Echocardiographic Assessment of Ventricular Synchrony in Congenital and Acquired Heart Disease in Children

Abstract

Electromechanical dyssynchrony is an important consequence of and contributor to ventricular dysfunction. Echocardiography can be useful to assess the mechanisms underlying mechanical dyssynchrony, to evaluate the impact of mechanical dyssynchrony on ventricular function, and to try to predict the therapeutic response to cardiac resynchronization therapy (CRT). Mechanical dyssynchrony has been demonstrated in several pediatric acquired and congenital cardiac conditions, but experience is still limited. Moreover, the optimal method to identify dyssynchrony remains unclear, and data predicting the response to CRT in pediatrics are lacking. Understanding mechanisms of electromechanical dyssynchrony by echocardiography seems promising, at least in left bundle branch block (LBBB), but may be limited in children due to the uncommon occurrence of LBBB in this population. This review addresses the commonly used methods to diagnose mechanical dyssynchrony, discusses the emerging concepts on the mechanisms of the various types of mechanical dyssynchrony, and discusses the possible significance of mechanical synchrony in pediatric and acquired congenital heart disease.

Strain and strain rate echocardiography in children with Wilson’s disease

“…Difficulties with angle dependency of tissue Doppler imaging, the effects of preload, and the translational motion of the heart were overcome by strain and strain rate echocardiography, which were then adopted as new models in the assessment of myocardial performance and local deformation properties 1315. Strain imaging, based on speckle tracking, in particular, enabled assessment of myocardial motion and deformation irrespective of angle and geometry, allowing an improved examination of the myocardial mechanics.…”

“…Strain and strain rate echocardiography are superior to tissue Doppler echocardiography in the evaluation of regional myocardial function because they are not affected by the translation and stretching of neighbouring myocardial segments 16. 2D strain and strain rate echocardiography also can assess different clinical conditions, such as hypertension, obesity, post exercise, Marfan syndrome, healthy children and infants 1518…”

Echocardiographic Assessment of Ventricular Function in Pediatric Patients: A Comprehensive Guide

“…For assessment of mechanical dyssynchrony different timing parameters have been proposed and found to be poorly reproducible and poorly predictive of the response to cardiac resynchronization therapy [23]. We still acquire the data and use it in our dyssynchrony assessment as described in other publications by our group [24,25]. We look at patterns of mechanical activation in different segments simultaneously looking for significant temporal delays or abnormal contraction patterns.…”

Current Status and Future Direction of Cardiac Resynchronization Therapy for Congenital Heart Disease and Pediatric Patients

“…11 However, a multicenter prospective study conducted recently in Japan (the J-CRT study) 12 did not find a single echocardiographic criterion that could significantly predict the response to CRT; rather, the response to therapy correlated with a combination of parameters of dyssynchrony between the septum and LV free wall measured by M-mode and tissue Doppler imaging, as well as LBBB on ECG. These results could not necessarily be applied to the field of CHD where RBBB instead of LBBB is a common cause of wide QRS and various ventricular morphologies are included.…”