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Archives of cardiovascular diseases
Volume 106, n° 4
pages 263-264 (avril 2013)
Doi : 10.1016/j.acvd.2013.03.049
Feasibility and reproducibility of tissue motion annular displacement of mitral valve in children with and without heart disease

V. Chelini, S. Hascoet, K. Hadeed, O. Weil, M. Peyre, Y. Dulac, P. Acar
 CHU Hôpital des Enfants, Toulouse, France 

Objectives .– New parameters of systolic left ventricular (LV) function using speckle tracking echocardiography are available. Little is known about the accuracy of these parameters in children. The aim of this study was to define the feasibility and reproducibility of tissue motion annular displacement of mitral valve (TMAD) in children with and without heart disease. We also aimed to assess the correlations between TMAD and usual left ventricular systolic function parameters.

Patients and methods .– We included in this prospective monocentric study 22 children with cardiopathy (13 boys, mean age 104months) and 22 healthy children (12 boys, mean age 116months). TMAD relies on strain vectors measured by speckle tracking technique. Cine loops were registered during a standard 2D echocardiography in the apical four-chamber view allowing a good visualization of the mitral annulus and the left ventricular apex. Cine loops were analyzed using off-line QLAB 9® software (Philips Medical Systems). Three regions of interest (ROI) were placed: two at the septal and lateral parts of the mitral annulus and the third at the apex. The displacement of the midpoint between the two annular ROIs toward the apex was automatically calculated.

Results .– TMAD indexed feasibility was 100% (CI95% 94.8–100%) in children with cardiopathy and 86% (CI95% 71.5–100%) in healthy children. Feasibility of TMAD was not significantly different between children with or without cardiopathy. Intraobserver variability of TMAD was respectively 19% and 11% in children with and without cardiopathy. Interobserver variability of TMAD was respectively 19% and 16% in children with and without cardiopathy. TMAD was not correlated to age nor to body surface area. TMAD was not correlated to LV ejection fraction using biplane Simpson methods in healthy children whereas indexed TMAD was correlated to stroke volume (r =0.591, P =0.0122), cardiac index (r =0.532, P =0.0241), indexed TAPSE (r =0.691, P =0.0034) and conversely correlated to end-diastolic LV diameter (r =−0.677, P =0.0041), to end-diastolic LV volume (r =−0.629, P =0.0076) and to end-systolic LV volume (r =−0.616, P =0.0090) in healthy children.

Conclusion .– Speckle tracking is a promising technology to assess myocardial strain. However, feasibility and reproducibility of new systolic parameters such as twist are low. Conversely, TMAD using speckle-tracking technology seems an easy measurable marker with an excellent feasibility and reproducibility to assess the mitral annular displacement. It seems independent of body surface area and well correlated with stroke volume. The advantage of TMAD over tissue Doppler imaging relies on the peculiarities of speckle tracking technology. Speckle tracking is angle independent and thereby permits the measurement of strain vectors that are not parallel to the ultrasound beam. TMAD is an interesting tool in children. Its accuracy to estimate systolic function needs to be further investigated in children.

© 2013  Published by Elsevier Masson SAS.
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