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Role of automated functional imaging and myocardial work in assessment of cardiac function in children with obstructive sleep apnea

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Abstract

Background

Early identification of abnormal left ventricular function in children with obstructive sleep apnea (OSA) is difficult using conventional echocardiographic indices and commonly used clinical markers of myocardial damage. We sought to investigate the value of automatic function imaging and myocardial work parameters in predicting early cardiac impairment in children having OSA with preserved left heart function and thereby identifying an optimal index for assessment.

Patients and Methods

Fifty-two children who presented with symptoms of nocturnal sleep snoring and open-mouth breathing and 34 healthy controls were enrolled in this study. Clinical characteristics and conventional echocardiographic data were collected, and image analysis was performed using two-dimensional speckle-tracking echocardiography to obtain left ventricular global longitudinal strain (GLS), post-systolic index, peak strain dispersion, global work index (GWI), global constructive work (GCW), global wasted work, and global work efficiency.

Results

Children with OSA had significantly lower GLS, GWI, and GCW than those without (P < 0.05). Additionally, GWI (β = −32.87, 95% CI: −53.47 to −12.27), and GCW (β = −35.09, 95% CI: −55.35 to −14.84) were found to correlate with the disease severity in the multiple linear regression mode, with worsening values observed as the severity of the disease increased. ROC curve analysis revealed that GCW was the best predictor of myocardial dysfunction, with an AUC of 0.809 (P < 0.001), and the best cutoff point for diagnosing myocardial damage in children with OSA was 1965.5 mmHg%, with a sensitivity of 92.5% and a specificity of 58.7%.

Conclusions

GLS, GWI, and GCW were identified as predictors of myocardial dysfunction in children with OSA, with GCW being the best predictor.

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Acknowledgements

We thank Medjaden Inc. for scientific editing of this manuscript.

Authors’ contributions

Juncheng Ni and Fan Zhang are equal contributors.

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Not applicable.

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Author notes

  1. Jun-Cheng Ni and Fan Zhang are equal contributors.

Authors and Affiliations

  1. Department of Pediatric Cardiology, Children’s Hospital of Soochow University, 92 Zhongnan Road, SuzhouJiangsu, 215003, China

    Jun-Cheng Ni, Fan Zhang, Xin-Lu Hu, Yao-Wen Sun, Long Chen, Jie Huang & Qiu-Qin Xu

  2. Department of Pediatrics, The First People’s Hospital of Kunshan, 566 East Qian-Jin Road, KunshanJiangsu, 215300, China

    Wen-Qing Xu

  3. Department of Child and Adolescent Health Care, Children’s Hospital of Soochow University, 92 Zhongnan Road, SuzhouJiangsu, 215003, China

    Xiao-Yan Zhao

  4. Department of Respiratory Medicine, Children’s Hospital of Soochow University, 92 Zhongnan Road, SuzhouJiangsu, 215003, China

    Yu-Qing Wang

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Contributions

QQX, as the corresponding author, was the chief investigator. JCN, FZ, WQX, XLH, XYZ, YWS, LC, YQW and JH were co-investigators. JCN, WQX, XLH, YWS and LC collected and managed ultrasonography data. FZ, XYZ, YQW and JH collected and analyzed clinical data. JCN drafted the manuscript. WQX participated in data interpretation and manuscript drafting. All authors read and approved the final manuscript. JCN and FZ equally contribute to this study as first co-authors.

Corresponding author

Correspondence to Qiu-Qin Xu.

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Ethical Approval

The study protocol was approved by the medical ethics committee of the Children’s Hospital of Soochow University (approval number: 2021CS134). The guardians of all the enrolled children signed an informed consent form upon admission.

Competing interests

The authors have no competing interests as defined by BMC, or other interests that might be perceived to influence the results and/or discussion reported in this paper.

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Ni, JC., Zhang, F., Xu, WQ. et al. Role of automated functional imaging and myocardial work in assessment of cardiac function in children with obstructive sleep apnea. Int J Cardiovasc Imaging 40, 601–611 (2024). https://doi.org/10.1007/s10554-023-03030-6

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