost no data regarding their clinical significance. Purpose To test whether early postoperative decline in right ventricular (RV) longitudinal function is predictive of long-term outcomes after aortic valve replacement (AVR) in patients with severe aortic stenosis (AS). Methods Between January 2009 and December 2015, we prospectively explored all consecutive patients referred to our cardiovascular surgery department for AVR presenting with severe AS, normal left ventricular ejection fraction (> 50%) and TAPSE (> 14 mm). TAPSE and PSV were assessed 7 days after cardiac surgery for all patients and 1-year after AVR in a subgroup of 100 patients. Patients were followed for major events (ME), i.e. cardiovascular death, cardiac hospitalization, acute heart failure and stroke. Results Among a total of 752 patients, 135 patients presented poor acoustic window precluding reliable post-operative measurement of RV parameters. Six hundred and seventeen patients were followed-up for ME. TAPSE and PSV were severely decreased after surgery (P < 0.0001) with an incomplete but significant recovery 1-year after AVR. Longer cardio-pulmonary bypass duration was the only independent parameter associated with more important decrease in RV function after AVR. After a mean follow-up of 4 ± 2.3 years, no association was shown between early postoperative alteration in TAPSE and long-term prognosis (P = 0.21 by Log-rank test for trend for ME) (Fig. 1). Conclusion The early and severe postoperative decline in RV longitudinal function reverses within a year and is not predictive of long-term outcomes after AVR.
Fig. 1
Events-free survival according to TAPSE quartiles.
Disclosure of interest peting interest.
The authors declare that they have no com-
https://doi.org/10.1016/j.acvdsp.2017.11.311 423
Echocardiographic right ventricular function reference values in pediatrics: Which is the best mathematical model to define Z-Scores? P. Amedro 1,2,∗ , C. Bredy 1 , C. Soulatges 1 , S. Guillaumont 1 , M. Vincenti 1,2 , T. Mura 3 1 Cardiologie pédiatrique et congénitale, CHU de Montpellier, Montpellier cedex 5, France 2 UMR CNRS 9214, Inserm U1046, université de Montpellier, Montpellier, France 3 Épidémiologie, CHU de Montpellier, Montpellier, France ∗ Corresponding author. E-mail address: [email protected] (P. Amedro) Purpose The aim of our study was to determine the most appropriate mathematical model for right ventricular (RV) function normal values in children. Methods Normal children aged 0 to 18 years referred to the pediatric cardiology consultation were screened in this prospective cross-sectional study. Each RV parameters (S’, E’, A’ waves, TEI index, TAPSE) was modeled with four explanatory variables: age, size, weight and body surface area. Four different mathematical models were successively applied: a linear model, a polynomial model of degree 2, a linear regression model by spline with free knot, and a polynomial regression model of degree 2 by spline with a free knot. The choice of the best explanatory variable and the best modelization method was made on the basis of the model’s coefficient of determination (R2 ). Results We included 314 normal children aged 2 days to 18 years (46% female, 88 infants, 26 neonates, 226 children). The modelization of the RV variables over all ages did not follow a linear model, with the lowest coefficients of determination in the four explanatory variables. The quadratic spline model best adjusted the modelization of all RV variables. No model accurately explained the TEI index in any of the four explanatory variables. The S’ wave was best modelized by the quadratic spline model with the weight. The knot at 6.86 kg corresponded to the curves’ break. The E’ wave was best modelized by the quadratic spline model with the age. The knot at 0.29 years corresponded to the curve’s break. The A’ wave was
03-Echocardiography and imaging
53
best modelized by the quadratic model with the size. The knot at 81 cm corresponded to the break of the curve. The TAPSE was best modelized by the quadratic spline model with the weight (Fig. 1). The knot at 9.04 kg corresponded to the curve’s break (Fig. 1). Conclusion The quadratic spline model best applies to echocardiographic RV reference values in pediatrics.
Fig. 1 Disclosure of interest peting interest.
The authors declare that they have no comFig. 1 Relation between measured and predicted mPAP: insufficient predictive power.
https://doi.org/10.1016/j.acvdsp.2017.11.312 428
Disclosure of interest peting interest.
