Myocardial work during various right ventricle load conditions in pediatric congenital heart disease - 04/09/25
, Hadeed Khaled 2, Philippe Acar 1, Pierrick Pyra 3, Aitor Guitarte 3, Paul Vignaud 1, Yves Dulac 3, Clement Karsenty 4
Bienvenue sur EM-consulte, la référence des professionnels de santé.
Article gratuit.
Connectez-vous pour en bénéficier!
Abstract |
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 (Fig. 1).
Results |
Both overload groups showed RV enlargement (95±24ml/m2 in the pressure overload group and 119±25ml/m2 in the volume overload group versus 53±14ml/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.
Le texte complet de cet article est disponible en PDF.Plan
Vol 118 - N° 8-9S
P. S281 - septembre 2025 Retour au numéro
Article précédent
- Left atrial strain abnormalities and history of life-threatening arrhythmia in corrected tetralogy of Fallot : A cardiac MRI analysis
- Arthur Missana, Nunes Ferreira, Thomas Foulon, Pascale Maragnes, Cynthia Cousergue, Michèle Hamon, Fabien Labombarda
- Prevalence and Clinical Impact of Myocardial Crypts in FBN1 mutation: New Insights from CT Imaging in Marfan Syndrome
- Ronan Mirabello, Jocelyn Domagne, Laurent Chaussavoine, Michèle Hamon, Fabien Labombarda
Bienvenue sur EM-consulte, la référence des professionnels de santé.