Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2018 May 8;18(1):87.
doi: 10.1186/s12872-018-0826-0.

Novel functional advanced echocardiography for the assessment of myocardial mechanics in children with neurocardiogenic syncope - a blinded prospective speckle tracking head-up tilt-table challenge study

Kai O Hensel  1   2 , Markus Roskopf  3 , Francisca Abellan Schneyder  3 , Andreas Heusch  3
Affiliations

Novel functional advanced echocardiography for the assessment of myocardial mechanics in children with neurocardiogenic syncope - a blinded prospective speckle tracking head-up tilt-table challenge study

Kai O Hensel et al. BMC Cardiovasc Disord. .

Abstract

Background: Data on left ventricular (LV) function in patients with neurocardiogenic syncope (NS) is conflicting in adults and lacking in children. The aim of this study was to analyze LV myocardial performance in children with NS at rest and during head-up tilt-table (HUTT) testing.

Methods: This is the first study to combine HUTT and speckle-tracking echocardiography (STE) in children with NS. 43 consecutive normotensive pediatric patients with NS (mean age 13.9 ± 2.6 years, 51% female) and 41 sex- and age-matched healthy controls were included in the study. The study groups consisted of 21 patients with a positive HUTT reaction (HUTT+) and 22 with a negative HUTT reaction (HUTT-). STE was used to analyze peak systolic LV myocardial strain and strain rate.

Results: Conventional echocardiographic parameters were similar in all analyzed groups. When compared to healthy controls, children with NS had depressed levels of circumferential strain rate (p = 0.032) and significantly depressed longitudinal strain rate (p < 0.001) at rest. Interestingly, during HUTT testing LV global strain and strain rate were similar in both groups. LV strain rate was lowest in HUTT+ followed by HUTT- and control subjects both at rest and during HUTT.

Conclusions: Resting LV longitudinal strain rate is attenuated in children with NS, especially in those with a positive HUTT response. This is further evidence that NS patients feature altered cardiac mechanics rendering them prone to vasovagal perturbations that can ultimately result in collapse.

Trial registration: Witten/Herdecke University ethics committee clinical study number: UWH-73-2014.

Keywords: Collapse; Functional autonomic response test; LV function; Pediatric echocardiography; Strain rate; Vasovagal syncope.

PubMed Disclaimer

Conflict of interest statement

Ethics approval and consent to participate

The study was carried out in accordance with the declaration of Helsinki’s ethical principles for medical research involving human subjects and approved by the Witten/Herdecke University ethics committee (clinical study number: UWH-73-2014). A written informed consent was signed by all included patients/volunteers and their legal guardian.

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Left ventricular circumferential and longitudinal strain and strain rate at baseline. p-values were calculated using the Mann-Whitney-U test
Fig. 2
Fig. 2
Left ventricular circumferential and longitudinal strain and strain rate during head-up tilt testing. p-values were calculated using the Mann-Whitney-U test
Fig. 3
Fig. 3
Echocardiographic image examples of speckle tracking derived left ventricular circumferential (a) and longitudinal (b) strain rate analyses in a patient with neurocardiogenic syncope
See this image and copyright information in PMC

References

    1. Kapoor WN. Syncope. N Engl J Med. 2000;343(25):1856–1862. doi: 10.1056/NEJM200012213432507. - DOI - PubMed
    1. Friedman KG, Alexander ME. Chest pain and syncope in children: a practical approach to the diagnosis of cardiac disease. J Pediatr. 2013;163(3):896–901. doi: 10.1016/j.jpeds.2013.05.001. - DOI - PMC - PubMed
    1. Lewis DA, Dhala A. Syncope in the pediatric patient. The cardiologist's perspective. Pediatr Clin N Am. 1999;46(2):205–219. doi: 10.1016/S0031-3955(05)70113-9. - DOI - PubMed
    1. Massin MM, Bourguignont A, Coremans C, Comte L, Lepage P, Gerard P. Syncope in pediatric patients presenting to an emergency department. J Pediatr. 2004;145(2):223–228. doi: 10.1016/j.jpeds.2004.01.048. - DOI - PubMed
    1. Pratt JL, Fleisher GR. Syncope in children and adolescents. Pediatr Emerg Care. 1989;5(2):80–82. doi: 10.1097/00006565-198906000-00002. - DOI - PubMed

Publication types

MeSH terms