Can MRI detect pulmonary hypertension in a population pre-selected by echocardiography? Vener 1,2 ,
Odille 2 ,
Voilliot 1,2 ,
Chaouat 1 ,
The authors declare that they have no com-
https://doi.org/10.1016/j.acvdsp.2017.11.313 Chabot 1 ,
C. F. D. A. F. J. Felblinger 1,2 , L. Bonnemains 2,3,∗ 1 CHU de Nancy, Nancy, France 2 U947, Inserm, Nancy, France 3 Pédiatrie, CHU de Strasbourg, Strasbourg, France ∗ Corresponding author. E-mail address: [email protected] (L. Bonnemains) Background The place of MRI in the assessment of pulmonary hypertension remains controversial. Several studies proposed to use MRI to assess pulmonary pressure but the level of proof is low. Purpose To evaluate the diagnostic power of cardiac MRI within a non-selected population of patients suspected of pulmonary hypertension after an echocardiography. Material and methods Fifty-six consecutive patients, suspected of pulmonary hypertension after an echocardiography, were assessed with right heart catheterization and cardiac MRI (including a high temporal resolution pulmonary flow curve). We extracted from the MR data the main parameters proposed by all precedent studies available in the literature. We looked for multivariate linear relations between those parameters and the mean pulmonary arterial pressure (mPAP), and eventually assessed with a logic regression the ability of those parameters to diagnose pulmonary hypertension in our population. Results The multivariate model retained only two parameters: the right ventricle ejection fraction and the pulmonary trunk minimum area. The prediction of mPAP (r2 = 0.5) yielded limits of agreement of 15 mmHg. However, the prediction of pulmonary hypertension within the population was feasible and the method yielded a specificity of 80% for a sensitivity of 100% (Fig. 1). Conclusion The performance of MRI to assess mPAP is too low to be used as a replacement for right heart catheterization but MRI could be used as second line examination after echocardiography to avoid right heart catheterization for normal patients.
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Influence of the body position on the systolic speckle-tracking derived left and right ventricular function indexes of ultra-trailers F. Chagué 1,∗ , A. Gudjoncik 1 , C. Guenancia 1 , F. Compagnon 2 , C. Richard 1 , O. Ganansia 3 , V. Pasquereau 4 , Y. Cottin 1 1 Service de cardiologie, CHU de Dijon, Dijon, France 2 Service des urgences, centre hospitalier Coulommiers, Coulommiers, France 3 Service des urgences, hôpital St-Joseph, Paris, France 4 Service de réanimation, centre hospitalier Mantes, Mantes, France ∗ Corresponding author. E-mail address: [email protected] (F. Chagué) Background Preload is prone to vary during ultra long duration exercise (ULDE) and this can complicate the analysis of left ventricular (LV) and right ventricular (RV) function under such conditions. Purpose We studied LV and RV contractility indexes while preload conditions were changed. Methods Twenty-two healthy male amateur ultra trailers (mean age 47) underwent serial echocardiographic assessments in three positions at rest: left-side decubitus in the standard position (P1), head-up and legs down (P2) then in the Trendelenburg position (P3). Heart rate (HR) and systolic blood pressure (SBP) were monitored. Preload was estimated by the biplane LV end diastolic volume (LVEDV). Statistical analyses were conducted using repeated measures ANOVA. Results HR and SBP did not vary. LV-EDV was significantly greater in P3 than in P2 (P = 0.004) and in P1 (P = 0.001). LV Radial Peak Strain (LV-RPS) and LV Circumferential Peak Strain (LV-CPS) did not change. LV Longitudinal Peak Strain (LV-LPS) was greater in P3 than in P2 (P < 0.01) and greater in P1 than in P2 (P < 0.001). RV Longitudinal Peak Srain (RV-LPS) was greater in P3 than in P2 (P < 0.03). The LV Longitudinal Strain Rate (LV-LSR), the LV Circumferential Strain
03-Echocardiography and imaging
assessment in the clinical work-up of these patients could improve the evaluation of cardiovascular risk and may be helpful in the clinical-decision making process. Disclosure of interest The authors declare that they have no competing interest. https://doi.org/10.1016/j.acvdsp.2017.11.310 236
