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Early changes in right ventricular function and their clinical consequences in childhood and adolescent dilated cardiomyopathy

Published online by Cambridge University Press:  27 April 2010

Lars Grosse-Wortmann ,
Susan L. Roche ,
Shi-Joon Yoo ,
Mike Seed  and
Paul Kantor
Lars Grosse-Wortmann*
Affiliation:
The Labatt Family Heart Centre, Division of Cardiology, Department of Paediatrics, The Hospital for Sick Children, The University of Toronto, Toronto, Canada Department of Diagnostic Imaging, The Hospital for Sick Children, The University of Toronto, Toronto, Canada
Susan L. Roche
Affiliation:
The Labatt Family Heart Centre, Division of Cardiology, Department of Paediatrics, The Hospital for Sick Children, The University of Toronto, Toronto, Canada
Shi-Joon Yoo
Affiliation:
The Labatt Family Heart Centre, Division of Cardiology, Department of Paediatrics, The Hospital for Sick Children, The University of Toronto, Toronto, Canada Department of Diagnostic Imaging, The Hospital for Sick Children, The University of Toronto, Toronto, Canada
Mike Seed
Affiliation:
The Labatt Family Heart Centre, Division of Cardiology, Department of Paediatrics, The Hospital for Sick Children, The University of Toronto, Toronto, Canada Department of Diagnostic Imaging, The Hospital for Sick Children, The University of Toronto, Toronto, Canada
Paul Kantor
Affiliation:
The Labatt Family Heart Centre, Division of Cardiology, Department of Paediatrics, The Hospital for Sick Children, The University of Toronto, Toronto, Canada
*
Correspondence to: Dr L. Grosse-Wortmann MD, The Labatt Family Heart Centre, Division of Cardiology, Department of Paediatrics, The Hospital for Sick Children, 555 University Avenue, M5G 1X8, Toronto, Ontario, Canada. Tel: +00 1 416 813 7326; Fax: +00 1 416 813 5857; E-mail: lars.grosse-wortmann@sickkids.ca
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Abstract

The aim of the paper was to investigate the right ventricle in paediatric dilated cardiomyopathy. We examined 11 patients with dilated cardiomyopathy as well as 12 normal paediatric controls. Cardiac magnetic resonance imaging was performed for ventricular size and function. N-terminal pro-brain natriuretic peptide was collected at this time and the results from the most recent echocardiogram and exercise test were reviewed.

We found that patients with dilated cardiomyopathy had significantly faster heart rates, that is, 85 versus 65 beats per minute, lower left ventricular ejection fraction, that is, 42 versus 61%, and right ventricular ejection fraction of 44 versus 54%, lower left and right ventricular stroke volumes, that is, 35.5 versus 49.5 millilitres per square metre and 40.9 versus 56.4 millilitres per square metre, respectively, and lower mitral and tricuspid valve inflow e/a wave velocity ratios of 2.02 versus 2.80 and 1.25 versus 2.58, respectively, than the controls. Tricuspid valve annulus velocity, measured by tissue Doppler echocardiography, correlated with right ventricular ejection fraction (r = 0.60, p = 0.05). Right ventricular ejection fraction and indexed right ventricular end-diastolic volume correlated with N-terminal pro-brain natriuretic peptide (r = −0.67, p = 0.03, r = 0.65, p = 0.04, respectively), and right ventricular ejection fraction correlated with the oxygen uptake at the anaerobic threshold (r = 0.67, p = 0.049). Neither left ventricular ejection fraction nor left ventricular volume correlated with N-terminal pro-brain natriuretic peptide or exercise tolerance. The right ventricular function is decreased in the early stages of dilated cardiomyopathy. Right ventricular size and ejection fraction may be important indicators of sub-clinical cardiac failure and we suggest monitoring them routinely in dilated cardiomyopathy.

Keywords

Magnetic resonance imagingventricular volumeechocardiography
Type
Original Articles
Information
Cardiology in the Young , Volume 20 , Issue 4 , August 2010 , pp. 418 - 425
Copyright
Copyright © Cambridge University Press 2010

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