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McKechnie AC, Elgersma KM, Ambrose MB, Sanchez Mejia AA, Shah KM, Iwaszko Wagner T, Trebilcock A, Hallock C. Nurse-guided Mobile Health Care Program to Reduce Emotional Distress Experienced by Parents of Infants Prenatally Diagnosed with Critical Congenital Heart Disease: A Pilot Study. Prog Pediatr Cardiol 2024; 72:101687. [PMID: 38130374 PMCID: PMC10732467 DOI: 10.1016/j.ppedcard.2023.101687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2023]
Abstract
Background Following prenatal diagnosis of critical congenital heart disease (CCHD), parents encounter emotional distress while facing caregiving challenges. Supportive psycho-educational interventions using mobile health (mHealth) can make care more accessible. Objectives We tested a novel nurse-guided mHealth care program, Preparing Heart and Mind™ (PHM™), with the objectives of examining feasibility and estimating the effect of the intervention on parents' emotional distress. Methods This pilot study design randomized participants using a 2:1 intervention to control ratio. Analysis involved description of retention, and intervention attendance and engagement, and adjusted linear mixed models to estimate group differences in depressive (CES-D), anxiety (STAI-S), and traumatic stress (IES-r) symptoms. Results The sample included 55 parents (n=38 PHM™ group, n=17 control). Complete retention of 37 (67%) parents included 29 (76%) in the PHM™ group and 8 (47%) control. Most attrition was due to infant death (7 parents), transplant referral (2 parents), or postnatal diagnostic ineligibility (4 parents). For the PHM™ group, ≥96% of parents attended pre- and postnatal sessions and most (65%) messaged with the nurse. mHealth engagement was highest prenatally, with handling uncertainty the most viewed topic (average 94% pages viewed). In linear mixed models analyses, the PHM™ group had on average 4.84 points lower depression (95% CI: -10.68-1.04), 6.56 points lower anxiety (-14.04-0.92), and 6.28 points lower trauma (-14.44-1.88) scores by study end. Conclusion Findings suggest that a nurse-guided mHealth approach is feasible and may contribute to a clinically important reduction in parents' emotional distress.
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Affiliation(s)
- Anne Chevalier McKechnie
- University of Minnesota School of Nursing, Child and Family Health Cooperative, 6-138D Weaver-Densford Hall, 308 Harvard Street SE, Minneapolis, MN 55455, USA
| | - Kristin M Elgersma
- University of Minnesota School of Nursing, Child and Family Health Cooperative, 6-138D Weaver-Densford Hall, 308 Harvard Street SE, Minneapolis, MN 55455, USA
| | - Matthew B Ambrose
- University of Minnesota Medical School, Department of Pediatrics, 420 Delaware Street SE, Minneapolis, MN 55455
- M Health Fairview Maternal and Fetal Medicine Center, 606 24th Avenue South, Minneapolis, MN 55454
| | - Aura A Sanchez Mejia
- Baylor College of Medicine, Department of Pediatrics, 1 Baylor Plaza, Houston, TX 77030
- Texas Children's Hospital Maternal-Fetal Medicine, 6651 Main Street, Houston, TX 77030
| | - Kavisha M Shah
- University of Minnesota Medical School, Department of Pediatrics, 420 Delaware Street SE, Minneapolis, MN 55455
- M Health Fairview Maternal and Fetal Medicine Center, 606 24th Avenue South, Minneapolis, MN 55454
| | - Taylor Iwaszko Wagner
- University of Minnesota School of Nursing, Child and Family Health Cooperative, 6-138D Weaver-Densford Hall, 308 Harvard Street SE, Minneapolis, MN 55455, USA
| | - Anna Trebilcock
- University of Minnesota School of Nursing, Child and Family Health Cooperative, 6-138D Weaver-Densford Hall, 308 Harvard Street SE, Minneapolis, MN 55455, USA
| | - Carrie Hallock
- GetWell, 7700 Old Georgetown Rd., 4th Floor, Bethesda, MD 20814
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Kiener A, Doan TT, Nguyen MB, Sanchez Mejia AA, Pignatelli R, Sachdeva S, Parthiban A. Pediatric 3-Dimensional Transesophageal Echocardiography: Safety and Feasibility in Young Patients. J Am Soc Echocardiogr 2024:S0894-7317(24)00102-0. [PMID: 38431182 DOI: 10.1016/j.echo.2024.02.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2024] [Accepted: 02/23/2024] [Indexed: 03/05/2024]
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McKechnie AC, Elgersma KM, Iwaszko Wagner T, Trebilcock A, Damico J, Sosa A, Ambrose MB, Shah K, Sanchez Mejia AA, Pridham KF. An mHealth, patient engagement approach to understand and address parents' mental health and caregiving needs after prenatal diagnosis of critical congenital heart disease. PEC Innov 2023; 3:100213. [PMID: 37771461 PMCID: PMC10523263 DOI: 10.1016/j.pecinn.2023.100213] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 08/10/2023] [Accepted: 09/08/2023] [Indexed: 09/30/2023]
Abstract
