Assessment of Left-ventricular Diastolic Function in Pediatric Intensive-care Patients: a Review of Parameters and Indications Compared with Those for Adults

Overview

Journal World J Pediatr

Specialty Pediatrics

Date 2020 Jun 8

PMID 32506345

Citations 4

Authors

Morgan Recher

Astrid Botte

Jerome Soquet

Jean-Benoit Baudelet

Francois Godart

Stephane Leteurtre

Affiliations

Soon will be listed here.

Abstract

Background: The incidence of diastolic heart failure has increased over time. The evaluation of left-ventricular diastolic function is complex, ongoing, and remains poorly performed in pediatric intensive-care patients. This study aimed to review the literature and to provide an update on the evaluation of left-ventricular diastolic function in adults and children in intensive care.

Data Sources: We searched data from PubMed/Medline. Thirty-two studies were included. Four pragmatic questions were identified: (1) What is the physiopathology of diastolic dysfunction? (2) Which tools are required to evaluate diastolic function? (3) What are the echocardiographic criteria needed to evaluate diastolic function? (4) When should diastolic function be evaluated in pediatric intensive care?

Results: Early diastole allows characterization of relaxation, whereas compliance assessments and filling pressures are evaluated during late diastole. The evolution of diastolic function differs between adults and children. Unlike in adults, decreased compliance occurs at the same time as delayed relaxation in children. Diastolic function can be evaluated by Doppler echocardiography. The echocardiographic criteria for ventricular relaxation include the E wave, E/A wave ratio, and isovolumic relaxation time. Ventricular compliance can be assessed by the E/e' wave ratio, atrial volume, and Ap wave duration during pulmonary vein flow. In adult intensive-care patients, the E/e' ratio can be used as an index of tolerance for volume expansion in septic patients and to adjust the inotropic support.

Conclusion: Clinical studies would allow some of these parameters to be validated for use in children in intensive care.

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References

Yu C, Lin H, Yang H, Kong S, Zhang Q . Progression of systolic abnormalities in patients with "isolated" diastolic heart failure and diastolic dysfunction. Circulation. 2002; 105(10):1195-201. DOI: 10.1161/hc1002.105185. View

Clarkson P, Wheeldon N, MacDonald T . Left ventricular diastolic dysfunction. Q J Med. 1994; 87(3):143-8. View

Gaasch W . Diagnosis and treatment of heart failure based on left ventricular systolic or diastolic dysfunction. JAMA. 1994; 271(16):1276-80. View

Owan T, Hodge D, Herges R, Jacobsen S, Roger V, Redfield M . Trends in prevalence and outcome of heart failure with preserved ejection fraction. N Engl J Med. 2006; 355(3):251-9. DOI: 10.1056/NEJMoa052256. View

Owan T, Redfield M . Epidemiology of diastolic heart failure. Prog Cardiovasc Dis. 2005; 47(5):320-32. DOI: 10.1016/j.pcad.2005.02.010. View

Zile M, Baicu C, Gaasch W . Diastolic heart failure--abnormalities in active relaxation and passive stiffness of the left ventricle. N Engl J Med. 2004; 350(19):1953-9. DOI: 10.1056/NEJMoa032566. View

Greenstein Y, Mayo P . Evaluation of Left Ventricular Diastolic Function by the Intensivist. Chest. 2017; 153(3):723-732. DOI: 10.1016/j.chest.2017.10.032. View

Tissot C, Singh Y, Sekarski N . Echocardiographic Evaluation of Ventricular Function-For the Neonatologist and Pediatric Intensivist. Front Pediatr. 2018; 6:79. PMC: 5893826. DOI: 10.3389/fped.2018.00079. View

Paulus W, Tschope C, Sanderson J, Rusconi C, Flachskampf F, Rademakers F . How to diagnose diastolic heart failure: a consensus statement on the diagnosis of heart failure with normal left ventricular ejection fraction by the Heart Failure and Echocardiography Associations of the European Society of Cardiology. Eur Heart J. 2007; 28(20):2539-50. DOI: 10.1093/eurheartj/ehm037. View

10.

Senni M, Tribouilloy C, Rodeheffer R, Jacobsen S, Evans J, Bailey K . Congestive heart failure in the community: a study of all incident cases in Olmsted County, Minnesota, in 1991. Circulation. 1998; 98(21):2282-9. DOI: 10.1161/01.cir.98.21.2282. View

11.

Appleton C, Hatle L, Popp R . Relation of transmitral flow velocity patterns to left ventricular diastolic function: new insights from a combined hemodynamic and Doppler echocardiographic study. J Am Coll Cardiol. 1988; 12(2):426-40. DOI: 10.1016/0735-1097(88)90416-0. View

12.

Mawad W, Friedberg M . The continuing challenge of evaluating diastolic function by echocardiography in children: developing concepts and newer modalities. Curr Opin Cardiol. 2016; 32(1):93-100. DOI: 10.1097/HCO.0000000000000346. View

13.

Kawaguchi M, Hay I, Fetics B, Kass D . Combined ventricular systolic and arterial stiffening in patients with heart failure and preserved ejection fraction: implications for systolic and diastolic reserve limitations. Circulation. 2003; 107(5):714-20. DOI: 10.1161/01.cir.0000048123.22359.a0. View

14.

Iwanaga Y, Nishi I, Furuichi S, Noguchi T, Sase K, Kihara Y . B-type natriuretic peptide strongly reflects diastolic wall stress in patients with chronic heart failure: comparison between systolic and diastolic heart failure. J Am Coll Cardiol. 2006; 47(4):742-8. DOI: 10.1016/j.jacc.2005.11.030. View

15.

Dragulescu A, Mertens L, Friedberg M . Interpretation of left ventricular diastolic dysfunction in children with cardiomyopathy by echocardiography: problems and limitations. Circ Cardiovasc Imaging. 2013; 6(2):254-61. DOI: 10.1161/CIRCIMAGING.112.000175. View

16.

Vasan R, Levy D . Defining diastolic heart failure: a call for standardized diagnostic criteria. Circulation. 2000; 101(17):2118-21. DOI: 10.1161/01.cir.101.17.2118. View

17.

Zile M, Brutsaert D . New concepts in diastolic dysfunction and diastolic heart failure: Part I: diagnosis, prognosis, and measurements of diastolic function. Circulation. 2002; 105(11):1387-93. DOI: 10.1161/hc1102.105289. View

18.

Khouri S, Maly G, Suh D, Walsh T . A practical approach to the echocardiographic evaluation of diastolic function. J Am Soc Echocardiogr. 2004; 17(3):290-7. DOI: 10.1016/j.echo.2003.08.012. View

19.

Pettersen M, Du W, Skeens M, Humes R . Regression equations for calculation of z scores of cardiac structures in a large cohort of healthy infants, children, and adolescents: an echocardiographic study. J Am Soc Echocardiogr. 2008; 21(8):922-34. DOI: 10.1016/j.echo.2008.02.006. View

20.

OLeary P, Durongpisitkul K, Cordes T, Bailey K, Hagler D, Tajik J . Diastolic ventricular function in children: a Doppler echocardiographic study establishing normal values and predictors of increased ventricular end-diastolic pressure. Mayo Clin Proc. 1998; 73(7):616-28. DOI: 10.4065/73.7.616. View