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Myocardial work in children with Wolff-Parkinson-White syndrome

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Abstract

Wolff-Parkinson-White Syndrome (WPW) has been associated with reduced local myocardial deformation, and when left ventricular dysfunction is present, catheter ablation of the accessory pathway may be required, even in asymptomatic patients. We aimed to evaluate the diagnostic value of non-invasive myocardial work in predicting subtle abnormalities in myocardial performance in children with WPW.Seventy-five paediatric patients (age 8.7 ± 3.5 years) were retrospectively recruited for the study: 25 cases with manifest WPW and 50 age- and sex- matched controls (CTR). Global myocardial work index (MWI) was measured as the area of the left ventricle (LV) pressure-strain loops. From MWI, global Myocardial Constructive Work (MCW), Wasted Work (MWW), and Work Efficiency (MWE) were estimated. In addition, standard echocardiographic parameters of LV function were evaluated. Despite normal LV ejection fraction (EF) and global longitudinal strain (GLS), children with WPW had worse MWI, MCW, MWW, and MWE. At multivariate analysis, MWI and MCW were associated with GLS and systolic blood pressure, and QRS was the best independent predictor of low MWE and MWW. In particular, a QRS > 110 ms showed good sensitivity and specificity for worse MWE and MWW values. In children with WPW, myocardial work indices were found significantly reduced, even in the presence of normal LV EF and GLS. This study supports the systematic use of myocardial work during the follow-up of paediatric patients with WPW. Myocardial work analysis may represent a sensitive measure of LV performance and aid in decision-making.

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Acknowledgements

We would like to thank Assunta Carandente, Nadia Puzone, Gabriella Piccolo, Cecilia Spinelli-Barrile, Tiziana Varriale for their valuable help during this project.

Funding

The authors received no financial support for this study.

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Authors and Affiliations

  1. Adult Congenital Heart Disease Unit, AO Dei Colli, Monaldi Hospital, Via Leonardo Bianchi, Naples, Italy

    Nunzia Borrelli, Giovanni Domenico Ciriello, Rosaria Barracano, Giancarlo Scognamiglio & Berardo Sarubbi

  2. Division of Paediatric Cardiology, Department of Women’s and Children’s Health, University Hospital of Padua, Padua, Italy

    Giovanni Di Salvo, Jolanda Sabatino & Martina Avesani

  3. Division of Cardiology, Department of Medical and Surgical Science, Magna Graecia University, Catanzaro, Italy

    Isabella Leo

  4. Division of Paediatric Cardiology, University of Campania ‘Luigi Vanvitelli’, AO Dei Colli, Monaldi Hospital, Naples, Italy

    Maria Giovanna Russo

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  1. Nunzia Borrelli
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Contributions

NB, GDS and BS contributed to conception and design of the study. NB, GDC, JS, MA and IL collected the data and organized the database. JS and MA performed the statistical analysis. NB wrote the first draft of the manuscript. RB, JS, MA, IL, GDC, GS, MGR, BS and NB wrote sections of the manuscript. All authors contributed to manuscript revision, read, and approved the submitted version.

Corresponding author

Correspondence to Nunzia Borrelli.

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The authors declare no competing interests.

Conflict of interests

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Ethics approval

This study was performed in line with the principles of the Declaration of Helsinki. Approval was granted by the Ethics Committee of Azienda Ospedaliera dei Colli. Informed consent to participate in this study was obtained from patients’ parents or legal guardians.

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Borrelli, N., Di Salvo, G., Ciriello, G.D. et al. Myocardial work in children with Wolff-Parkinson-White syndrome. Int J Cardiovasc Imaging 39, 1697–1705 (2023). https://doi.org/10.1007/s10554-023-02883-1

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