Objective To provide an overview of the development of the Preparing Heart and Mind™ (PHM™) care program designed for parents with a prenatal diagnosis of critical congenital heart disease (CCHD) and describe issues of parental concern, caregiving competencies, and type and timing of PHM™ topics. Methods Guided participation theory underpinned intervention development and a mixed methods pilot of a novel, nurse-guided mHealth intervention. Parents were enrolled from the third trimester of pregnancy-12 weeks postnatally. Online surveys, session transcripts, and app use were descriptively analyzed. Results The sample included 19 mothers/birthing persons and 15 caregiving partners randomized to the intervention group. In 49 sessions, mental health/wellbeing (94%) and condition-specific information (86%) were top issues. Many caregiving competencies were developed, with mothers/birthing persons often focused on feeding (86%). Regulating emotions and co-parenting consistently needed support. PHM™ topics of preparing for hospitalization (47%) and handling uncertainty (45%) were most discussed. Two cases further characterize findings. Conclusion Nurse-parent collaborative understanding of issues emphasized the need for mental health assessments. Prenatal intervention opportunities were underscored through discussions of caregiving issues and PHM™ topics. Innovation PHM™ represents an innovative approach that holds promise for supporting parents' mental health and caregiving needs outside the healthcare setting.
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Affiliation(s)
| | - Kristin M. Elgersma
- School of Nursing, Child and Family Health, University of Minnesota, Minneapolis, MN, USA
| | - Taylor Iwaszko Wagner
- School of Nursing, Child and Family Health, University of Minnesota, Minneapolis, MN, USA
| | - Anna Trebilcock
- School of Nursing, Child and Family Health, University of Minnesota, Minneapolis, MN, USA
| | - Jenna Damico
- School of Nursing, Child and Family Health, University of Minnesota, Minneapolis, MN, USA
| | - Alejandra Sosa
- School of Nursing, Child and Family Health, University of Minnesota, Minneapolis, MN, USA
| | - Matthew B. Ambrose
- Medical School, Pediatrics-Cardiology, University of Minnesota, Minneapolis, MN, USA
| | - Kavisha Shah
- Medical School, Pediatrics-Cardiology, University of Minnesota, Minneapolis, MN, USA
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Cohen J, Arya B, Caplan R, Donofrio MT, Ferdman D, Harrington JK, Ho DY, Hogan W, Hornberger LK, Jhaveri S, Killen SAS, Lindblade CL, Michelfelder E, Moon-Grady AJ, Patel S, Quezada E, Ronai C, Sanchez Mejia AA, Schidlow DN, Stiver C, Thakur V, Srivastava S. Congenitally Corrected Transposition of the Great Arteries: Fetal Diagnosis, Associations, and Postnatal Outcome: A Fetal Heart Society Research Collaborative Study. J Am Heart Assoc 2023:e029706. [PMID: 37259984 PMCID: PMC10381988 DOI: 10.1161/jaha.122.029706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Background Fetal diagnosis of congenitally corrected transposition of the great arteries (ccTGA) has been increasingly reported; however, predictors of clinical outcomes remain underexplored. We undertook a multicenter, retrospective study to investigate natural history, associated anomalies, and outcomes of fetal ccTGA. Methods and Results Fetuses with ccTGA diagnosed from January 2004 to July 2020 within 20 North American programs were included. Fetuses with severe ventricular hypoplasia thought to definitively preclude biventricular repair were excluded. We included 205 fetuses diagnosed with ccTGA at a median gestational age of 23 (interquartile range, 21-27) weeks. Genetic abnormalities were found in 5.9% tested, with extracardiac anomalies in 6.3%. Associated cardiac defects were diagnosed in 161 (78.5%), with atrioventricular block in 23 (11.3%). On serial fetal echocardiogram, 39% demonstrated a functional or anatomic change, most commonly increased tricuspid regurgitation (6.7%) or pulmonary outflow obstruction (11.1%). Of 194 fetuses with follow-up, 26 were terminated, 3 experienced fetal death (2 with atrioventricular block), and 165 were live-born. Of 158 with postnatal data (median follow-up 3.7 years), 10 (6.6%) had death/transplant before 1 year. On univariable analysis, fetal factors associated with fetal death or death/transplant by 1 year included ≥ mild tricuspid regurgitation, pulmonary atresia, aortic obstruction, fetal arrhythmia, and worsening hemodynamics on serial fetal echocardiogram (defined as worse right ventricular function, tricuspid regurgitation, or effusion). Conclusions Associated cardiac lesions and arrhythmias are common in fetal ccTGA, and functional changes commonly occur through gestation. Worse outcomes are associated with fetal tricuspid regurgitation (≥mild), any arrhythmia, pulmonary atresia, aortic obstruction, and worsening hemodynamics on serial echocardiograms. These findings can inform prenatal counseling and perinatal management planning.
