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Pressure–Strain Loops, a Novel Non-invasive Approach for Assessment of Children with Cardiomyopathy

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Abstract

Non-invasive myocardial work (MW) by left ventricular (LV) pressure–strain loops (PSL) is a novel method for assessing myocardial function while adjusting for afterload, yet pediatric data remain lacking. The aims of this study were to investigate the different patterns of LV PSL and non-invasive MW in pediatric patients with hypertrophic (HCM) and dilated cardiomyopathy (DCM) and their association with exercise tolerance. We included 110 pediatric subjects (mean age, 13 ± 4 years, 35 DCM, 40 HCM, and 35 healthy controls). Standard and speckle-tracking echocardiography were performed. LV PSLs were generated, and global work index (GWI), MW efficiency (GWE), constructive work (GCW), and wasted work (GWW) were compared between groups. Regression analysis was used to assess the influence of ventricular function, dimensions, wall thickness, and wall stress on MW and to predict the association between MW and VO2 max as a surrogate of exercise capacity. Patients with DCM had significantly lower GWI compared to controls (GWI 479.6 ± 263.0 vs 1610.1 ± 211.0, P < 0.005). GWE was significantly reduced in DCM (79.3 ± 7.9 vs 95.2 ± 1.3, P < 0.005) due to significantly reduced GCW and increased GWW. HCM patients had significant reduction in GWI and GWE from normal (1237.7 ± 449.1 vs 1610.1 ± 211.0, P = 0.001 and 89.6 ± 4.9 vs 95.2 ± 1.3, P < 0.005, respectively), although less severe than with DCM. In a multivariate regression analysis, GWE had the highest association with VO2 max in both cohorts (DCM: β = 0.68, P = 0.001, HCM: β = 0.71, P = 0.007). Non-invasively assessed myocardial work and LV PSLs provide novel insights into the mechanisms of dysfunction in pediatric patients with cardiomyopathy with good prediction of clinical status and thus hold promise to further explore myocardial mechanistic with clinical relevance in different disease entities.

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Abbreviations

BSA:

Body surface area

CPET:

Cardiopulmonary exercise test

DCM:

Dilated cardiomyopathy

EDV:

End-diastolic volume

EF:

Ejection fraction

ESL:

Early systolic lengthening

ESWS:

End-systolic wall stress

FS:

Fraction shortening

GCW:

Global constructive work

GLS:

Global longitudinal strain

GWE:

Global work efficiency

GWI:

Global work index

GWW:

Global wasted work

HCM:

Hypertrophic cardiomyopathy

ICC:

Intra-class correlation coefficient

IVSD:

End-diastolic septal wall thickness

IVSs:

End-systolic septal wall thickness

LV:

Left ventricle

LVIDd:

Left ventricular end-diastolic diameter

LVIDs:

Left ventricular end-systolic diameter

LVM:

Left ventricular mass

LVMI:

Left ventricular mass indexed to body surface area

LVPWd:

Left ventricular posterior wall thickness in diastole

LVPWs:

Left ventricular posterior wall thickness in systole

MV:

Mitral valve

MVO2:

Myocardial oxygen consumption

PSL:

Pressure–strain loops

PSS:

Post-systolic shortening

PVL:

Pressure–volume loops

SBP:

Systolic blood pressure

VO2 max:

Maximal oxygen uptake

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Acknowledgements

We thank the Medical Writing Center at Children’s Mercy Kansas City for editing this manuscript.

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The authors received no financial support for this study.

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Authors and Affiliations

  1. Division of Cardiology, Ward Family Heart Center, Children’s Mercy Hospital, 2401 Gillham Road, Kansas City, MO, 64108, USA

    Doaa M. Aly

  2. Division of Cardiology, Department of Pediatrics, University of Colorado Anschutz Medical Campus and Children’s Hospital Colorado, Aurora, CO, USA

    Michael Nguyen, Scott Auerbach, Christopher Rausch & Michael V. DiMaria

  3. Johns Hopkins All Children’s Hospital, Heart Institute, St. Petersburg, FL, USA

    Bruce Landeck II

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Aly, D.M., Nguyen, M., Auerbach, S. et al. Pressure–Strain Loops, a Novel Non-invasive Approach for Assessment of Children with Cardiomyopathy. Pediatr Cardiol 43, 1704–1715 (2022). https://doi.org/10.1007/s00246-022-02902-3

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