Top

Published in:

01-06-2014 | Original Article

Evaluation of Cardiac Functions and Atrial Electromechanical Delay in Children With Adenotonsillar Hypertrophy

Authors: Abdullah Kocabaş, Nergis Salman, Filiz Ekici, İlker Çetin, Fatih Alper Akcan

Published in: Pediatric Cardiology | Issue 5/2014

Abstract

Deterioration of the right ventricular (RV) functions and the increase in the pulmonary arterial pressure (PAP) of children with moderate to severe adenotonsillar hypertrophy (ATH) have been well described. In addition to these complications, this study aimed to investigate the influence of ATH on the conduction system. The study investigated 46 patients with a diagnosis of ATH and 46 healthy control subjects. Conventional echocardiography, P-wave dispersion (Pd), tissue Doppler imaging (TDI) findings, and atrial electromechanical delay (AED) were compared between the patients and the control subjects before and after adenotonsillectomy. The maximum P-wave duration and Pd were significantly higher in the patients than in the control subjects (p < 0.001). The patient group showed significantly greater RV end-diastolic dimension (p = 0.01), right atrial area (p < 0.001), and mean PAP (p = 0.03) but lower E/A ratios for the mitral (p = 0.04) and tricuspid (p = 0.01) valves and a shorter pulmonary flow trace acceleration time (p = 0.03). The tricuspid annular-plane systolic excursion was similar between these groups (p = 0.21). In the patient group, TDI studies showed significantly lower E′/A′ ratios for the tricuspid lateral (p = 0.006) and mitral septal (p = 0.003) segments than in the control group. The myocardial performance index was lower for the mitral lateral, mitral septal, and tricuspid lateral segments in patient group (p < 0.001). Similarly, AED was prolonged in the patient group at all three segments (p < 0.001). Also, the patient group showed a significantly longer interatrial (p = 0.03) and intraatrial (p = 0.04) electromechanical delay. However, all the electro- and echocardiographic parameters were similar between the patients and the control subjects after adenotonsillectomy (p > 0.05). The prolongations in P-wave duration, Pd, and inter- and intraatrial electromechanical delays were first shown in this population. The cardiac changes induced by ATH-associated hypoxia may facilitate arrhythmias during the long term.

Abd El-Moneim ES, Badawy BS, Atya M (2009) The effect of adenoidectomy on right ventricular performance in children. Int J Pediatr Otorhinolaryngol 73:1584–1588CrossRefPubMed

Attia G, Ahmad MA, Saleh AB, Elsharkawy A (2010) Impact of obstructive sleep apnea on global myocardial performance in children assessed by tissue Doppler imaging. Pediatr Cardiol 31:1025–1036CrossRefPubMed

Biliciler-Denktas G, Rao PS (2013) Atrial electromechanical delay measured by tissue Doppler imaging in patients with secundum atrial septal defects. Echocardiography 30:619–620CrossRefPubMed

Brodsky L (1989) Modern assessment of tonsils and adenoids. Pediatr Clin North Am 36:1551–1569PubMed

Can I, Aytemir K, Demir AU, Deniz A, Ciftci O, Tokgozoglu L et al (2009) P-wave duration and dispersion in patients with obstructive sleep apnea. Int J Cardiol 133:e85–e89CrossRefPubMed

Cayler GG, Johnson EE, Lewis BE, Kortzeborn JD, Jordan J, Fricker GA (1969) Heart failure due to enlarged tonsils and adenoids: the cardiorespiratory syndrome of increased airway resistance. Am J Dis Child 118:708–717CrossRefPubMed

Chan JY, Li AM, Au CT, Lo AF, Ng SK, Abdullah VJ et al (2009) Cardiac remodelling and dysfunction in children with obstructive sleep apnoea: a community-based study. Thorax 64:233–239CrossRefPubMed

Ciftel M, Turan O, Simşek A, Kardelen F, Akçurin G, Ertuğ H (2012) Assessment of atrial electromechanical delay in children with acute rheumatic fever. Cardiol Young. doi:10.1007/s00246-013-0732-2 PubMed

Dabestani A, Mahan G, Gardin JM, Takenaka K, Burn C, Allfie A, Henry WL (1987) Evaluation of pulmonary artery pressure and resistance by pulsed Doppler echocardiography. Am J Cardiol 59:662–668CrossRefPubMed

10.

