Top

Published in:

01-08-2010 | Original Article

Electrocardiographic Strain Pattern in Children With Left Ventricular Hypertrophy: A Marker of Ventricular Dysfunction

Authors: Nishant Shah, Kavitha Chintala, Sanjeev Aggarwal

Published in: Pediatric Cardiology | Issue 6/2010

Abstract

The objective of this study was to assess the relation between strain pattern on electrocardiogram (ECG-strain) and echocardiographic indices of left ventricular (LV) structure and function in children with LV hypertrophy (LVH). ECG-strain is a marker of LVH and is associated with adverse cardiovascular prognosis in adults. The significance of ECG-strain and its relation to LV structure and function has not been studied in children. We retrospectively analyzed electrocardiograms (ECGs) and echocardiograms of 101 children enrolled in this study. Subjects were divided into three groups: group I (n = 21) comprised children with LVH confirmed by echocardiography (LVH_echo) with ECG-strain pattern; group II (n = 54) comprised children with LVH_echo without ECG-strain pattern; and group III (n = 26) comprised children without LVH (control group). ECG-strain was defined as a down-sloping convex ST-segment depression (≥0.1 mV) with an inverted asymmetrical T-wave opposite to the QRS axis in leads V5 and/or V6. LV structure and function was measured using conventional and tissue Doppler echocardiography. ECG-strain was associated with greater interventricular septal thickness, posterior wall thickness, and LV mass index (LVMI) compared with those without ECG-strain (P < 0.0001 for each variable). Concentric LVH was more common in those with ECG-strain (16 of 21 vs. 9 of 54 patients; P = < 0.0001). ECG-strain was associated with systolic, diastolic, and combined systolic–diastolic dysfunction in children with LVH_echo. Among children with LVH, ECG-strain is associated with higher LVMI, concentric pattern of LVH, and LV systolic and diastolic dysfunction. Whether this has similar adverse prognostic implications as it does in adults remains to be determined.

Anderson HV, Stokes MJ, Leon M, Abu-Halawa SA, Stuart Y, Kirkeeide RL (2000) Coronary artery flow velocity is related to lumen area and regional left ventricular mass. Circulation 102:48–54PubMed

Aurigemma GP, Gottdiener JS, Shemanski L, Gardin J, Kitzman D (2001) Predictive value of systolic and diastolic function for incident congestive heart failure in the elderly: the cardiovascular health study. J Am Coll Cardiol 37:1042–1048CrossRefPubMed

Bella JN, Palmieri V, Roman MJ, Liu JE, Welty TK, Lee ET et al (2002) Mitral ratio of peak early to late diastolic filling velocity as a predictor of mortality in middle-aged and elderly adults: the Strong Heart Study. Circulation 105:1928–1933CrossRefPubMed

Bursi F, Weston SA, Redfield MM, Jacobsen SJ, Pakhomov S, Nkomo VT et al (2006) Systolic and diastolic heart failure in the community. JAMA 296:2209–2216CrossRefPubMed

Daniels SR (1999) Hypertension-induced cardiac damage in children and adolescents. Blood Press Monit 4:165–170PubMed

de Simone G, Daniels SR, Devereux RB, Meyer RA, Roman MJ, de Divitiis O et al (1992) Left ventricular mass and body size in normotensive children and adults: Assessment of allometric relations and impact of overweight. J Am Coll Cardiol 20:1251–1260CrossRefPubMed

de Simone G, Devereux RB, Roman MJ, Ganau A, Saba PS, Alderman MH et al (1994) Assessment of left ventricular function by the midwall fractional shortening/end-systolic stress relation in human hypertension. J Am Coll Cardiol 23:1444–1451CrossRefPubMed

de Simone G, Devereux RB, Koren MJ, Mensah GA, Casale PN, Laragh JH (1996) Midwall left ventricular mechanics. An independent predictor of cardiovascular risk in arterial hypertension. Circulation 93:259–265PubMed

Devereux RB, Reichek N (1982) Repolarization abnormalities of left ventricular hypertrophy. Clinical, echocardiographic and hemodynamic correlates. J Electrocardiol 15:47–53CrossRefPubMed

10.

Gibson DG, Traill TA, Hall RJ, Brown DJ (1979) Echocardiographic features of secondary left ventricular hypertrophy. Br Heart J 41:54–59CrossRefPubMed

11.

Kannel WB, Levy D, Cupples LA (1987) Left ventricular hypertrophy and risk of cardiac failure: insights from the Framingham Study. J Cardiovasc Pharmacol 10(Suppl 6):S135–S140PubMed

12.

Kannel WB (1983) Prevalence and natural history of electrocardiographic left ventricular hypertrophy. Am J Med 75:4–11CrossRefPubMed

13.

Khouri SJ, Maly GT, Suh DD, Walsh TE (2004) A practical approach to the echocardiographic evaluation of diastolic function. J Am Soc Echocardiogr 17:290–297CrossRefPubMed

14.

Lang RM, Bierig M, Devereux RB, Flachskampf FA, Foster E, Pellikka PA et al (2005) Recommendations for chamber quantification: a report from the American Society of Echocardiography’s Guidelines and Standards Committee and the Chamber Quantification Writing Group, developed in conjunction with the European Association of Echocardiography, a branch of the European Society of Cardiology. J Am Soc Echocardiogr 18:1440–1463CrossRefPubMed

15.

