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

Published online by Cambridge University Press:  16 January 2017

Andrea Beaton ,
Hedda Richards ,
Michelle Ploutz ,
Lasya Gaur ,
Twalib Aliku ,
Peter Lwabi ,
Greg Ensing  and
Craig Sable
Andrea Beaton
Affiliation:
Division of Cardiology, Children’s National Health System, Washington, District of Columbia, United States of America
Hedda Richards
Affiliation:
Division of Cardiology, Children’s National Health System, Washington, District of Columbia, United States of America
Michelle Ploutz
Affiliation:
Division of Cardiology, Children’s National Health System, Washington, District of Columbia, United States of America
Lasya Gaur
Affiliation:
Division of Pediatric Cardiology, Johns Hopkins University, Baltimore, Maryland, United States of America
Twalib Aliku
Affiliation:
Department of Pediatrics, Gulu University, Gulu, Uganda
Peter Lwabi
Affiliation:
Uganda Heart Institute, Mulago Hospital, Kampala, Uganda
Greg Ensing
Affiliation:
Division of Cardiology, University of Michigan, Mott Children’s Hospital, Ann Arbor, Michigan, United States of America
Craig Sable*
Affiliation:
Division of Cardiology, Children’s National Health System, Washington, District of Columbia, United States of America
*
Correspondence to: C. Sable, MD, Division of Cardiology, Children’s National Health System, 111 Michigan Avenue, NW, Washington, DC 20010, United States of America. Tel: +1 202 476 2020; Fax: +1 202 476 5700; E-mail: csable@childrensnational.org
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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.

Keywords

Rheumatic heart diseaseechocardiographic screeningmyocardial strain
Type
Original Articles
Information
Cardiology in the Young , Volume 27 , Issue 6 , August 2017 , pp. 1180 - 1185
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Copyright
© Cambridge University Press 2017 

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