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LVOT-VTI is a Useful Indicator of Low Ventricular Function in Young Patients

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Abstract

Left ventricular outflow tract velocity time integral (LVOT-VTI), a Doppler-derived measure of stroke distance, is used as a surrogate marker of cardiac function in adults. LVOT-VTI is easily obtained, independent of ventricular geometry and wall motion abnormalities. We investigated the relationship between LVOT-VTI and conventional measures of function in young patients by comparing controls to children with dilated cardiomyopathy (DCM). Sixty-two healthy and 52 DCM patients over 1 year were studied retrospectively. The average pulsed (PW) and continuous wave (CW) LVOT-VTIs from apical views were measured from three cycles. Body surface area (BSA) and Ejection fraction (EF) were obtained. We compared LVOT-VTIs between study and control groups and assessed BSA’s impact on LVOT-VTI. The entire cohort was classified into three levels of LV function which were compared. We determined LVOT-VTI cutoff values that indicated an EF <50%. The mean PW-LVOT-VTI in the DCM group was significantly lower than that of the normal group (0.15 vs. 0.18 m; p < 0.0012). The mean CW-LVOT-VTI was significantly lower in DCM (0.20 vs. 0.24 m; p < 0.0001). There was no impact of BSA on LVOT-VTI except when comparing BSA and CW-LVOT-VTI in the normal group. There was a positive relationship between LVOT-VTI and EF for PW (Rs = 0.29, p = 0.0022) and CW (Rs = 0.22, p = 0.0364) and a difference in mean LVOT-VTI between EF groups (p < 0.0001). ROC analysis demonstrated that PW-LVOT-VTI <0.17 m (AUC = 0.73; p < 0.0001) and CW-LVOT-VTI <0.22 m (AUC = 0.76; p < 0.0001) was associated with EF <50%. This study indicates that LVOT-VTI can be a useful alternative measure of LV performance in children over 1 year.

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Acknowledgements

The authors wish to thank B. Rajaratnam and Sang Oh from the Department of Statistics, Stanford University for their help with the initial statistical analysis and data handling.

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Authors and Affiliations

  1. Pediatric Anesthesia, Lucile Packard Children’s Hospital, Stanford University Medical Center, Palo Alto, CA, USA

    Manchula Navaratnam & Chandra Ramamoorthy

  2. Pediatric Cardiology, Lucile Packard Children’s Hospital, Stanford University Medical Center, Palo Alto, CA, USA

    Rajesh Punn & Theresa A. Tacy

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  1. Manchula Navaratnam
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  2. Rajesh Punn
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Correspondence to Rajesh Punn.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Navaratnam, M., Punn, R., Ramamoorthy, C. et al. LVOT-VTI is a Useful Indicator of Low Ventricular Function in Young Patients. Pediatr Cardiol 38, 1148–1154 (2017). https://doi.org/10.1007/s00246-017-1630-9

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  • DOI: https://doi.org/10.1007/s00246-017-1630-9

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