Abstract
Patients with asthma develop pulmonary hypertension due to recurrent hypoxia and chronic inflammation, leading to right heart enlargement with ventricular hypertrophy. Patients with severe asthma can experience cor pulmonale later in life, but little is known about ventricular function during the early stages of the disease. This study aimed to investigate ventricular functions in asymptomatic children with asthma as detected by conventional echocardiography and tissue Doppler echocardiography (TDE). Fifty-one pediatric patients (mean age 10.4 ± 2.2 years) with asthma and 46 age- and sex-matched healthy children (mean age 10.9 ± 2.4 years) were studied. All subjects were examined by conventional echocardiography and TDE, and they had pulmonary function tests on spirometry. The right-ventricular (RV) wall was statistically (p = 0.01) thicker among asthmatic patients (4.7 ± 1.5 mm) compared with healthy children (3.6 ± 0.4 mm). However, conventional pulsed-Doppler indices of both ventricles did not differ significantly between asthmatic patients and healthy children (p > 0.05). The results of TDE examining RV diastolic function showed that annular peak velocity during early diastole (E′), annular peak velocity during late diastole (A′) (16.4 ± 1.8 and 5.1 ± 1.4 cm/s, respectively), E′/A′ ratio (3.2 ± 0.7), isovolumetric relaxation time (67.7 ± 10.2 ms) and myocardial performance index (48.1 % ± 7.0 %) of the lateral tricuspid annulus among asthmatic patients differed significantly (p = 0.01) from those of healthy children (13.2 ± 2.3, 8.2 ± 2.0 cm/s, 1.6 ± 0.5, 46.2 ± 8.7 ms, and 42.0 % ± 5.7 %, respectively). Only peak expiratory flow (PEF) rate from the pulmonary function tests was negatively correlated with the E′/A′ ratio of the tricuspid annulus (r = −0.38, p = 0.01). This study showed that although the findings of clinical and conventional echocardiography were apparently normal in children with asthma, TDE showed subclinical dysfunction of the right ventricle, which is negatively correlated with PEF. These findings signify the diagnostic value of TDE in the early detection and monitoring of such deleterious effects among asthmatic patients.
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References
Bardsley P, Evely R, Howard P (1986) Hypoxic cor pulmonale: a review. Herz 11:155–168
Bush A (2007) Diagnosis of asthma in children under five. Prim Care Respir J 16:7–15
Caso P, Galderisi M, Cicala S, Cioppa C, D’Andrea A, Lagioia G et al (2001) Association between myocardial right ventricular relaxation time and pulmonary arterial pressure in chronic obstructive lung disease: analysis by pulsed Doppler tissue imaging. J Am Soc Echocardiogr 14:970–977
Chicherina EN, Shipitsyna VV (2003) The cardiovascular system in patients with bronchial asthma of varying severity [in Russian]. Probl Tuberk Bolezn Legk 8:25–28
Coghlan JG, Davar J (2007) How should we assess right ventricular function in 2008? Eur Heart J 9(suppl H):H22–H28
Correale M, Totaro A, Ieva R, Brunetti ND, Di Biase M (2011) Time intervals and myocardial performance index by tissue Doppler imaging. Int Emerg Med 6:393–402
Davenport PW, Cruz M, Stecenko AA, Kifle Y (2000) Respiratory-related evoked potentials in children with life-threatening asthma. Am J Respir Crit Care Med 161:1830–1835
Eidem BW, O’Leary PW, Tei C, Seward JB (2000) Usefulness of the myocardial performance index for assessing right ventricular function in congenital heart disease. Am J Cardiol 86:654–658
Global Strategy for Asthma Management and Prevention, Global Initiative for Asthma (GINA) (2006) Available at: http://www.ginasthma.org/. Accessed 10 Jan 2012