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Affiliation(s)
| | | | | | | | | | | | - Deborah Y Ho
- Stanford School of Medicine, Lucile Packard Children's Hospital CA Palo Alto
| | | | | | | | | | | | | | | | - Sheetal Patel
- Ann & Robert H Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine Chicago IL
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Sanchez Mejia AA, Pignatelli RH, Rainusso N, Lilje C, Sachdeva S, Tunuguntla HP, Doan TT, Gandhi AA, Walters NC, Trajtenberg DP, Loar RW. Correlating decline in left ventricular ejection fraction and longitudinal strain in pediatric cancer patients. Int J Cardiovasc Imaging 2022; 39:747-755. [PMID: 36543913 DOI: 10.1007/s10554-022-02780-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Accepted: 12/11/2022] [Indexed: 12/24/2022]
Abstract
PURPOSE Left ventricular ejection fraction (LVEF) is routinely used to monitor cardiac function in cancer patients. Global longitudinal strain (GLS) detects subclinical myocardial dysfunction. There is no consensus on what constitutes a significant change in GLS in pediatric cancer patients. We aim to determine the change in GLS associated with a simultaneous decline in LVEF in pediatric cancer patients. METHODS This is a retrospective longitudinal study of pediatric cancer patients treated with anthracyclines between October 2017 and November 2019. GLS was measured by 2-dimensional speckle tracking. The study outcome was a decline in LVEF, defined as a decrease in LVEF of ≥ 10% points from baseline or LVEF < 55%. We evaluated two echocardiograms per patient, one baseline, and one follow-up. The follow-up echocardiogram was either (1) the first study that met the outcome or (2) the last echocardiogram available in patients without the outcome. Statistical analyses included receiver operator characteristic curves and univariable and multivariable Cox proportional hazards regression. RESULTS Out of 161 patients, 33 (20.5%) had a decline in LVEF within one year of follow-up. GLS reduction by ≥ 15% from baseline and follow-up GLS >-18% had sensitivities of 85% and 78%, respectively, and specificities of 86% and 83%, respectively, to detect LVEF decline. GLS reduction by ≥ 15% from baseline and follow-up GLS >-18% were independently associated with simultaneous LVEF decline [hazard ratio (95% confidence intervals): 16.71 (5.47-51.06), and 12.83 (4.62-35.63), respectively]. CONCLUSION Monitoring GLS validates the decline in LVEF in pediatric cancer patients.
