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. 2022 Apr 25:9:792622.
doi: 10.3389/fcvm.2022.792622. eCollection 2022.

Echocardiographic Normal Reference Ranges for Non-invasive Myocardial Work Parameters in Pediatric Age: Results From an International Multi-Center Study

Jolanda Sabatino  1   2   3   4   5   6 , Isabella Leo  3 , Antonio Strangio  3 , Sabrina La Bella  3 , Nunzia Borrelli  5   6 , Martina Avesani  1   5   6 , Manjit Josen  5   6 , Josefa Paredes  5   6 , Enrico Piccinelli  5   6 , Domenico Sirico  1   5   6 , Valeria Pergola  7 , Alain Fraisse  5   6 , Salvatore De Rosa  3   4 , Ciro Indolfi  3   4 , Giovanni Di Salvo  1   2   5   6
Affiliations

Echocardiographic Normal Reference Ranges for Non-invasive Myocardial Work Parameters in Pediatric Age: Results From an International Multi-Center Study

Jolanda Sabatino et al. Front Cardiovasc Med. .

Abstract

Aims: This international multi-center study aimed to demonstrate the feasibility and reliability of non-invasive myocardial work (MW) parameters in the pediatric population, and to provide normal reference ranges for this useful echocardiographic tool in this specific subset of patients.

Methods and results: In this retrospective multi-center study involving three pediatric laboratories, 150 healthy children and adolescents (mean age of 10.6 ± 4.5, 91 males) were enrolled. A complete echocardiographic examination has been performed, including global longitudinal strain (GLS) assessment. The following parameters of non-invasive MW have been obtained through a dedicated software: global work index (GWI), global constructive work (GCW), global work waste (GWW), and global work efficiency (GWE), using left ventricular (LV) strain loops and non-invasive brachial artery cuff pressure values. The lowest expected values were for GWI 1,723 mmHg% in males and 1,682 mmHg% in females, for GCW 2,089 and 2,106 mmHg%, for GWE 95.9 and 95.5% whereas the highest expected value for GWW was 78 mmHg% in men and 90 mmHg% in women. The univariable and multivariable analysis showed significant associations between either GWI or GCW with SBP (β coefficient = 0.446, p < 0.001; β coefficient = 0.456, p < 0.001, respectively) and LV GLS (β coefficient = -0.268, p = 0.001; β coefficient = -0.233, p = 0.003, respectively). Inter- and intra-observer variability showed good reproducibility of non-invasive MW parameters.

Conclusion: Non-invasive MW parameters were feasible and reliable in the pediatric population. This study provided normal reference ranges of these useful echocardiographic indices.

Keywords: advanced echocardiography; congenital heart disease; myocardial work indices; speckle tracking analysis; systolic function.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Non-invasive myocardial work indices in the study population. Mean values of non-invasive myocardial work parameters according to gender and age categories.
Figure 2
Figure 2
Inter-observer reproducibility. The Bland Altman analysis was performed to assess in a sample of patients the inter-observer variability of the main indices of non-invasive myocardial work. Continuous line represents mean values for each parameter, and dotted lines represent bias and 95% limits of agreement.
Figure 3
Figure 3
Representative schema of myocardial work calculation with reference cut-off values for age subgroups. LV global longitudinal strain measurement combined with the non-invasive blood pressure systolic and diastolic values, obtained by a brachial-cuff aneroid sphygmomanometer, is plugged into dedicated software. The time of opening and closure of the aortic and mitral valve is identified by the operator. Then, a trace showing the LV pressure-strain loop and a 17-segment bull's-eye of the MW index is calculated. At the bottom, the table resumes the normal reference ranges for each myocardial work parameter in the overall population and for each age group. GLS, global longitudinal strain; AVC, aortic valve closure; AVO, aortic valve opening; MVC, mitral valve closure; MWO, mitral valve opening; LV, left ventricular; MW, myocardial work.
See this image and copyright information in PMC

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