Ogah OS, Adebiyi AA, Oladapo OO, Aje A, Ojji DB, Adebayo AK et al (2006) Association between electrocardiographic left ventricular hypertrophy with strain pattern and left ventricular structure and function. Cardiology 106:14–21CrossRefPubMed

16.

Okin PM, Devereux RB, Nieminen MS, Jern S, Oikarinen L, Viitasalo M et al (2001) Relationship of the electrocardiographic strain pattern to left ventricular structure and function in hypertensive patients: the LIFE study. Losartan Intervention For End point. J Am Coll Cardiol 38:514–520CrossRefPubMed

17.

Okin PM, Devereux RB, Nieminen MS, Jern S, Oikarinen L, Viitasalo M, Toivonen L et al (2004) Electrocardiographic strain pattern and prediction of cardiovascular morbidity and mortality in hypertensive patients. Hypertension 44:48–54CrossRefPubMed

18.

Okin PM, Devereux RB, Fabsitz RR, Lee ET, Galloway JM, Howard BV (2002) Quantitative assessment of electrocardiographic strain predicts increased left ventricular mass: the Strong Heart Study. J Am Coll Cardiol 40:1395–1400CrossRefPubMed

19.

Palmieri V, Okin PM, Bella JN, Wachtell K, Oikarinen L, Gerdts E et al (2006) Electrocardiographic strain pattern and left ventricular diastolic function in hypertensive patients with left ventricular hypertrophy: the LIFE study. J Hypertens 24:2079–2084CrossRefPubMed

20.

Rembert JC, Kleinman LH, Fedor JM, Wechsler AS, Greenfield JC Jr (1978) Myocardial blood flow distribution in concentric left ventricular hypertrophy. J Clin Invest 62:379–386CrossRefPubMed

21.

Rivenes SM, Colan SD, Easley KA, Kaplan S, Jenkins KJ, Khan MN et al (2003) Usefulness of the pediatric electrocardiogram in detecting left ventricular hypertrophy: results from the Prospective Pediatric Pulmonary and Cardiovascular Complications of Vertically Transmitted HIV Infection (P2C2 HIV) multicenter study. Am Heart J 145:716–723CrossRefPubMed

22.

Roman MJ, Kligfield P, Devereux RB, Niles NW, Hochreiter C, Halle A et al (1987) Geometric and functional correlates of electrocardiographic repolarization and voltage abnormalities in aortic regurgitation. J Am Coll Cardiol 9:500–508CrossRefPubMed

23.

Salles G, Cardoso C, Nogueira AR, Bloch K, Muxfeldt E (2006) Importance of the electrocardiographic strain pattern in patients with resistant hypertension. Hypertension 48:437–442CrossRefPubMed

24.

Shapiro LM, McKenna WJ (1984) Left ventricular hypertrophy. Relation of structure to diastolic function in hypertension. Br Heart J 51:637–642CrossRefPubMed

25.

Tei C, Ling LH, Hodge DO, Bailey KR, Oh JK, Rodeheffer RJ et al (1995) New index of combined systolic and diastolic myocardial performance: a simple and reproducible measure of cardiac function—A study in normals and dilated cardiomyopathy. J Cardiol 26:357–366PubMed

26.

Tekten T, Onbasili AO, Ceyhan C, Unal S, Discigil B (2003) Novel approach to measure myocardial performance index: pulsed-wave tissue Doppler echocardiography. Echocardiography 20:503–510CrossRefPubMed

27.

Thiry PS, Rosenberg RM, Abbott JA (1975) A mechanism for the electrocardiogram response to left ventricular hypertrophy and acute ischemia. Circ Res 36:92–104PubMed

28.

Verdecchia P, Schillaci G, Borgioni C, Ciucci A, Gattobigio R, Zampi I et al (1998) Prognostic value of a new electrocardiographic method for diagnosis of left ventricular hypertrophy in essential hypertension. J Am Coll Cardiol 31:383–390CrossRefPubMed

Title: Electrocardiographic Strain Pattern in Children With Left Ventricular Hypertrophy: A Marker of Ventricular Dysfunction
Authors: Nishant Shah
Kavitha Chintala
Sanjeev Aggarwal
Publication date: 01-08-2010
Publisher: Springer-Verlag
Published in: Pediatric Cardiology / Issue 6/2010
Print ISSN: 0172-0643
Electronic ISSN: 1432-1971
DOI: https://doi.org/10.1007/s00246-010-9707-8

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Electrocardiographic Strain Pattern in Children With Left Ventricular Hypertrophy: A Marker of Ventricular Dysfunction

Abstract

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Please log in to get access to this content

Other articles of this Issue 6/2010

Left Aortic Arch and Right Descending Aorta With Kommerell’s Diverticulum

Intraatrial Baffle Repair of Anomalous Systemic Venous Return Without Hepatic Venous Drainage in Heterotaxy Syndrome

Epicardial Ablation of Ventricular Tachycardia in a Child on Venoarterial Extracorporeal Membrane Oxygenation

Analyses of Left Ventricular Myocardial Deformation by Speckle-Tracking Imaging During the Acute Phase of Kawasaki Disease

Fetal Right Ventricular Diverticulum With Pericardial Effusion: Report of a New Case Treated by In Utero Pericardiocentesis

Polysplenia and Interrupted Inferior Vena Cava With Azygos Continuation: 64-Slice Multidetector Row Computed Tomography Findings