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Affiliation(s)
- Aura A Sanchez Mejia
- Division of Pediatric Cardiology, Department of Pediatrics, Baylor College of Medicine, 6651 Main St. Suite E1920, 77030, Houston, TX, USA
- Texas Children's Hospital, 6621 Fannin St, 77030, Houston, TX, USA
| | - Ricardo H Pignatelli
- Division of Pediatric Cardiology, Department of Pediatrics, Baylor College of Medicine, 6651 Main St. Suite E1920, 77030, Houston, TX, USA
- Texas Children's Hospital, 6621 Fannin St, 77030, Houston, TX, USA
| | - Nino Rainusso
- Texas Children's Hospital, 6621 Fannin St, 77030, Houston, TX, USA
- Division of Pediatric Hematology/Oncology, Department of Pediatrics, Baylor College of Medicine Feigin Center, 1102 Bates St., Suite 1030.07, 77030, Houston, TX, USA
| | - Christian Lilje
- Division of Pediatric Cardiology, Department of Pediatrics, Baylor College of Medicine, 6651 Main St. Suite E1920, 77030, Houston, TX, USA
- Texas Children's Hospital, 6621 Fannin St, 77030, Houston, TX, USA
| | - Shagun Sachdeva
- Division of Pediatric Cardiology, Department of Pediatrics, Baylor College of Medicine, 6651 Main St. Suite E1920, 77030, Houston, TX, USA
- Texas Children's Hospital, 6621 Fannin St, 77030, Houston, TX, USA
| | - Hari P Tunuguntla
- Division of Pediatric Cardiology, Department of Pediatrics, Baylor College of Medicine, 6651 Main St. Suite E1920, 77030, Houston, TX, USA
- Texas Children's Hospital, 6621 Fannin St, 77030, Houston, TX, USA
| | - Tam T Doan
- Division of Pediatric Cardiology, Department of Pediatrics, Baylor College of Medicine, 6651 Main St. Suite E1920, 77030, Houston, TX, USA
- Texas Children's Hospital, 6621 Fannin St, 77030, Houston, TX, USA
| | - Anusha A Gandhi
- Baylor College of Medicine, One Baylor Plaza, 77030, Houston, TX, USA
| | - Nicole C Walters
- Baylor College of Medicine, One Baylor Plaza, 77030, Houston, TX, USA
| | | | - Robert W Loar
- Cook Children's Medical Center, 801 7th Ave, 76104, Fort Worth, TX, USA
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Qasim A, Kaushal S, Bansal M, Lasa JJ, Sanchez Mejia AA. Echocardiographic Clues in Diagnosis of Takayasu Arteritis in a Child with Severe Acute Respiratory Syndrome Coronavirus 2-Related Multisystem Inflammatory Syndrome. ACTA ACUST UNITED AC 2021; 5:217-220. [PMID: 33817452 PMCID: PMC7998046 DOI: 10.1016/j.case.2021.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Echocardiography of the abdominal aorta is key in children with severe hypertension. Takayasu arteritis may present with hypertension and depressed ventricular function. Takayasu arteritis can present with severe aorta thrombosis in the setting of MIS-C.
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Affiliation(s)
- Amna Qasim
- Section of Pediatric Cardiology, Baylor College of Medicine and Texas Children's Hospital, Houston, Texas.,Department of Pediatrics, Baylor College of Medicine and Texas Children's Hospital, Houston, Texas
| | - Sonia Kaushal
- Section of Pediatric Cardiology, Baylor College of Medicine and Texas Children's Hospital, Houston, Texas.,Department of Pediatrics, Baylor College of Medicine and Texas Children's Hospital, Houston, Texas
| | - Manish Bansal
- Section of Pediatric Cardiology, Baylor College of Medicine and Texas Children's Hospital, Houston, Texas.,Department of Pediatrics, Baylor College of Medicine and Texas Children's Hospital, Houston, Texas
| | - Javier J Lasa
- Section of Pediatric Cardiology, Baylor College of Medicine and Texas Children's Hospital, Houston, Texas.,Section of Critical Care Medicine, Baylor College of Medicine and Texas Children's Hospital, Houston, Texas.,Department of Pediatrics, Baylor College of Medicine and Texas Children's Hospital, Houston, Texas
| | - Aura A Sanchez Mejia
- Section of Pediatric Cardiology, Baylor College of Medicine and Texas Children's Hospital, Houston, Texas.,Department of Pediatrics, Baylor College of Medicine and Texas Children's Hospital, Houston, Texas
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Abstract
PURPOSE OF REVIEW This review aims to describe the assessment of pulmonary hypertension and ventricular function in neonates with congenital diaphragmatic hernia and the long-term follow-up of their pulmonary vascular disease. RECENT FINDINGS In 2015, the pediatric pulmonary hypertension guidelines from the American Heart Association and American Thoracic Society suggested class I level of evidence B guidelines for routine evaluation of patients with congenital diaphragmatic hernia, including longitudinal care in an interdisciplinary pulmonary hypertension program and following the recommendations offered for all children with pulmonary hypertension. Congenital diaphragmatic hernia causes compression of the lungs during critical stages of fetal development and results in lung hypoplasia. As a result, there is abnormal development of pulmonary vasculature that leads to post-natal pulmonary hypertension and increased afterload to the right ventricle. Left ventricular filling is affected by decreased pre-load and mechanical compression by abdominal content leading to decreased systemic perfusion. Persistent pulmonary hypertension after surgical repair of congenital diaphragmatic hernia is associated with increased mortality. Assessment and monitoring of pulmonary hypertension and ventricular function in this population of neonates is crucial to determine response to medical treatment, the need for extracorporeal membrane oxygenation, and the timing of surgical repair.
