title: Assessment of ventricular functions by tissue Doppler echocardiography in children with asthma.
abstract: Patients with asthma develop pulmonary hypertension due to recurrent hypoxia and chronic inflammation, leading to right heart enlargement with ventricular hypertrophy. Patients with severe asthma can experience cor pulmonale later in life, but little is known about ventricular function during the early stages of the disease. This study aimed to investigate ventricular functions in asymptomatic children with asthma as detected by conventional echocardiography and tissue Doppler echocardiography (TDE). Fifty-one pediatric patients (mean age 10.4 ± 2.2 years) with asthma and 46 age- and sex-matched healthy children (mean age 10.9 ± 2.4 years) were studied. All subjects were examined by conventional echocardiography and TDE, and they had pulmonary function tests on spirometry. The right-ventricular (RV) wall was statistically (p = 0.01) thicker among asthmatic patients (4.7 ± 1.5 mm) compared with healthy children (3.6 ± 0.4 mm). However, conventional pulsed-Doppler indices of both ventricles did not differ significantly between asthmatic patients and healthy children (p > 0.05). The results of TDE examining RV diastolic function showed that annular peak velocity during early diastole (E'), annular peak velocity during late diastole (A') (16.4 ± 1.8 and 5.1 ± 1.4 cm/s, respectively), E'/A' ratio (3.2 ± 0.7), isovolumetric relaxation time (67.7 ± 10.2 ms) and myocardial performance index (48.1 % ± 7.0 %) of the lateral tricuspid annulus among asthmatic patients differed significantly (p = 0.01) from those of healthy children (13.2 ± 2.3, 8.2 ± 2.0 cm/s, 1.6 ± 0.5, 46.2 ± 8.7 ms, and 42.0 % ± 5.7 %, respectively). Only peak expiratory flow (PEF) rate from the pulmonary function tests was negatively correlated with the E'/A' ratio of the tricuspid annulus (r = -0.38, p = 0.01). This study showed that although the findings of clinical and conventional echocardiography were apparently normal in children with asthma, TDE showed subclinical dysfunction of the right ventricle, which is negatively correlated with PEF. These findings signify the diagnostic value of TDE in the early detection and monitoring of such deleterious effects among asthmatic patients.
authors.affiliation: Department of Pediatric Cardiology, Kecioren Training and Research Hospital, Ankara, Turkey. pedkard@gmail.com
authors.forename: Osman
authors.initials: O
authors.lastname: Ozdemir
authors.forename: Yasemin
authors.initials: Y
authors.lastname: Ceylan
authors.forename: Cem Hasan
authors.initials: CH
authors.lastname: Razi
authors.forename: Ozben
authors.initials: O
authors.lastname: Ceylan
authors.forename: Nesibe
authors.initials: N
authors.lastname: Andiran
mesh_terms: D001249:Asthma / Q000150:complications / Q000175:diagnosis*; D016022:Case-Control Studies; D002648:Child; D015150:Echocardiography, Doppler / Q000379:methods; D018619:Echocardiography, Doppler, Pulsed / Q000379:methods*; D005260:Female; D006801:Humans; D017380:Hypertrophy, Right Ventricular / Q000000981:diagnostic imaging* / Q000503:physiopathology; D008297:Male; D008991:Monitoring, Physiologic / Q000379:methods; D010366:Peak Expiratory Flow Rate; D011379:Prognosis; D012016:Reference Values; D012129:Respiratory Function Tests; D012720:Severity of Illness Index; D018497:Ventricular Dysfunction, Right / Q000000981:diagnostic imaging* / Q000503:physiopathology; D016278:Ventricular Function, Right / Q000502:physiology