Echocardiographic Normal Reference Ranges for Non-invasive Myocardial Work Parameters in Pediatric Age: Results From an International Multi-Center Study

Jolanda Sabatino; Isabella Leo; Antonio Strangio; Sabrina La Bella; Nunzia Borrelli; Martina Avesani; Manjit Josen; Josefa Paredes; Enrico Piccinelli; Domenico Sirico; Valeria Pergola; Alain Fraisse; Salvatore De Rosa; Ciro Indolfi; Giovanni Di Salvo

doi:10.3389/fcvm.2022.792622

Echocardiographic Normal Reference Ranges for Non-invasive Myocardial Work Parameters in Pediatric Age: Results From an International Multi-Center Study

Front Cardiovasc Med. 2022 Apr 25:9:792622. doi: 10.3389/fcvm.2022.792622. eCollection 2022.

Authors

Jolanda Sabatino^{1

2

3

4

5

6}, Isabella Leo³, Antonio Strangio³, Sabrina La Bella³, Nunzia Borrelli^{5

6}, Martina Avesani^{1

5

6}, Manjit Josen^{5

6}, Josefa Paredes^{5

6}, Enrico Piccinelli^{5

6}, Domenico Sirico^{1

5

6}, Valeria Pergola⁷, Alain Fraisse^{5

6}, Salvatore De Rosa^{3

4}, Ciro Indolfi^{3

4}, Giovanni Di Salvo^{1

2

5

6}

Affiliations

¹ Division of Paediatric Cardiology, Department of Women's and Children's Health, University Hospital Padua, Padua, Italy.
² Pediatric Research Institute (IRP) "Città della Speranza", Padua, Italy.
³ Division of Cardiology, Department of Medical and Surgical Science, Magna Graecia University, Catanzaro, Italy.
⁴ Cardiovascular Research Center, Magna Graecia University, Catanzaro, Italy.
⁵ Department of Paediatric Cardiology, Royal Brompton Hospital, London, United Kingdom.
⁶ National Heart and Lung Institute, Imperial College, London, United Kingdom.
⁷ Department of Cardiac Thoracic Vascular Sciences and Public Health, University of Padua, Padua, Italy.

Abstract

Aims: This international multi-center study aimed to demonstrate the feasibility and reliability of non-invasive myocardial work (MW) parameters in the pediatric population, and to provide normal reference ranges for this useful echocardiographic tool in this specific subset of patients.

Methods and results: In this retrospective multi-center study involving three pediatric laboratories, 150 healthy children and adolescents (mean age of 10.6 ± 4.5, 91 males) were enrolled. A complete echocardiographic examination has been performed, including global longitudinal strain (GLS) assessment. The following parameters of non-invasive MW have been obtained through a dedicated software: global work index (GWI), global constructive work (GCW), global work waste (GWW), and global work efficiency (GWE), using left ventricular (LV) strain loops and non-invasive brachial artery cuff pressure values. The lowest expected values were for GWI 1,723 mmHg% in males and 1,682 mmHg% in females, for GCW 2,089 and 2,106 mmHg%, for GWE 95.9 and 95.5% whereas the highest expected value for GWW was 78 mmHg% in men and 90 mmHg% in women. The univariable and multivariable analysis showed significant associations between either GWI or GCW with SBP (β coefficient = 0.446, p < 0.001; β coefficient = 0.456, p < 0.001, respectively) and LV GLS (β coefficient = -0.268, p = 0.001; β coefficient = -0.233, p = 0.003, respectively). Inter- and intra-observer variability showed good reproducibility of non-invasive MW parameters.

Conclusion: Non-invasive MW parameters were feasible and reliable in the pediatric population. This study provided normal reference ranges of these useful echocardiographic indices.

Keywords: advanced echocardiography; congenital heart disease; myocardial work indices; speckle tracking analysis; systolic function.