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DOI: 10.1055/s-0035-1555995
Can Normalization to Organ Size and Heart Rate Increase Clinical Utility in the Interpretation of Aortic and Pulmonary Velocity Time Integral in Children?
Introduction: Physiological factors as heart rate, organ size or the Frank Starling mechanism influence cardiac output. Aim of this study was to create percentiles for aortic (VTIAo) and pulmonary velocity time integral (VTIPa) useful for clinical practice.
Methods: 377 echocardiographic datasets recorded in healthy children (0–20 years) were analyzed. Measurement of left ventricular length, VTIAo (group I) respectively right ventricular length, VTIPa (group II) and heart rate (HR) was performed. To assess practicability 40 patients (0–6 years) with shunt lesions (group A: patent ductus arteriosus (PDA); group B: atrial septal defect (ASD)) were investigated and values integrated into the percentiles. Our method was compared with other reference values for VTIAo (C. Pees, Pediatr Cardiol 2013;34:1194–1200).
Results: Feasibility was 91% for group I (330 datasets: 166 male, 164 female) and 86% for group II (324 datasets: 164 male, 160 female). VTI/HR and ventricular length provided excellent correlations in children younger than 7 years (group I: r=0,824; group II: r=0,772). Adolescent individuals (7–20 years) showed lower correlation because of higher stroke volume variability (group I: male r=0,462, female r=0,458; group II: male r=0,521, female r=0,456). With the percentiles created more known aortic hyperperfusion (group A) could be detected (50% >2 standard deviation (SD); 100% >1 SD) than with reference data of C (35% > 2 SD; 50% > 1 SD). Sensitivity of percentiles for VTIPa (group B) was also satisfactory (65% > 2 SD; 90% > 1 SD).
Conclusion: These reference values might facilitate the differentiation between normal and pathological VTI especially in young children.