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Subtle Myocardial Dysfunction and Fibrosis in Children with Rheumatic Heart Disease: Insight from 3D Echocardiography, 3D Speckle Tracking and Cardiac Magnetic Resonance Imaging

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Abstract

Rheumatic heart disease (RHD) is a major cause of morbidity and mortality in developing countries, so early diagnosis and treatment can reduce morbidity and mortality resulting from subsequent valvular damage. The aim of this study was to detect subtle myocardial dysfunction among children with RHD with preserved left ventricular systolic function. This is a cross-sectional case–control study that was conducted on 30 children with RHD (who had valvular affection of any degree and were not in activity) compared to 23 healthy children. After history taking and cardiac examination, 2D echocardiography, tissue Doppler imaging, 3D-echocardiography and 3D speckle tracking echocardiography were done to both groups, whereas cardiac magnetic resonance imaging was done only to the patient group. The 3D-derived left ventricular end-diastolic volume and sphericity index among patients were significantly increased when compared to controls [131.5 (101.5 to 173.7) vs. 69 (58 to 92), P = 0.001, and 0.46 (0.36 to 0.59) vs. 0.33 (0.29 to 0.38), P = 0.001, respectively]. The 3D-derived ejection fraction and longitudinal strain did not differ significantly among both groups. The 3D-derived global circumferential strain was higher in patients when compared to controls [− 14 (− 16 to − 10) vs. − 11(− 13 to − 10), P = 0.04]. None of the examined patients demonstrated late enhancement myocardial fibrosis. In children with RHD and preserved systolic function, subtle systolic dysfunction could not be detected using conventional and novel non-conventional methods. This may indicate that the myocardial affection during the acute stage of rheumatic carditis is minimal with almost complete resolution.

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This research received no grant from any funding agency in the public, commercial or not-for-profit sectors.

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Authors and Affiliations

  1. Pediatric Cardiology Unit, Department of Pediatrics, Cairo University Children’s Hospital, Cairo University, 2 Aly Basha Ibrahim Street, PO Box: 11111, Cairo, Egypt

    R. Sobhy, M. Samir, G. Abdelmohsen, H. Ibrahim, M. Y. Abd El Rahman, N. Abdelrahman & H. Hamza

  2. Department of Radiology, Cairo University, Cairo, Egypt

    N. Behairy & O. Imam

Authors
  1. R. Sobhy
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  2. M. Samir
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  3. G. Abdelmohsen
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  4. H. Ibrahim
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  5. M. Y. Abd El Rahman
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  6. N. Abdelrahman
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  7. N. Behairy
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  8. O. Imam
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  9. H. Hamza
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Correspondence to R. Sobhy.

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The authors declare that there is no conflict of interests.

Ethical Standard

All procedures that were performed were in accordance with the ethical standards of the Kasr Al Ainy Research Committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. The study protocol was approved by the institutional review board.

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Sobhy, R., Samir, M., Abdelmohsen, G. et al. Subtle Myocardial Dysfunction and Fibrosis in Children with Rheumatic Heart Disease: Insight from 3D Echocardiography, 3D Speckle Tracking and Cardiac Magnetic Resonance Imaging. Pediatr Cardiol 40, 518–525 (2019). https://doi.org/10.1007/s00246-018-2006-5

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  • DOI: https://doi.org/10.1007/s00246-018-2006-5

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