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Affiliation(s)
- Aura A Sanchez Mejia
- Department of Pediatrics, University of Minnesota, 2450 Riverside Ave, East Building, 5th Floor, Minneapolis, MN, 55454, USA.
| | - Nathan J Rodgers
- Department of Pediatrics, University of Minnesota, 2450 Riverside Ave, East Building, 5th Floor, Minneapolis, MN, 55454, USA
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Mejia AAS, Simpson KE, Hildebolt CF, Pahl E, Matthews KL, Rainey CA, Canter CE, Jay PY, Johnson MC. Tissue Doppler septal Tei index indicates severity of illness in pediatric patients with congestive heart failure. Pediatr Cardiol 2014; 35:411-8. [PMID: 24061276 PMCID: PMC3944049 DOI: 10.1007/s00246-013-0794-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2013] [Accepted: 08/28/2013] [Indexed: 11/30/2022]
Abstract
The Doppler Tei index is an independent predictor of outcomes in adult heart failure. Tissue Doppler imaging (TDI) may be a superior method to measure the Tei index in children because it is less affected by heart rate variability. We hypothesized that the TDI Tei index reflects severity of illness in pediatric heart failure. Twenty-five pediatric heart failure patients were prospectively enrolled. Listing for heart transplantation or death were the outcomes used to define severity of illness. Baseline demographics, brain natriuretic peptide (BNP), and standard echocardiographic and TDI-derived parameters were analyzed to determine outcome indicators. Ten of the 25 patients (40%) were listed for transplantation. There were no deaths. Multivariate analysis combining age, heart rate, standard echocardiographic parameters, and BNP resulted in shortening fraction (p = 0.002) as the best indicator of listing for transplantation (R(2) = 0.32). A second multivariate analysis combining age, heart rate, TDI parameters, and BNP resulted in age (p = 0.03) and septal Tei index (p = 0.03) as the best predictive model (R(2) = 0.36). The area under the receiver operating characteristic (ROC) curve for septal Tei index was 0.84 (95% confidence interval = 0.64-0.96,), and it was comparable with the ROC curve for shortening fraction, p = 0.76. Optimal values of sensitivity (100%) and specificity (60%) were obtained with septal Tei index values >0.51. The TDI septal Tei index is an indicator of disease severity in pediatric heart failure patients and offers potential advantages compared with standard echocardiographic measures of left-ventricular ejection.
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Affiliation(s)
- Aura A Sanchez Mejia
- Department of Pediatrics. Washington University School of Medicine. St Louis Children’s Hospital. St Louis, MO
| | - Kathleen E. Simpson
- Department of Pediatrics. Washington University School of Medicine. St Louis Children’s Hospital. St Louis, MO
| | - Charles F Hildebolt
- Mallinkrodt Institute of Radiology. Washington University School of Medicine. St Louis, MO
| | - Elfriede Pahl
- Department of Pediatrics. Northwestern University Feinberg School of Medicine. Ann & Robert H. Lurie Children’s Hospital of Chicago. Chicago, IL
| | - Kathleen L Matthews
- Department of Pediatrics. Northwestern University Feinberg School of Medicine. Ann & Robert H. Lurie Children’s Hospital of Chicago. Chicago, IL
| | - Cheryl A Rainey
- Department of Pediatrics. Washington University School of Medicine. St Louis Children’s Hospital. St Louis, MO
| | - Charles E Canter
- Department of Pediatrics. Washington University School of Medicine. St Louis Children’s Hospital. St Louis, MO
| | - Patrick Y Jay
- Department of Pediatrics. Washington University School of Medicine. St Louis Children’s Hospital. St Louis, MO
| | - Mark C Johnson
- Department of Pediatrics. Washington University School of Medicine. St Louis Children’s Hospital. St Louis, MO
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Levy PT, Sanchez Mejia AA, Machefsky A, Fowler S, Holland MR, Singh GK. Normal ranges of right ventricular systolic and diastolic strain measures in children: a systematic review and meta-analysis. J Am Soc Echocardiogr 2014; 27:549-60, e3. [PMID: 24582163 DOI: 10.1016/j.echo.2014.01.015] [Citation(s) in RCA: 121] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2013] [Indexed: 01/21/2023]
