Subtle myocardial effects of rheumatic heart disease in children are revealed earlier with two-dimensional speckle tracking echocardiography

Hüseyin Ilgın Bal, İrem Türkyılmaz, Ş. Kayalı, Ayhan Kılıç
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Abstract

Objective. Rheumatic heart disease (RHD) is the most common cause of acquired heart disease in developing countries and remains a serious public health problem. In the subclinical course of carditis, the absence of typical symptoms and the normal range of classical echocardiographic measurements used to evaluate cardiac functions have required new echocardiographic methods and parameters. Previous studies regarding rheumatic heart disease in children and adults have shown that strain patterns obtained by speckle tracking echocardiography, are in fact affected although left ventricular systolic functions are preserved, yet some studies have suggested otherwise. The aim of our study is to compare the use of speckle tracking echocardiography with conventional methods in the evaluation of cardiac functions and myocardial involvement in children with subclinical RHD. Materials and Methods. The study group consisted of 24 patients with asymptomatic cardiovascular who had no history of acute rheumatic fever, but had definite or probable rheumatic valve disease. This study group was determined according to the World Heart Federation guidelines by an echocardiographic examination performed for different reasons, as well as the control group of 22 healthy children. In order to evaluate the left ventricular regional myocardial functions of the patients, tissue Doppler echocardiography (TDE) and speckle tracking echocardiographic parameters were compared with the control group. Results. The mean ages of the patient and control groups were 14.1±2.7 years and 13.9±2.3 years, respectively. There was no statistically significant difference between the two groups in terms of conventional methods (p>0.05) but global longitudinal strain and strain rate values were found to be significantly lower in the patient group (p<0.01). These changes appeared to be relevant throughout the duration of the illness. Conclusion. In patients with subclinical rheumatic heart disease, conventional echocardiographic evaluations are likely negative, whereas two-dimensional speckle tracking echocardiography reveal systolic and diastolic dysfunctions of the disease.
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二维斑点追踪超声心动图能更早发现儿童风湿性心脏病对心肌的微妙影响
目的。风湿性心脏病(RHD)是发展中国家最常见的后天性心脏病,仍然是一个严重的公共卫生问题。在心脏炎的亚临床病程中,由于没有典型症状,而且用于评估心脏功能的经典超声心动图测量值范围正常,因此需要新的超声心动图方法和参数。以往关于儿童和成人风湿性心脏病的研究表明,虽然左心室收缩功能保持不变,但斑点追踪超声心动图获得的应变模式实际上会受到影响,但也有一些研究提出了相反的观点。我们的研究旨在比较使用斑点追踪超声心动图和传统方法评估亚临床 RHD 儿童的心脏功能和心肌受累情况。研究组由 24 名无症状心血管患者组成,他们没有急性风湿热病史,但有明确或可能的风湿性瓣膜病。该研究组是根据世界心脏联盟的指南,通过因不同原因进行的超声心动图检查确定的,同时还包括由 22 名健康儿童组成的对照组。为了评估患者的左心室区域心肌功能,组织多普勒超声心动图(TDE)和斑点追踪超声心动图参数与对照组进行了比较。患者组和对照组的平均年龄分别为(14.1±2.7)岁和(13.9±2.3)岁。两组在常规方法上无明显统计学差异(P>0.05),但发现患者组的整体纵向应变和应变率值明显较低(P<0.01)。这些变化似乎与整个病程有关。在亚临床风湿性心脏病患者中,常规超声心动图评估很可能是阴性的,而二维斑点追踪超声心动图可显示疾病的收缩和舒张功能障碍。
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