Left atrial remodelling among Turner syndrome patients: novel insights from non-invasive 3D echocardiography

Mohamed Abd El Rahman; Anna-Maria Jung; Michael Zemlin; Tilman R Rohrer; Rita Schuck; Felix Sebastian Oberhoffer; Hashim Abdul-Khaliq

doi:10.21037/qims-21-515

Left atrial remodelling among Turner syndrome patients: novel insights from non-invasive 3D echocardiography

Quant Imaging Med Surg. 2022 May;12(5):2634-2648. doi: 10.21037/qims-21-515.

Authors

Mohamed Abd El Rahman^{1

2}, Anna-Maria Jung³, Michael Zemlin⁴, Tilman R Rohrer³, Rita Schuck^{5

6}, Felix Sebastian Oberhoffer^#^{1

7}, Hashim Abdul-Khaliq^#¹

Affiliations

¹ Department of Pediatric Cardiology, Saarland University Hospital, Homburg (Saar), Germany.
² Department of Pediatrics and Pediatric Cardiology, Cairo University, Cairo, Egypt.
³ Section for Pediatric Endocrinology, Department of General Pediatrics and Neonatology, Saarland University Medical Center, Homburg (Saar), Germany.
⁴ Department of General Pediatrics and Neonatology, Saarland University Hospital, Homburg (Saar), Germany.
⁵ Department of Congenital Heart Disease, German Heart Center Berlin, Berlin, Germany.
⁶ Department of Rheumatology, Knappschaftsklinikum Saar, Puettlingen, Germany.
⁷ Department of Pediatric Cardiology and Pediatric Intensive Care, Medical Hospital of the University of Munich, Ludwig Maximilians University Munich, Munich, Germany.

^# Contributed equally.

Abstract

Background: To assess (I) the left atrial (LA) size, function and (II) the impact of excess weight on the LA and left ventricular (LV) performance in Turner syndrome (TS) patients.

Methods: Twenty-five TS patients without congenital heart disease (CHD) and 19 healthy, age-matched controls underwent three-dimensional echocardiography (3DE) for LA volume measurements and two-dimensional speckle tracking echocardiography (2DSTE) for LA strain measurements. LV performance was measured through LV Tei-index, indexed isovolumetric contraction (ICT/√RR interval), indexed relaxation (IVRT/√RR interval) and indexed filling time (FT/√RR interval).

Results: Compared to healthy controls, normal-weight TS patients (n=16) displayed significantly increased heart rate (92.88±16.66 vs. 76.53±15.65 bpm; P=0.005), reduced indexed LV filling time (11.67±2.55 vs. 15.16±5.07; P=0.018), reduced 3D maximum LA volume at LV end systole/BSA (16.74±5.00 vs. 19.89±4.32 mL/m²; P=0.05), reduced 3D LA total emptying volume/BSA [10.04 (5.05/18.46) vs. 13.11 (7.69/18.46) mL/m²; P=0.001] and reduced 3D LA active emptying volume/BSA [2.61 (0.1/3.82) vs. 3.44 (1.64/6.37) mL/m²; P=0.006]. Compared to normal-weight TS patients, overweight/obese TS patients (n=9) showed impaired LV Tei-index [0.38 (0.26/0.55) vs. 0.27 (0.07/0.41); P=0.009], prolonged indexed IVRT (2.04±0.72 vs. 1.30±0.64; P=0.015), prolonged indexed ICT [1.96 (1.57/2.73) vs. 1.29 (0.35/2.69); P=0.009] and increased 3D LA active emptying volume/BSA (3.38±1.21 vs. 2.29±1.07 mL/m²; P=0.032).

Conclusions: Normal-weight TS patients with increased heart rate and reduced LV filling time display subtle LV diastolic dysfunction in the form of reduced LA reservoir and pump function. Manifested systolic and diastolic LV dysfunction among overweight TS patients is partially compensated through an increase in LA active pump function.

Keywords: 2D speckle tracking echocardiography; 3D echocardiography; Turner syndrome (TS); left atrium.