Clinical significance of right ventricular longitudinal function parameters after aortic valve replacement A. Coisne 1,2,∗ , T. Modine 3 , F. Outteryck 1 , S. Mouton 1 , R. Pilato 1 , H. Ridon 1 , M. Richardson 1 , A. Duva Pentiah 1 , B. Boutie 1 , M. Jacquelinet 1 , S. Ninni 1,2 , S. Ortmans 1 , M. Koussa 3 , P. Lancellotti 4 , D. Montaigne 1,2 1 Department of clinical physiology and echocardiography, heart valve clinic, Institut Cœur Poumon, CHRU de Lille, Lille, France 2 European genomic institute for diabetes (E.G.I.D), Inserm UMR 1011, Institut Pasteur de Lille, Lille university hospital, Lille, France 3 Department of cardiovascular surgery, CHRU de Lille, Lille, France 4 University of Liège hospital, GIGA cardiovascular sciences, departments of cardiology, heart valve clinic, CHU Sart Tilman, Liège, Belgium ∗ Corresponding author. E-mail address: [email protected] (A. Coisne) Background Parameters of longitudinal systolic function, i.e. tricuspid annular plane systolic excursion (TAPSE) and peak systolic velocity (PSV) of tricuspid annulus, are used to quantify RV function in daily practice. Changes in TAPSE and PSV after cardiac surgery have been described for many years with almost no data regarding their clinical significance. Purpose To test whether early postoperative decline in right ventricular (RV) longitudinal function is predictive of long-term outcomes after aortic valve replacement (AVR) in patients with severe aortic stenosis (AS). Methods Between January 2009 and December 2015, we prospectively explored all consecutive patients referred to our cardiovascular surgery department for AVR presenting with severe AS, normal left ventricular ejection fraction (> 50%) and TAPSE (> 14 mm). TAPSE and PSV were assessed 7 days after cardiac surgery for all patients and 1-year after AVR in a subgroup of 100 patients. Patients were followed for major events (ME), i.e. cardiovascular death, cardiac hospitalization, acute heart failure and stroke. Results Among a total of 752 patients, 135 patients presented poor acoustic window precluding reliable post-operative measurement of RV parameters. Six hundred and seventeen patients were followed-up for ME. TAPSE and PSV were severely decreased after surgery (P < 0.0001) with an incomplete but significant recovery 1-year after AVR. Longer cardio-pulmonary bypass duration was the only independent parameter associated with more important decrease in RV function after AVR. After a mean follow-up of 4 ± 2.3 years, no association was shown between early postoperative alteration in TAPSE and long-term prognosis (P = 0.21 by Log-rank test for trend for ME) (Fig. 1). Conclusion The early and severe postoperative decline in RV longitudinal function reverses within a year and is not predictive of long-term outcomes after AVR.
Fig. 1
Events-free survival according to TAPSE quartiles.
Disclosure of interest peting interest.
The authors declare that they have no com-
https://doi.org/10.1016/j.acvdsp.2017.11.311 423
Echocardiographic right ventricular function reference values in pediatrics: Which is the best mathematical model to define Z-Scores? P. Amedro 1,2,∗ , C. Bredy 1 , C. Soulatges 1 , S. Guillaumont 1 , M. Vincenti 1,2 , T. Mura 3 1 Cardiologie pédiatrique et congénitale, CHU de Montpellier, Montpellier cedex 5, France 2 UMR CNRS 9214, Inserm U1046, université de Montpellier, Montpellier, France 3 Épidémiologie, CHU de Montpellier, Montpellier, France ∗ Corresponding author. E-mail address: [email protected] (P. Amedro) Purpose The aim of our study was to determine the most appropriate mathematical model for right ventricular (RV) function normal values in children. Methods Normal children aged 0 to 18 years referred to the pediatric cardiology consultation were screened in this prospective cross-sectional study. Each RV parameters (S’, E’, A’ waves, TEI index, TAPSE) was modeled with four explanatory variables: age, size, weight and body surface area. Four different mathematical models were successively applied: a linear model, a polynomial model of degree 2, a linear regression model by spline with free knot, and a polynomial regression model of degree 2 by spline with a free knot. The choice of the best explanatory variable and the best modelization method was made on the basis of the model’s coefficient of determination (R2 ). Results We included 314 normal children aged 2 days to 18 years (46% female, 88 infants, 26 neonates, 226 children). The modelization of the RV variables over all ages did not follow a linear model, with the lowest coefficients of determination in the four explanatory variables. The quadratic spline model best adjusted the modelization of all RV variables. No model accurately explained the TEI index in any of the four explanatory variables. The S’ wave was best modelized by the quadratic spline model with the weight. The knot at 6.86 kg corresponded to the curves’ break. The E’ wave was best modelized by the quadratic spline model with the age. The knot at 0.29 years corresponded to the curve’s break. The A’ wave was
03-Echocardiography and imaging
53
best modelized by the quadratic model with the size. The knot at 81 cm corresponded to the break of the curve. The TAPSE was best modelized by the quadratic spline model with the weight (Fig. 1). The knot at 9.04 kg corresponded to the curve’s break (Fig. 1). Conclusion The quadratic spline model best applies to echocardiographic RV reference values in pediatrics.
