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Assessment of left-ventricular diastolic function in pediatric intensive-care patients: a review of parameters and indications compared with those for adults

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Abstract

Background

The incidence of diastolic heart failure has increased over time. The evaluation of left-ventricular diastolic function is complex, ongoing, and remains poorly performed in pediatric intensive-care patients. This study aimed to review the literature and to provide an update on the evaluation of left-ventricular diastolic function in adults and children in intensive care.

Data sources

We searched data from PubMed/Medline. Thirty-two studies were included. Four pragmatic questions were identified: (1) What is the physiopathology of diastolic dysfunction? (2) Which tools are required to evaluate diastolic function? (3) What are the echocardiographic criteria needed to evaluate diastolic function? (4) When should diastolic function be evaluated in pediatric intensive care?

Results

Early diastole allows characterization of relaxation, whereas compliance assessments and filling pressures are evaluated during late diastole. The evolution of diastolic function differs between adults and children. Unlike in adults, decreased compliance occurs at the same time as delayed relaxation in children. Diastolic function can be evaluated by Doppler echocardiography. The echocardiographic criteria for ventricular relaxation include the E wave, E/A wave ratio, and isovolumic relaxation time. Ventricular compliance can be assessed by the E/e’ wave ratio, atrial volume, and Ap wave duration during pulmonary vein flow. In adult intensive-care patients, the E/e’ ratio can be used as an index of tolerance for volume expansion in septic patients and to adjust the inotropic support.

Conclusion

Clinical studies would allow some of these parameters to be validated for use in children in intensive care.

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Funding

No financial or nonfinancial benefits have been received or will be received from any party related directly or indirectly to the subject of this article.

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    Authors and Affiliations

    1. ULR 2694 - METRICS : Évaluation des Technologies de santé et des Pratiques Médicales, Univ. Lille, CHU Lille, 59000, Lille, France

      Morgan Recher & Stephane Leteurtre

    2. Pediatric and Neonatal Intensive Care Unit, CHU Bordeaux, 33076, Bordeaux, France

      Astrid Botte

    3. Cardiac Surgery Unit, CHU Lille, 59000, Lille, France

      Jerome Soquet

    4. Congenital and Pediatric Cardiology Unit, CHU Lille, 59000, Lille, France

      Jean-Benoit Baudelet & François Godart

    5. Réanimation et Surveillance Continue Pédiatriques, Hôpital Jeanne de Flandre, CHU de Lille, 59037, Lille Cedex, France

      Morgan Recher

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    1. Morgan Recher
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    Contributions

    Dr. MR and Dr. AB conceptualized the study, conducted the initial analyses, drafted the initial manuscript, reviewed, and revised the manuscript; Dr. JS and Dr. JBB reviewed and revised the manuscript; Pr. FG reviewed and revised the manuscript; Prof. SL conceptualized the study, reviewed and revised the manuscript. All authors have approved the final manuscript as submitted and agree to be accountable for all aspects of the work.

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    Correspondence to Morgan Recher.

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    Recher, M., Botte, A., Soquet, J. et al. Assessment of left-ventricular diastolic function in pediatric intensive-care patients: a review of parameters and indications compared with those for adults. World J Pediatr 17, 21–30 (2021). https://doi.org/10.1007/s12519-020-00369-x

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