Evaluation of cardiac function in pediatric patients with mild to moderate bronchial asthma in the era of cardiac strain imaging

Role of Toll-like Receptors Nine and Ten Polymorphisms in Childhood Bronchial Asthma Control and Their Relation to Cardiac Function

Background: Asthma is designated as the most widely spread chronic disease in children. Toll-like receptors (TLRs) are linked to several human diseases, including allergic diseases. We aimed to assess the link between TLR9 (rs187084) and TLR10 (rs11096956) gene polymorphisms and bronchial asthma and its control and their relation to respiratory and cardiac functions. Methods: This is a case-control study comprising 80 participants aged between 5 and 12 years old, divided into 20 healthy non-asthmatic participants and 60 asthmatic ones. The asthmatic group members were diagnosed clinically according to the diagnosis guidelines of The Global Initiative for Asthma (GINA) 2019 and subdivided according to GINA 2019 guidelines for asthma control into three subgroups (well-controlled, partially controlled, and uncontrolled). Genetic polymorphisms in TLR9 (rs187084) and TLR10 (rs11096956) were detected using real-time PCR. Results: We found a significant increase in TLR9 polymorphisms among asthmatic cases compared to the control (OR = 9.09 for the CT genotype and 5.24 for the TT genotype) and a similar increase in TLR10 polymorphisms (OR = 4.29 for the GT genotype and 10.71 for the TT genotype). Also, there was a significant increase in TLR9 and TLR10 polymorphisms among uncontrolled cases compared to both well-controlled cases and the control group. We discovered a significant association between TLR9 (rs187084) gene polymorphisms and pulmonary function tests (PFTs), with better results in the CC genotype. Additionally, a significant association with both RVFWSL (right ventricle free-wall longitudinal strain) and GLS (left ventricle global longitudinal strain apical 2-chamber view) with better values was linked to the CC genotype. Regarding TLR10 (rs11096956), there was a significant association between gene polymorphisms and PFTs, with better function in the GG genotype. Additionally, there was a significant association between TLR10 (rs11096956) gene polymorphisms and GLS AVG (left ventricle global longitudinal strain average), with the GG type having significantly better cardiac function. Conclusion: Subclinical cardiac dysfunction of the left and right ventricles was detected in asthmatic children. The CC genotype of TLR9 and the GG genotype of TLR10 are associated with better asthma control and better cardiac function. Therefore, TLR9 and TLR10 have a role in asthma control and cardiac dysfunction.

Safety of erythrocyte transfusion over a short period in pediatric patients assessed using cardiac deformation imaging

Erythrocyte transfusion is a time-consuming process for both health care personnel and patients. This research is aimed at assessing the safety of erythrocyte transfusion over a short period of time in pediatric patients using innovative echocardiographic parameters, such as tissue Doppler imaging and 2D speckle-tracking echocardiography. Twenty pediatric patients with chronic hemolytic anemia were included in the study. Patients with underlying cardiac, renal, or respiratory dysfunction and severe anemia (hemoglobin < 60 g/L) were excluded. The patients were grouped into small cohorts, and erythrocyte transfusion was initiated at 6 ml/kg/h. If tolerated, the rate was progressively increased by 1 ml/kg/h per cohort until reaching 12 ml/kg/h. Symptoms and signs of clinical intolerance and vital signs were evaluated during and following transfusions. Conventional echocardiography, tissue Doppler imaging, and 2D speckle-tracking echocardiography were performed before and after transfusion. No symptoms or signs of clinical intolerance were reported during or after transfusion. Following transfusion, the heart rate decreased significantly (P = 0.018). No significant changes in the systolic or diastolic functions of the right or left ventricles were observed after transfusion. Following transfusion, significant improvements in the ejection times of the left and right ventricles (P = 0.001 and P = 0.007, respectively) were noted. Similarly, the myocardial performance index significantly improved (P = 0.038 and P = 0.046, respectively). Conclusion: This exploratory study addresses the issue of whether erythrocyte transfusion may be administered at up to 12 ml/kg/h in selected stable pediatric patients with chronic anemia without the risk of developing transfusion-associated circulatory overload or affecting cardiac function. In addition to reducing tachycardia, erythrocyte transfusion improves biventricular ejection time and myocardial performance index (Tei-index).

