Function Heterogeneity of Different Segments of Left Ventricle in Pediatric Dilated Cardiomyopathy: A Tissue Doppler Study

Abstract

Background: Dilated cardiomyopathy (DCM) is characterized by impaired systolic and diastolic function of one or both ventricles. Aim of the Work: To assess left ventricular (LV) regional systolic as well as global systolic, diastolic functions and desynchrony in children with idiopathic DCM using tissue Doppler imaging. Materials and Methods: The study comprised 30 patients with idiopathic DCM (4.4+3.3 years) and 10 healthy children as a control group. Electrocardiography (ECG)-gated echocardiography was done using m-mode and conventional Doppler as well as tissue Doppler imaging to obtain modified Tei index, mitral annular wave velocities (S', E' and A') as well as offline analysis of color tissue velocity imaging to obtain the peak systolic velocities of 12 LV points in apical four chamber, two chamber and long axis views. Results: The peak systolic velocities of mitral annulus as well as the different LV segments of patients were significantly lower than that of the control group. The E/E' ratio of patients was (11.39+2.4). S' and E' wave of lateral and septal aspects of mitral annulus were correlated. The Tei index of LV of patients (0.568+0.1136) was significantly higher than that of the control group. The averaged mid LV segments showed significantly lower peak systolic velocity (3.018+0.777cm/sec). There was significant difference between different LV segments as regards the peak systolic velocities (P<0.05). When comparing the time to peak standard deviation (TPSD) of lateral wall (±36.071) to septal wall (±33.020), no marked difference was detected (P>0.05). Conclusion: The diastolic dysfunction among children with idiopathic DCM lies in the borderline zone. Systolic and diastolic dysfunctions correlate. There is regional heterogeneity of left ventricular systolic velocities being in general lower in mid segments. No marked left ventricular systolic desynchrony in DCM was found in pediatric age group. Level of Evidence of Study: IIA. (1)