Value of Three-Dimensional Speckle-Tracking in Detecting Left Ventricular Dysfunction in Patients with Valvular Diseases

Abstract

SUMMARY L eft ventricular (LV) dysfunction has long been regarded as the main determinant of clinical symptoms, functional class, and prognosis. Accurate quantification of (LV) function has become the accepted standard rather than the more traditional estimate used in many echo laboratories, because many critical clinical decisions rest on the degree of LV dysfunction (Olszewski et al., 2007). Valvular heart disease (VHD) burdens the left ventricle with a volume load that leads to a series of left ventricular (LV) compensatory adaptations and adjustments that vary considerably during the prolonged clinical course of valve disease. Valvular heart disease promotes left ventricular dilatation and eccentric remodeling (Teoh et al., 1990). Echocardiography remains the first-line test for assessing cardiac function in routine clinical practice. And LV ejection fraction (LVEF) is the most popular index of myocardial systolic function (Yip et al., 2011). The newly developed three-dimensional speckle tracking echocardiography (STE) provides a fast and comprehensive quantitative assessment of LV myocardial dynamics in all four dimensions, and does so with all LV segments in their spatial and temporal relation to each other within the same data set (Perez et al., 2009). The Aim of this work was to assess the value of three-dimensional speckle-tracking echocardiography for the detection of subclinical left ventricular dysfunction in patients with valvular heart disease and to compare it with conventional 2D echocardiography. This study was conducted at the Pediatric Cardiology Clinic, Pediatric Department at Ain Shams University, over the period from October 2014 to August 2015 on 30 patients with isolated valvular heart disease either congenital or rheumatic heart disease. All Studied Children were Subjected to:  Thorough history taking laying stress on symptoms of rheumatic fever or heart failure  Detailed clinical general and local cardiac examination lying stress on weight, height Body mass index,Blood pressure and Pulse  Precordial examination with special emphasis on eliciting special character of murmur associated valvular lesions.  Signs of LV dysfunction as or pulmonary hypertension.  Transthoracic Echocardiographic imaging routine 2D echocardiography to delineate the valve lesion, cardiac chamber dimensions, presence of pulmonary hypertensionand to exclude any other heart disease. M-mode echocardiography to assess the left ventricle dimension, systolic function and diastolic function. Also continuous pulsed, color Doppler echocardiography and 3D speckle tracking echocardiography to evaluate left ventricular function usinga commercially available cardiac ultrasound unit device model (VIVID E9 GE Vingmed ultrasound system, A/S N-3191Horten Norway). The age of the studied group ranged from (6) years to (16) years, with mean of (11.37) years and SD of (± 2.91), their weight ranged from (18) kg to (49) kg with mean (33.28) kg and SD of (± 9.13), their height ranged from (108) cm to (159) cm with mean of (138.73) cm and SD of (± 15.10). (26.7%) of studied patients have valve affection due to congenital causes while (73.3%) due to rheumatic causes. (60%) of studied patients was single valve affection while (40%) was multiple valve affection. The most prevalent valve lesion was MR which represent (60%) of the all patients. The most prevalent treatment was long acting penicillin and antifailure drugs which represent (40%) of the patients. The weight, body mass index, systolic blood pressure and diastolic blood pressure showed statistically significant difference between patient and control group while sex and age detected no statistically significant. There was a statistically significant higher values of end systolic volume (ESV) and end diastolic volume (EDV) and among patient group when compared to the control group as regards mean value of M-mode echocardiography parameters There was a statistically significant lower values of stroke volume (SV) and ejection fraction (EF) among patient group when compared to the control groupas regards mean value of M-mode echocardiography parameters. There was a statistically significant higher values of the end systolic volume (ESV), end diastolic volume (EDV) and end systolic mass (ES mass) among patients group when compared to the control group. There was a statistically significant lower values of the ejection fraction (EF) among patients group when compared to the control group as regards mean value of 3D speckle echocardiography parameters. There was a statistically significant higher values of the end systolic mass (ES mass) and global peak longitudinal strain (GPSL) among male when compared to female patient as regards 3D speckle parameters.