Han MK, McLaughlin VV, Criner GJ, Martinez FJ (2007) Pulmonary diseases and the heart. Circulation 116:2992–3005
Healy F, Hanna BD, Zinman R (2010) Clinical practice. The impact of lung disease on the heart and cardiac disease on the lungs. Eur J Pediatr 169:1–6
Lai WW, Geva T, Shirali GS, Frommelt PC, Humes RA, Brook MM et al (2006) Guidelines and standards for performance of a pediatric echocardiogram: a report from the Task Force of the Pediatric Council of the American Society of Echocardiography. J Am Soc Echocardiogr 19:1413–1430
Lang RM, Bierig M, Devereux RB, Flachskampf FA, Foster E, Pellikka PA et al (2005) Recommendations for chamber quantification: A report from the American Society of Echocardiography’s Guidelines and Standards Committee and the Chamber Quantification Writing Group, developed in conjunction with the European Association of Echocardiography, a branch of the European Society of Cardiology. J Am Soc Echocardiogr 18:1440–1463
Mansencal N, Bouvier E, Joseph T, Farcot JC, Pillière R, Redheuil A et al (2004) Value of tissue Doppler imaging to predict left ventricular filling pressure in patients with coronary artery disease. Echocardiography 21:133–138
Massoud MN, el-Nawawy AA, el-Nazar SY, Abdel-Rahman GM (2000) Tumour necrosis factor-alpha concentration in severely asthmatic children. East Mediterr Health J 6:432–436
Miller MR, Hankinson J, Brusasco V, Burgos F, Casaburi R, Coates A et al (2005) Standardisation of spirometry. Eur Respir J 26:319–338
Nikitin NP, Witte K (2004) Application of tissue Doppler imaging in cardiology. Cardiology 101:170–184
Palka P, Lange A, Fleming AD, Fenn LN, Bouki KP, Shaw TR et al (1996) Age-related transmural peak mean velocities and peak velocity gradients by Doppler myocardial imaging in normal subjects. Eur Heart J 17:940–950
Quiñones MA, Otto CM, Stoddard M, Waggoner A, Zoghbi WA et al (2002) Recommendations for quantification of Doppler echocardiography: a report from the Doppler Quantification Task Force of the Nomenclature and Standards Committee of the American Society of Echocardiography. J Am Soc Echocardiogr 15:167–184
Sabit R, Bolton CE, Fraser AG, Edwards JM, Edwards PH, Ionescu AA et al (2010) Sub-clinical left and right ventricular dysfunction in patients with COPD. Respir Med 104:1171–1178
Shedeed SA (2010) Right ventricular function in children with bronchial asthma: a tissue Doppler echocardiographic study. Pediatr Cardiol 31:1008–1015
Uyan AP, Uyan C, Ozyurek H (2003) Assessment of right ventricular diastolic filling parameters by Doppler echocardiography. Pediatr Int 45:263–267
Vitarelli A, Conde Y, Cimino E, Stellato S, D’Orazio S, D’Angeli I et al (2006) Assessment of right ventricular function by strain rate imaging in chronic obstructive pulmonary disease. Eur Respir J 27:268–275
Yu CM, Sanderson JE, Chan S, Yeung L, Hung YT, Woo KS (1996) Right ventricular diastolic dysfunction in heart failure. Circulation 93:1509–1514
Yu CM, Lin H, Ho PC, Yang H (2003) Assessment of left and right ventricular systolic and diastolic synchronicity in normal subjects by tissue Doppler echocardiography and the effects of age and heart rate. Echocardiography 20:19–27
Zeybek C, Yalcin Y, Erdem A, Polat TB, Aktuglu-Zeybek AC, Bayoglu V et al (2007) Tissue Doppler echocardiographic assessment of cardiac function in children with bronchial asthma. Pediatr Int 49:911–917
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Ozdemir, O., Ceylan, Y., Razi, C.H. et al. Assessment of Ventricular Functions by Tissue Doppler Echocardiography in Children with Asthma. Pediatr Cardiol 34, 553–559 (2013). https://doi.org/10.1007/s00246-012-0493-3
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DOI: https://doi.org/10.1007/s00246-012-0493-3