Atrial Function Impairments after Pediatric Cardiac Surgery Evaluated by STE Analysis

Abstract

Background: Applications of atrial speckle tracking echocardiography (STE) strain (ε) analysis in pediatric cardiac surgery have been limited. This study aims to evaluate the feasibility of atrial STE ε analysis and the progression of atrial ε values as a function of post-operative time in children after pediatric cardiac surgery. Methods: 131 children (mean 1.69 ± 2.98; range 0.01−15.16 years) undergoing cardiac surgery were prospectively enrolled. Echocardiographic examinations were performed pre-operatively and at 3 different post-operative intervals: Time 1 (24−36 h), Time 2 (3−5 days), Time 3 (>5 days, before discharging). The right and left atrium longitudinal systolic contractile (Ct), Conduit (Cd), and Reservoir (R) ε were evaluated with a novel atrial specific software with both P- and R-Gating methods. One hundred and thirty-one age-matched normal subjects (mean 1.7 ± 3.2 years) were included as controls. Results: In all, 309 examinations were performed over the post-operative times. For each post-operative interval, all STE atrial ε parameters assessed were significantly lower compared to controls (all p < 0.0001). The lowest atrial ε values were found at Time 1, with only partial recovery thereafter (p from 0.02 to 0.04). All atrial ε values at discharge were decreased compared to the controls (all p < 0.0001). Significant correlations of the atrial ε values with cardio-pulmonary-bypass time, left and right ventricular ε values (p < 0.05), and ejection fraction (p < 0.05) were demonstrated. Conclusions: Atrial ε is highly reduced after surgery with only partial post-operative recovery in the near term. Our study additionally demonstrates that post-surgical atrial and ventricular ε responses correlated with each other.

Keywords: STE echocardiography; atria; congenital heart disease; pediatric cardiac surgery.

Figure 1

Left atrial ε analysis in the four-chamber view by using the atrial specific software for strain STE analysis with P-gating method. LA = Left atrium, LV = Left Ventricle, RA = Right Atrium, RV = Right Ventricle, Sr = strain reservoir, Sct = strain contractile, Scd = strain conduit.

Figure 2

Left atrial ε analysis in the four-chamber view by using the atrial specific software for strain STE analysis with R-gating method. LA = Left atrium, LV = Left Ventricle, RA = Right Atrium, RV = Right Ventricle, Sr = strain reservoir, Sct = strain contractile, Scd = strain conduit.

Figure 3

Left Atrial Strain trends at different pre-/post-operative times and in comparison to the control group. Median and interquartile range of ε values over time are shown. p values in the patient group were determined relative to strain from Time 1 to Time 3. Horizontal line = median; Box = interquartile range.

Figure 4

Right Atrial Strain trends at different pre-/post-operative times and in comparison to the control group. Median and interquartile range of ε values over time are shown. p values in the patient group were determined relative to strain from Time 1 to Time 3. Horizontal line = median; Box = interquartile range.