Cardiac strain findings in children with latent rheumatic heart disease detected by echocardiographic screening

Andrea Beaton, Hedda Richards, Michelle Ploutz, Lasya Gaur, Twalib Aliku, Peter Lwabi, Greg Ensing, Craig Sable

Research output: Contribution to journalArticle

Abstract

Background: Identification of patients with latent rheumatic heart disease by echocardiography presents a unique opportunity to prevent disease progression. Myocardial strain is a more sensitive indicator of cardiac performance than traditional measures of systolic function. Objective: The objective of this study was to test the hypothesis that abnormalities in myocardial strain may be present in children with latent rheumatic heart disease. Methods: Standard echocardiography images with electrocardiogram gating were obtained from Ugandan children found to have latent rheumatic heart disease as well as control subjects. Traditional echocardiography measures of systolic function were obtained, and offline global longitudinal strain analysis was performed. Comparison between groups was performed using strain as a continuous (Mann–Whitney U-test) and categorical (cut-off 5th percentile for age) variable. Results: Our study included 14 subjects with definite rheumatic heart disease, 13 with borderline rheumatic heart disease, and 112 control subjects. None of the subjects had abnormal left ventricular size or ejection fraction. Global longitudinal strain was lower than the 5th percentile in 44% of the subjects with any rheumatic heart disease (p=0.002 versus controls) and 57% of the subjects with definite rheumatic heart disease (p=0.03). The mean absolute strain values were significantly lower when comparing subjects with any rheumatic heart disease with controls (20.4±3.95 versus 22.4±4.35, p=0.025) and subjects with definite rheumatic heart disease with controls (19.9±4.25 versus 22.4±4.35, p=0.033). Conclusion: Global longitudinal strain is decreased in subjects with rheumatic heart disease in the absence of abnormal systolic function. Larger studies with longer-term follow-up are required to determine whether there is a role for strain to help better understand the pathophysiology of latent rheumatic heart disease.

Original languageEnglish (US)
Pages (from-to)1-6
Number of pages6
JournalCardiology in the Young
DOIs
StateAccepted/In press - Jan 16 2017

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Rheumatic Heart Disease
Echocardiography
Disease Progression
Electrocardiography

Keywords

  • echocardiographic screening
  • myocardial strain
  • Rheumatic heart disease

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Cardiology and Cardiovascular Medicine

Cite this

Cardiac strain findings in children with latent rheumatic heart disease detected by echocardiographic screening. / Beaton, Andrea; Richards, Hedda; Ploutz, Michelle; Gaur, Lasya; Aliku, Twalib; Lwabi, Peter; Ensing, Greg; Sable, Craig.

In: Cardiology in the Young, 16.01.2017, p. 1-6.

Research output: Contribution to journalArticle

Beaton, Andrea ; Richards, Hedda ; Ploutz, Michelle ; Gaur, Lasya ; Aliku, Twalib ; Lwabi, Peter ; Ensing, Greg ; Sable, Craig. / Cardiac strain findings in children with latent rheumatic heart disease detected by echocardiographic screening. In: Cardiology in the Young. 2017 ; pp. 1-6.
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abstract = "Background: Identification of patients with latent rheumatic heart disease by echocardiography presents a unique opportunity to prevent disease progression. Myocardial strain is a more sensitive indicator of cardiac performance than traditional measures of systolic function. Objective: The objective of this study was to test the hypothesis that abnormalities in myocardial strain may be present in children with latent rheumatic heart disease. Methods: Standard echocardiography images with electrocardiogram gating were obtained from Ugandan children found to have latent rheumatic heart disease as well as control subjects. Traditional echocardiography measures of systolic function were obtained, and offline global longitudinal strain analysis was performed. Comparison between groups was performed using strain as a continuous (Mann–Whitney U-test) and categorical (cut-off 5th percentile for age) variable. Results: Our study included 14 subjects with definite rheumatic heart disease, 13 with borderline rheumatic heart disease, and 112 control subjects. None of the subjects had abnormal left ventricular size or ejection fraction. Global longitudinal strain was lower than the 5th percentile in 44{\%} of the subjects with any rheumatic heart disease (p=0.002 versus controls) and 57{\%} of the subjects with definite rheumatic heart disease (p=0.03). The mean absolute strain values were significantly lower when comparing subjects with any rheumatic heart disease with controls (20.4±3.95 versus 22.4±4.35, p=0.025) and subjects with definite rheumatic heart disease with controls (19.9±4.25 versus 22.4±4.35, p=0.033). Conclusion: Global longitudinal strain is decreased in subjects with rheumatic heart disease in the absence of abnormal systolic function. Larger studies with longer-term follow-up are required to determine whether there is a role for strain to help better understand the pathophysiology of latent rheumatic heart disease.",
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