Evaluation of the Early Effects of Childhood Asthma and Its Treatment on Cardiac Function as Revealed by Two-Dimensional Speckle-Tracking Echocardiography

There is minimal information available regarding the early effects of bronchial asthma (BA) and its treatment on cardiac function in children. We used two-dimensional speckle-tracking echocardiography (2D-STE) to evaluate cardiac function before and after the treatment of childhood BA. We enrolled 44 children with moderate and severe BA who had not been treated over the preceding 3 months or who were newly diagnosed. All children received the same treatment (that recommended by the Global Initiative for Asthma [GINA] in 2017). All children also underwent transthoracic 2D-STE before treatment and 6 months later. Clinical data were compared before and after treatment. After treatment, significant increases were evident in right ventricular (RV) systolic and diastolic strain, as well as the systolic strain rate. Before and after treatment, the RV global longitudinal systolic strains were - 22.8 ± 3.6 and - 25.1 ± 4.5, respectively (p = 0.036); the RV global longitudinal diastolic strains were - 18.5 ± 6.0 and - 21.5 ± 5.2, respectively (p = 0.038); and the RV systolic strain rates were - 1.26 ± 0.4 and - 1.12 ± 0.3, respectively (p = 0.025). After treatment, significant increases were observed in the right atrial (RA) peak longitudinal strain and strain rate. Before and after treatment, the RA peak atrial longitudinal strains were 32.5 ± 10.8 and 44.7 ± 11.2, respectively (p = 0.042) and the RA longitudinal strain rates were - 1.6 ± 0.3 and - 2.0 ± 0.5, respectively (p = 0.041). RV and RA subclinical dysfunction may develop in children with early-stage BA. However, asthma treatment appears to improve such dysfunction. In children with BA, clinical and subclinical changes in cardiac functions can be easily detected via 2D-STE.

Evaluation of cardiac function in asthmatic children by Tissue Doppler Echocardiography

BACKGROUND

Bronchial asthma is a global health problem with rising prevalence in developing countries. Children with severe asthma can experience cor pulmonale later in life, but little is known about the cardiac changes that might be present earlier in mild or moderate severity of disease. This study aimed to evaluate biventricular function among children suffering from persistent asthma by Tissue Doppler Echocardiography (TDE).

RESULTS

Thirty-five asthmatic children enrolled from Alexandria Children's Hospital between September 2021 to May 2022; they were compared to 35 healthy matched children. Chronic respiratory disease, cardiac disease, or other comorbidities were excluded. The mean age of cases was 8.87 ± 2.03 years with a male/female ratio of 54.3%:45.7%. There were 28.3% mild cases, 45.7% moderate, and 25.7% severe. Conventional echocardiographic variables of cardiac function were normal for both ventricles. The TDE indices of medial mitral annulus (S' velocity and peak E') were significantly reduced (14.55 ± 2.30 and 14.69 ± 2.30) versus controls (15.68 ± 1.96, 15.69 ± 1.76, P; 0.044, P < 0.0045) but with preserved LV function. The lateral tricuspid annulus (S' velocity and peak E') was significantly reduced (11.53 ± 3.24 and 11.56 ± 3.18) versus controls (15.71 ± 0.98, 16.02 ± 1.75, < 0.001*), while E/A and IVRT were significantly increased (1.49 ± 0.06 versus 1.70 ± 0.18 and 102.39 ± 5.37 versus 140.10 ± 34.35, respectively, P < 0.001*) with impaired RV function. Peak expiratory flow rate (PEFR) was negatively correlated with the IVRT of the tricuspid annulus (P = 0.002, r = -0.503*) and to the E'/A' (P = 0.036, r =-0.355*). All TDE variables of lateral tricuspid annulus of severe subgroups were significantly  changed versus moderate or mild subgroups.

CONCLUSIONS

Tissue Doppler echocardiography is the recommended modality for early detection of biventricular cardiac dysfunction among children with different levels of asthma severity. Periodic screening is advised through the use of IVRT especially for RV.