Abstract
BACKGROUND Establishment of the range of normal values and associated variations of two-dimensional (2D) speckle-tracking echocardiography (STE)-derived right ventricular (RV) strain is a prerequisite for its routine clinical application in children. The objectives of this study were to perform a meta-analysis of normal ranges of RV longitudinal strain measurements derived by 2D STE in children and to identify confounders that may contribute to differences in reported measures. METHODS A systematic review was conducted in PubMed, Embase, Scopus, the Cochrane Central Register of Controlled Trials, and ClinicalTrials.gov. Search hedges were created to cover the concepts of pediatrics, STE, and the right heart ventricle. Two investigators independently identified and included studies if they reported the 2D STE-derived RV strain measure RV peak global longitudinal strain, peak global longitudinal systolic strain rate, peak global longitudinal early diastolic strain rate, peak global longitudinal late diastolic strain rate, or segmental longitudinal strain at the apical, middle, and basal ventricular levels in healthy children. Quality and reporting of the studies were assessed. The weighted mean was estimated using random effects with 95% confidence intervals (CIs), heterogeneity was assessed using Cochran's Q statistic and the inconsistency index (I(2)), and publication bias was evaluated using funnel plots and Egger's test. Effects of demographic, clinical, equipment, and software variables were assessed in a metaregression. RESULTS The search identified 226 children from 10 studies. The reported normal mean values of peak global longitudinal strain among the studies varied from -20.80% to -34.10% (mean, -29.03%; 95% CI, -31.52% to -26.54%), peak global longitudinal systolic strain rate varied from -1.30 to -2.40 sec(-1) (mean, -1.88 sec(-1); 95% CI, -2.10 to -1.59 sec(-1)), peak global longitudinal early diastolic strain rate ranged from 1.7 to 2.69 sec(-1) (mean, 2.34 sec(-1); 95% CI, 2.00 to 2.67 sec(-1)), and peak global longitudinal late diastolic strain rate ranged from 1.00 to 1.30 sec(-1) (mean, 1.18 sec(-1); 95% CI, 1.04 to 1.33 sec(-1)). A significant base-to-apex segmental strain gradient (P < .05) was observed in the RV free wall. There was significant between-study heterogeneity and inconsistency (I(2) > 88% and P < .01 for each strain measure), which was not explained by age, gender, body surface area, heart rate, frame rate, tissue-tracking methodology, equipment, or software. The metaregression showed that these effects were not significant determinants of variations among normal ranges of strain values. There was no evidence of publication bias (P = .59). CONCLUSIONS This study is the first to define normal values of 2D STE-derived RV strain in children on the basis of a meta-analysis. The normal mean value in children for RV global strain is -29.03% (95% CI, -31.52% to -26.54%). The normal mean value for RV global systolic strain rate is -1.88 sec(-1) (95% CI, -2.10 to -1.59 sec(-1)). RV segmental strain has a stable base-to-apex gradient that highlights the dominance of deep longitudinal layers of the right ventricle that are aligned base to apex. Variations among different normal ranges did not appear to be dependent on differences in demographic, clinical, or equipment parameters in this meta-analysis. All of the eligible studies used equipment and software from one manufacturer (GE Healthcare).
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Affiliation(s)
- Philip T Levy
- Department of Pediatrics, Washington University School of Medicine, St. Louis, Missouri.
| | - Aura A Sanchez Mejia
- Department of Pediatrics, Washington University School of Medicine, St. Louis, Missouri
| | - Aliza Machefsky
- Department of Pediatrics, Washington University School of Medicine, St. Louis, Missouri
| | - Susan Fowler
- Department of Pediatrics, Washington University School of Medicine, St. Louis, Missouri
| | - Mark R Holland
- Department of Radiology, Indiana University-Purdue University Indianapolis, Indianapolis, Indiana
| | - Gautam K Singh
- Department of Pediatrics, Washington University School of Medicine, St. Louis, Missouri
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