小儿先天性心脏病不同右心室负荷条件下的心肌功

IF 2.2 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Archives of Cardiovascular Diseases Pub Date : 2025-09-01 DOI:10.1016/j.acvd.2025.06.062

Ramona Ghenghea , Hadeed Khaled , Philippe Acar , Pierrick Pyra , Aitor Guitarte , Paul Vignaud , Yves Dulac , Clement Karsenty

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引用次数: 0

摘要

评估儿童右心室（RV）功能具有挑战性，特别是右心室过载。传统的超声心动图不考虑后负荷，限制了准确性。本研究旨在评估不同右心室负荷条件下儿童右心室心肌功（RVMW），一种综合收缩功能和后负荷的方法。方法该前瞻性单中心研究于2023年3月至2024年3月进行。35例患儿分为两组：容量过载组（三尖瓣前分流）18例，压力过载组（毛细血管前肺动脉高压）17例。选取17名健康儿童作为对照组。所有受试者均行二维和三维经胸超声心动图（TTE）评估右心室体积和功能。RVMW是根据肺动脉压和右心室应变的压力-应变关系得出的（图1）。结果两组右心室体积均增大（压力过载组为95±24 ml/m2，容量过载组为119±25 ml/m2，而对照组为53±14 ml/m2），两组间右心室体积差异无统计学意义（p = 0.26）。传统超声心动图参数显示右心室纵向功能正常，但压力过载组右心室自由壁应变（FWS）低于容量过载组（- 23.4±5.2 vs - 31.3±4.5%,p < 0.001）。RVMW指标，包括RV总功指数（GWI）、总收缩功（GCW），压力超负荷组高于容积超负荷组（823±278比468±81,1083±405比586±77mmHg%， p = 0.0007和p <； 0.0001）。GWI和GCW与TAPSE/PAPS呈负相关（r = - 0.81和r = - 0.80; p < 0.001），与肺VTI/PAPS呈负相关（r = - 0.75和0.75;p < 0.001）。结论右心室血流动力学负荷儿童的RVMW评估是可行的，且与健康对照存在差异。在这项研究中，我们提供了证据，将RVMW的应用范围扩大到不同类型的右心室血流动力学过载的儿童，包括压力和容量过载。虽然MW具有巨大的潜力并越来越受到关注，但需要更大规模的研究来充分确定其作用并将其纳入常规临床实践。

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Myocardial work during various right ventricle load conditions in pediatric congenital heart disease

Introduction

Assessing right ventricular (RV) function in pediatric population is challenging, especially with RV overload. Traditional echocardiography doesn’t account for afterload, limiting accuracy. This study aimed to assess RV myocardial work (RVMW), a method integrating contractile function and afterload, in children with varying RV load conditions.

Method

This prospective single center study was conducted from March 2023 to March 2024. A total of 35 children were divided into two groups: 18 with volume overload (pre-tricuspid shunts) and 17 with pressure overload group (precapillary pulmonary arterial hypertension). A control group of 17 healthy children was included. All subjects underwent 2D and 3D transthoracic echocardiography (TTE) to assess RV volumes and function. RVMW was derived from the pressure-strain relationship incorporating pulmonary artery pressures and RV strain (Figure 1).

Results

Both overload groups showed RV enlargement (95 ± 24 ml/m² in the pressure overload group and 119 ± 25 ml/m² in the volume overload group versus 53 ± 14 ml/m² in the control group), without significant differences in RV volume between them (p = 0.26). Traditional echocardiographic parameters indicated normal RV longitudinal function, but RV free wall strain (FWS) was lower in the pression overload group compared to the volume overload group (−23.4 ± 5.2 vs. −31.3 ± 4.5%, p < 0.001). RVMW indices, including RV global work index (GWI), global contractile work (GCW), were higher in the pressure overload group compared to the volume overload group (823 ± 278 vs. 468 ± 81 and 1083 ± 405 vs. 586 ± 77mmHg%, p = 0.0007 and p < 0.0001 respectively). GWI and GCW were negatively correlated with TAPSE/PAPS (r = −0.81 and r = −0.80; p < 0.001) and with pulmonary VTI/PAPS (r = −0.75 and 0.75; p < 0.001).

Conclusion

The assessment of RVMW is feasible in children with RV hemodynamic overload and shows differences compared to healthy controls. In this study, we offer evidence that expands the use of RVMW to children with different types of RV hemodynamic overload, including pressure and volume overload. While MW holds significant potential and is gaining increasing attention, larger studies are necessary to fully define its role and integration into routine clinical practice.

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来源期刊

Archives of Cardiovascular Diseases 医学-心血管系统

CiteScore

4.40

自引率

6.70%

发文量

审稿时长

34 days

期刊介绍： The Journal publishes original peer-reviewed clinical and research articles, epidemiological studies, new methodological clinical approaches, review articles and editorials. Topics covered include coronary artery and valve diseases, interventional and pediatric cardiology, cardiovascular surgery, cardiomyopathy and heart failure, arrhythmias and stimulation, cardiovascular imaging, vascular medicine and hypertension, epidemiology and risk factors, and large multicenter studies. Archives of Cardiovascular Diseases also publishes abstracts of papers presented at the annual sessions of the Journées Européennes de la Société Française de Cardiologie and the guidelines edited by the French Society of Cardiology.