Allergic asthma is a risk factor for human cardiovascular diseases

Asthma is an allergic airway disease in which type 2-mediated inflammation has a pathogenic role. Cardiovascular diseases (CVDs) are type 1-dominant inflammatory diseases in which type 2 cytokines often have a protective role. However, clinical studies demonstrate that allergic asthma and associated allergies are essential risk factors for CVD, including coronary heart diseases, aortic diseases, peripheral arterial diseases, pulmonary embolism, right ventricular dysfunction, atrial fibrillation, cardiac hypertrophy and even hypertension. Mast cells, eosinophils, inflammatory cytokines and immunoglobulin (Ig)E accumulate in asthmatic lungs and in the injured heart and vasculature of patients with CVD. Clinical studies show that many anti-asthmatic therapies affect the risk of CVD. As such, allergic asthma and CVD may share common pathogenic mechanisms. Preclinical investigations indicate that anti-asthmatic drugs have therapeutic potential in certain CVDs. In this Review, we discuss how asthma and allied allergic conditions may contribute to the prevalence, incidence and progression of CVD and vice versa.

Functional recovery of cardiomyopathy induced by atrial tachycardia in children: Insight from cardiac strain imaging

AIM

To evaluate systolic and diastolic cardiac function in children who had cardiomyopathy induced by ectopic atrial tachycardia (EAT).

METHODS

Twenty-two pediatric patients who had cardiomyopathy induced by EAT and 25 age-matched controls were recruited in this case-control study. The patients were examined after rhythm control and normalization of their left ventricular systolic function. Different echocardiographic modalities including tissue Doppler imaging and two-dimension speckle tracking echocardiography were utilized to assess the ventricular and atrial function.

RESULTS

The patients' median age was 51 months (interquartile range: 28.5-84 months). The median time interval required for normalization of left ventricular ejection fraction (EF) among patients was 1.5 months (interquartile range: 1.5-2.12 months). Compared to controls, patients had a significantly higher median left ventricular myocardial performance index (MPI) at the interventricular septum (0.44 vs. 0.38, p = .001) and left ventricular lateral wall (0.46 vs. 0.32, p = .0001). The median right ventricular MPI of the patients' group was significantly higher when compared to the control group (0.34 vs. 0.26, p = .0001). The median right atrial (RA) reservoir function in patients was significantly reduced compared to controls (30% vs. 36.63%, p = .007).

CONCLUSIONS

Shortly after rhythm normalization and restoration of left ventricular EF, using tissue Doppler imaging and two-dimension speckle tracking echocardiography, children who had cardiomyopathy induced by EAT continue to have left ventricular diastolic dysfunction, right ventricular dysfunction, and reduced RA reservoir function.

Evolution of ventricular function in children with permanent right ventricular pacing after tetralogy of Fallot repair: A midterm follow-up

OBJECTIVE

We aim to evaluate the midterm effect of chronic apical right ventricular (RV) pacing on right and left ventricular (LV) function using different modalities of echocardiography including conventional echocardiography, tissue Doppler imaging and two-dimension speckle tracking echocardiography.

METHODS

This case-control study enrolled 49 patients divided into two groups: a paced group and a nonpaced group. The paced group included 23 patients that underwent tetralogy of Fallot (TOF) repair and required permanent pacemaker insertion for postoperative complete heart block. The nonpaced group included 26 patients that had TOF repair at the same period.

RESULTS

The median age for the paced and nonpaced groups was 6 and 8 years, respectively (P = .169). The follow-up duration after TOF surgical repair was 4 years for the paced patients and 5 years for nonpaced patients (P = .411). In the nonpaced group, the QRS duration increased and LV global longitudinal strain (GLS) decreased significantly with increasing duration after TOF repair, P value was .006 and .042, respectively. In the paced group, tricuspid annular systolic plane excursion (TAPSE) was significantly correlated with age (r = .578; P = .004) and duration following TOF correction (r = .724; P < .001).

CONCLUSION

Chronic RV apical pacing in children after TOF repair was associated with better clinical status, preservation of RV systolic function, and prevention of progressive QRS prolongation. RV pacing was not associated with progressive deterioration of LV systolic function with increasing the time interval following TOF repair. Therefore, RV pacing can be beneficial in corrected TOF patients presenting with RV failure.