INDEXED STROKE VOLUME IN CHILDREN WITH VARYING LEFT VENTRICLE EJECTION FRACTION AND ITS CORRELATION WITH VARIOUS CARDIAC FACTORS
Main Article Content
Abstract
OBJECTIVE: To determine the variation in indexed stroke volume (LVSVi) in children with varying left ventricle ejection fraction (LVEF) using cardiac magnetic imaging (CMR) and its correlation with various cardiac factors.
METHODS: This observational comparative study was conducted at The Children’s Hospital, Lahore, Pakistan from December 2018 to November 2021. All children below 18 years’ age presenting to hospital for CMR for tissue characterization, having normal vital organs function and no clinical signs of heart failure were included in the study. Relevant clinical data was recorded. CMR was performed using 1.5T Philips Ingenia MRI scanner. The data were analyzed with varying LVEF and correlation of LVSVi with various cardiac factors including indexed left ventricular end diastolic volume (LVEDVi), cardiac output (CO) and heart rate (HR).
RESULTS: Out of 175 patients, 170 children up to 18 years old completed the test with mean age 14.3±3.3 years. Mean LVSVi was 42+12 ml/m2 which followed Frank Starling curve except in children with LVEF <36%. Mean LVEDVi was 86±34 ml/m2. LVSVi did not correlate with heart rate or indexed ventricular systolic volumes acting as an independent variable. Minimum LVSVi remained similar all groups as demonstrated through centile distribution.
CONCLUSION: Indexed stroke volume is an independent variable in children having normal vital organs function with varying LVEF. It can serve as an independent monitoring parameter for clinical management of children with impaired ejection fraction.
Article Details
Work published in KMUJ is licensed under a
Creative Commons Attribution 4.0 License
Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work.
References
Halperin HR, Tsitlik JE, Guerci AD, Mellits ED, Levin HR, Shi AY, et al. Determinants of blood flow to vital organs during cardiopulmonary resuscitation in dogs. Circulation 1986;73(3):539-50. https://doi.org/10.1161/01.cir.73.3.539
Schultheiss HP, Fairweather D, Caforio ALP, Escher F, Hershberger RE, Lipshultz SE, et al. Dilated cardiomyopathy. Nat Rev Dis Primers 2019;5(1):32. https://doi.org/10.1038/s41572-019-0084-1
Reineke DC, Mohacsi PJ. New role of ventricular assist devices as bridge to transplantation: European perspective. Curr Opin Organ Transplant 2017;22(3):225-30. https://doi.org/10.1097/mot.0000000000000412
Sigurdsson TS, Lindberg L. Indexing haemodynamic variables in young children. Acta Anaesthesiol Scand 2021;65(2):195-202. https://doi.org/10.1111/aas.13720
Young DB. Control of Cardiac Output. San Rafael (CA): Morgan & Claypool Life Sciences; 2010. Chapter 1, Introduction. [Accessed on: February 5, 2021]. Available from URL: https://www.ncbi.nlm.nih.gov/books/NBK54473/
Patel AR, Kramer CM. Role of Cardiac Magnetic Resonance in the Diagnosis and Prognosis of Nonischemic Cardiomyopathy. JACC Cardiovasc Imaging 2017;10(Pt A):1180-93. https://doi.org/10.1016/j.jcmg.2017.08.005
Massin MM, Astadicko I, Dessy H. Epidemiology of heart failure in a tertiary pediatric center. Clin Cardiol 2008;31(8):388-91. https://doi.org/10.1002/clc.20262
Harkness A, Ring L, Augustine, DX, Oxborough D, Robinson S, Sharma V. Normal Reference Intervals for Cardiac Dimensions and Function for Use in Echocardiographic Practice: A Guideline from the British Society of Echocardiography. Echo Res Pract 2020;7(1):G1-18. https://doi.org/10.1530/erp-19-0050
Massé L, Antonacci M. Low cardiac output syndrome: identification and management. Crit Care Nurs Clin North Am 2005;17(4):375-83. https://doi.org/10.1016/j.ccell.2005.07.005
Backer DD. Stroke volume variations. Minerva Anestesiol 2003;69(4):285-8.
Erez E, Mazwi ML, Marquez AM, Moga MA, Eytan D. Hemodynamic patterns before inhospital cardiac arrest in critically Ill children: An exploratory study. Crit Care Explor. 2021;3(6):e0443. https://doi.org/10.1097/cce.0000000000000443
Kerkhof PLM, de Ven PMV, Yoo B, Peace RA, Heyndrickx GR, Handly N. Ejection fraction as related to basic components in the left and right ventricular volume domains. Int J Cardiol 2018;255:105-10. https://doi.org/10.1016/j.ijcard.2017.09.019
Inoue T, Kobirumaki-Shimozawa F, Kagemoto T, Fujii T, Terui T, Kusakari Y, et al. Depressed Frank-Starling mechanism in the left ventricular muscle of the knock-in mouse model of dilated cardiomyopathy with troponin T deletion mutation ΔK210. J Mol Cell Cardiol. 2013;63:69-78. https://doi.org/10.1016/j.yjmcc.2013.07.001
Chew MS. Haemodynamic monitoring using echocardiography in the critically ill: a review. Cardiol Res Pract 2012;2012:139537. https://doi.org/10.1155/2012/139537
Jeong H, Lee H, Jung J, Kim H, Yu J, Yoon H, et al. Evaluation of left ventricular function with cardiac magnetic resonance imaging and echocardiography after administration of dobutamine and esmolol in healthy beagle dogs. J Vet Med Sci 2021;83(4):581-91. https://doi.org/10.1292/jvms.18-0703
Vinet A, Nottin S, Lecoq AM, Guenon P, Obert P. Reproducibility of cardiac output measurements by Doppler echocardiography in prepubertal children and adults. Int J Sports Med 2001;22(6):437-41. https://doi.org/10.1055/s-2001-16241
Aligholizadeh E, Teeter W, Patel R, Hu P, Fatima S, Yang S, et al. A novel method of calculating stroke volume using point-of-care echocardiography. Cardiovasc Ultrasound 2020;18(1):37. https://doi.org/10.1186/s12947-020-00219-w
Sabaz MN, Akın A, Bilici M, Demir F, Türe M, Balık H. Factors affecting mortality in children with dilated cardiomyopathy. Turk J Pediatr 2019;61(4):485-92. https://doi.org/10.24953/turkjped.2019.04.003
Ferrari G, Molfetta AD, Zieliński K, Fresiello L, Górczyńska K, Pałko KJ, et al. Control of a Pediatric Pulsatile Ventricular Assist Device: A Hybrid Cardiovascular Model Study. Artif Organs 2017;41(12):1099-108. https://doi.org/10.1111/aor.12929
Nardo MD, MacLaren G, Marano M, Cecchetti C, Bernaschi P, Amodeo A. ECLS in Pediatric Cardiac Patients. Front Pediatr 2016;4:109. https://doi.org/10.3389/fped.2016.00109
Cooper DS, Jacobs JP, Moore L, Stock A, Gaynor JW, Chancy T, et al. Cardiac extracorporeal life support: state of the art in 2007. Cardiol Young 2007;17 Suppl 2:104-15. https://doi.org/10.1017/s1047951107001217