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Archives of cardiovascular diseases
Volume 106, n° 4
page 263 (avril 2013)
Doi : 10.1016/j.acvd.2013.03.048

Feasibility and reproducibility of peak left ventricular twist in children with and without heart disease

V. Chelini a, S. Hascoet b, K. Hadeed b, O. Weil b, M. Peyre b, Y. Dulac b, P. Acar b
a CHU Hôpital des Enfants, Toulouse, France 
b CHU de Toulouse, 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 systolic peak left ventricular (LV) twist in healthy children and in children with heart disease. We also aimed to assess the correlations between left ventricular twist 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). Peak LV twist (difference between maximal apical rotation and maximal basal rotation obtained on para-sternal views) was measured off-line in a dedicated workstation (Qlab® 9). Feasibilities were compared within the two groups.

Results .– Peak LV twist feasibility was 77% (CI95% 59,4–94,6%) in patients and 64% (CI95% 43,9–84,1%) in healthy children. Feasibility of twist was not significantly different between children with or without cardiopathy. Intraobserver variability of peak LV twist was 43% in patients and 41% in healthy children. Interobserver variability of peak LV twist was 39% in patients and 36% in healthy children. Peak LV twist was correlated to body surface area (r =0.631, P =0.0229). Indexed Peak LV twist was significantly correlated to Simpson's LV ejection fraction (r =0.678, P =0.0146) and conversely correlated with indexed end-systolic left ventricular volume (r =−0.604, P =0.0293) in healthy children unlike non-indexed Peak LV twist. Peak LV twist and indexed peak LV twist were not correlated to mitral annular mean maximal tissular doppler imaging velocity.

Conclusion .– Despite a promising concept to assess systolic function, feasibility of peak LV twist is currently low in child with heart disease and also in healthy children. Intra and inter observer variabilities are high. The high heart rate variability and the difficulty to acquire echo loops without any movement in children may be the limiting factors. Therefore, it seems too early to extend the use of these parameters in clinical practice. The improvement of speckle tracking technology and a thorough formation of operators are probably necessary before using this new promising parameter in clinical practice.

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