Fig. 1 Disclosure of interest peting interest.
The authors declare that they have no comFig. 1 Relation between measured and predicted mPAP: insufficient predictive power.
https://doi.org/10.1016/j.acvdsp.2017.11.312 428
Disclosure of interest peting interest.
Can MRI detect pulmonary hypertension in a population pre-selected by echocardiography? Vener 1,2 ,
Odille 2 ,
Voilliot 1,2 ,
Chaouat 1 ,
The authors declare that they have no com-
https://doi.org/10.1016/j.acvdsp.2017.11.313 Chabot 1 ,
C. F. D. A. F. J. Felblinger 1,2 , L. Bonnemains 2,3,∗ 1 CHU de Nancy, Nancy, France 2 U947, Inserm, Nancy, France 3 Pédiatrie, CHU de Strasbourg, Strasbourg, France ∗ Corresponding author. E-mail address: [email protected] (L. Bonnemains) Background The place of MRI in the assessment of pulmonary hypertension remains controversial. Several studies proposed to use MRI to assess pulmonary pressure but the level of proof is low. Purpose To evaluate the diagnostic power of cardiac MRI within a non-selected population of patients suspected of pulmonary hypertension after an echocardiography. Material and methods Fifty-six consecutive patients, suspected of pulmonary hypertension after an echocardiography, were assessed with right heart catheterization and cardiac MRI (including a high temporal resolution pulmonary flow curve). We extracted from the MR data the main parameters proposed by all precedent studies available in the literature. We looked for multivariate linear relations between those parameters and the mean pulmonary arterial pressure (mPAP), and eventually assessed with a logic regression the ability of those parameters to diagnose pulmonary hypertension in our population. Results The multivariate model retained only two parameters: the right ventricle ejection fraction and the pulmonary trunk minimum area. The prediction of mPAP (r2 = 0.5) yielded limits of agreement of 15 mmHg. However, the prediction of pulmonary hypertension within the population was feasible and the method yielded a specificity of 80% for a sensitivity of 100% (Fig. 1). Conclusion The performance of MRI to assess mPAP is too low to be used as a replacement for right heart catheterization but MRI could be used as second line examination after echocardiography to avoid right heart catheterization for normal patients.
196
Influence of the body position on the systolic speckle-tracking derived left and right ventricular function indexes of ultra-trailers F. Chagué 1,∗ , A. Gudjoncik 1 , C. Guenancia 1 , F. Compagnon 2 , C. Richard 1 , O. Ganansia 3 , V. Pasquereau 4 , Y. Cottin 1 1 Service de cardiologie, CHU de Dijon, Dijon, France 2 Service des urgences, centre hospitalier Coulommiers, Coulommiers, France 3 Service des urgences, hôpital St-Joseph, Paris, France 4 Service de réanimation, centre hospitalier Mantes, Mantes, France ∗ Corresponding author. E-mail address: [email protected] (F. Chagué) Background Preload is prone to vary during ultra long duration exercise (ULDE) and this can complicate the analysis of left ventricular (LV) and right ventricular (RV) function under such conditions. Purpose We studied LV and RV contractility indexes while preload conditions were changed. Methods Twenty-two healthy male amateur ultra trailers (mean age 47) underwent serial echocardiographic assessments in three positions at rest: left-side decubitus in the standard position (P1), head-up and legs down (P2) then in the Trendelenburg position (P3). Heart rate (HR) and systolic blood pressure (SBP) were monitored. Preload was estimated by the biplane LV end diastolic volume (LVEDV). Statistical analyses were conducted using repeated measures ANOVA. Results HR and SBP did not vary. LV-EDV was significantly greater in P3 than in P2 (P = 0.004) and in P1 (P = 0.001). LV Radial Peak Strain (LV-RPS) and LV Circumferential Peak Strain (LV-CPS) did not change. LV Longitudinal Peak Strain (LV-LPS) was greater in P3 than in P2 (P < 0.01) and greater in P1 than in P2 (P < 0.001). RV Longitudinal Peak Srain (RV-LPS) was greater in P3 than in P2 (P < 0.03). The LV Longitudinal Strain Rate (LV-LSR), the LV Circumferential Strain