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Optimal noninvasive assessment of initial left ventricular dysfunction in children with ectopic atrial tachycardia

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Abstract

Tissue Doppler imaging (TDI) can identify cardiac dysfunction in adults. This study is aimed to improve early identification of initial left ventricular (LV) dysfunction secondary to ectopic atrial tachycardia (EAT) in children by TDI. A total of 70 children with EAT were included in the present study. Cardiac function was evaluated by conventional echocardiography, TDI, and plasma N-terminal pro-brain natriuretic peptide (NT-proBNP). Doppler signals obtained from the mitral inflow and TDI of the mitral annulus were the average values of three consecutive heartbeats. Left ventricular ejection fraction (LVEF), peak early diastolic transmitral velocity (E), peak systolic mitral annulus velocity (S′), early diastolic mitral annular velocity (E′), the ratio E/E′, and TDI-derived myocardial performance index (TDI-MPI) were compared between two groups of children with normal or elevated plasma NT-proBNP concentrations. Of the children, 18.6 % demonstrated tachycardia-induced cardiomyopathy (TIC). Compared with LVEF, the TDI-MPI and E/E′ showed better correlations with elevated plasma NT-proBNP. Addition of TDI-MPI and E/E′ to LVEF provided increased information to detect elevated plasma NT-proBNP (91.67 % sensitivity).

Conclusions: TIC occurred in 18.6 % of children with EAT. Initial LV dysfunction assessed by the TDI-MPI and E/E′ is associated with elevated plasma NT-proBNP, even the LVEF is normal.

What is known:

• Tissue Doppler imaging (TDI) can identify cardiac dysfunction in adults.

• Ectopic atrial tachycardia (EAT) is more likely to be incessant and lead to tachycardia-induced cardiomyopathy (TIC), especially in pediatric population.

What is new:

• TDI can improve early identification of initial left ventricular (LV) dysfunction secondary to EAT in children, which is beneficial for optimizing prompt intervention in children with EAT to improve prognosis in daily clinical practice.

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Abbreviations

EAT:

Ectopic atrial tachycardia

ET:

Ejection time

ICT:

Isovolumic contraction time

IRT:

Isovolumic relaxation time

LV:

Left ventricular

LVEF:

Left ventricular ejection fraction

LVFS:

Left ventricular fraction shortening

NT-proBNP:

N-terminal pro-brain natriuretic peptide

TDI:

Tissue Doppler imaging

TDI-MPI:

TDI-derived myocardial performance index

TIC:

Tachycardia-induced cardiomyopathy

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Conflicts of interest

This work was supported by Special Fund for the Clinically Characteristic Application Research of the Capital (July 2013 to October 2016).

Authors Contribution

X-M Li initially conceptualized this study. All the authors performed the data acquisition and analysis. XM Li and Ge wrote the manuscript. All the authors contributed to (and agreed upon) the final version.

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Authors and Affiliations

  1. Department of Pediatric Cardiology, Heart Center, the First Hospital of Tsinghua University, Medical Center, Tsinghua University, Beijing, 100016, China

    Hai-Yan Ge, Xiao-Mei Li, Xiu-Jie Tang, Yan Zhang, Hai-Ju Liu & Yan-Hui Li

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  1. Hai-Yan Ge
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  2. Xiao-Mei Li
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Correspondence to Xiao-Mei Li.

Additional information

Communicated by Jaan Toelen

Revisions received: 29 October 2014 / 20 January 2015

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Ge, HY., Li, XM., Tang, XJ. et al. Optimal noninvasive assessment of initial left ventricular dysfunction in children with ectopic atrial tachycardia. Eur J Pediatr 174, 1015–1022 (2015). https://doi.org/10.1007/s00431-015-2500-1

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  • DOI: https://doi.org/10.1007/s00431-015-2500-1

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