Speckle-Tracking Echocardiographic Measures of Right Ventricular Diastolic Function Correlate with Reference Standard Measures Before and After Preload Alteration in Children

Abstract

Background The accuracy of echocardiographic measures of right ventricular (RV) diastolic function has been sparsely studied. Our objective was to evaluate the correlation between echocardiographic and reference standard measures of RV diastolic function derived from micromanometer pressure analysis before and after preload alteration in children. Methods Echocardiograms and micromanometer pressure analyses were prospectively performed before and after fluid bolus in children undergoing right heart catheterization. The isovolumic relaxation time constant (tau) and end-diastolic pressure (EDP) were measured. Conventional and speckle-tracking echocardiographic (STE) parameters of RV systolic and diastolic function were assessed. Normal saline bolus was given to increase RV EDP by 20%. Results 28 studies were performed in 22 patients with congenital heart disease or post heart transplantation. Mean age was 8.7 ± 6.1 yrs. RV longitudinal early diastolic strain rate (EDSR) correlated with tau before (r = 0.57, p = 0.001) and after fluid bolus (r = 0.48, p = 0.008). No conventional echocardiographic measures correlated with tau both before and after fluid bolus. Multiple regression analysis revealed RV EDSR and LV circumferential EDSR as independent predictors of RV tau. There were no independent predictors of EDP. Conclusion RV EDSR appears to correlate with the reference-standard measure of early active ventricular relaxation in children at baseline and after changes in preload. Conventional echocardiographic measures of diastolic function were not predictive of diastolic function after preload alteration. Future studies should assess the prognostic significance of STE measures of diastolic function in this population.

Standard volume infusion unmasked diastolic dysfunction in pediatric heart transplant recipients during surveillance cardiac catheterization, but without echocardiographic correlates

“…Several other studies on adult patients have also demonstrated pre‐load conditions must be accounted for when evaluating diastolic function by mitral valve inflow velocities 7,17 . We are aware of only one pediatric study utilizing pre‐load alteration to help evaluate diastolic function in the cardiac catheterization lab, but the authors focused on right ventricular hemodynamics, without assessments of LVEDP or PCWP 11 . In our cohort, cardiac catheterization measures of diastolic function (LVEDP or PCWP) were normal, then increased significantly to abnormal values following pre‐load alteration.…”

“…7,17 We are aware of only one pediatric study utilizing pre-load alteration to help evaluate diastolic function in the cardiac catheterization lab, but the authors focused on right ventricular hemodynamics, without assessments of LVEDP or PCWP 11. In our cohort, cardiac cathe-e′> 10 was associated with an abnormal PCWP 15,16.…”

“…This likely results in an incomplete evaluation of diastolic function, in this age group, due to its inherent load dependence. Conversely, an intravenous fluid bolus may allow a more robust investigation of diastolic function in children suspected of diastolic dysfunction 11 …”

“…Conversely, an intravenous fluid bolus may allow a more robust investigation of diastolic function in children suspected of diastolic dysfunction. 11 Echocardiographic assessment of pediatric diastolic function offers multiple theoretical advantages. This non-invasive, costeffective, outpatient imaging modality allows both a preload dependent (mitral valve inflow, E and A wave velocities) and independent, dynamic (tissue Doppler imaging, e′ and a′ velocities) measurement of left ventricular diastolic function.…”