Dąbrowska-Kugacka A, Lewicka-Nowak E, Ruciński P, Zagożdżon P, Raczak G, Kutarski A (2011) Relationship between P-wave duration and atrial electromechanical delay assessed by tissue Doppler echocardiography. Pacing Clin Electrophysiol 34:23–31CrossRefPubMed

11.

Daubert JC, Pavin D, Jauvert G, Mabo P (2004) Intra- and interatrial conduction delay: implications for cardiac pacing. Pacing Clin Electrophysiol 27:507–525CrossRefPubMed

12.

den Uijl DW, Gawrysiak M, Tops LF, Trines SA, Zeppenfeld K, Schalij MJ et al (2011) Prognostic value of total atrial conduction time estimated with tissue Doppler imaging to predict the recurrence of atrial fibrillation after radiofrequency catheter ablation. Europace 13:1533–1540CrossRef

13.

Di Lisi D, Bonura F, Macaione F, Peritore A, Meschisi M, Cuttitta F et al (2011) Chemotherapy-induced cardiotoxicity: role of the tissue Doppler in the early diagnosis of left ventricular dysfunction. Anticancer Drugs 22:468–472CrossRefPubMed

14.

Dilaveris PE, Gialafos EJ, Sideris SK, Theopistou AM, Andrikopoulos GK, Kyriakidis M et al (1998) Simple electrocardiographic markers for the prediction of paroxysmal idiopathic atrial fibrillation. Am Heart J 135:733–738CrossRefPubMed

15.

Duman D, Naiboglu B, Esen HS, Toros SZ, Demirtunc R (2008) Impaired right ventricular function in adenotonsillar hypertrophy. Int J Cardiovasc Imaging 24:261–267CrossRefPubMed

16.

Gami AS, Pressman G, Caples SM, Kanagala R, Gard JJ, Davison DE et al (2004) Association of atrial fibrillation and obstructive sleep apnea. Circulation 110:364–367CrossRefPubMed

17.

Görür K, Döven O, Unal M, Akkuş N, Ozcan C (2001) Preoperative and postoperative cardiac and clinical findings of patients with adenotonsillar hypertrophy. Int J Pediatr Otorhinolaryngol 59:41–46CrossRefPubMed

18.

Harada K, Tamura M, Toyono M, Yasuoka K (2002) Comparison of the right ventricular Tei index by tissue Doppler imaging to that obtained by pulsed Doppler in children without heart disease. Am J Cardiol 90:566–569CrossRefPubMed

19.

Hoffstein V, Mateika S (1994) Cardiac arrhythmias, snoring, and sleep apnea. Chest 106:466–471CrossRefPubMed

20.

Isaaz K, Thompson A, Ethevenot G, Cloez JL, Brembilla B, Pernot C (1989) Doppler echocardiographic measurement of low-velocity motion of the left ventricular posterior wall. Am J Cardiol 64:66–75CrossRefPubMed

21.

Kaul S, Tei C, Hopkins JM, Shah PM (1984) Assessment of right ventricular function using two-dimensional echocardiography. Am Heart J 107:526–531CrossRefPubMed

22.

Kim SH, Cho GY, Shin C, Lim HE, Kim YH, Song WH et al (2008) Impact of obstructive sleep apnea on left ventricular diastolic function. Am J Cardiol 101:1663–1668CrossRefPubMed

23.

Koç S, Aytekin M, Kalay N, Ozcetin M, Burucu T, Ozbek K et al (2012) The effect of adenotonsillectomy on right ventricle function and pulmonary artery pressure in children with adenotonsillar hypertrophy. Int J Pediatr Otorhinolaryngol 76:45–48CrossRefPubMed

24.

Kocabaş A, Kardelen F, Ertuğ H, Aldemir-Kocabaş B, Tosun O, Yeşilipek A et al (2013) Assessment of early-onset chronic progressive anthracycline cardiotoxicity in children: different response patterns of right and left ventricles. Pediatr Cardiol. doi:10.1007/s00246-013-0735-z

25.

Miman MC, Kirazli T, Ozyurek R (2000) Doppler echocardiography in adenotonsillar hypertrophy. Int J Pediatr Otorhinolaryngol 54:21–26CrossRefPubMed

26.

Naiboglu B, Deveci S, Duman D, Kaya KS, Toros S, Kinis V et al (2008) Effect of upper airway obstruction on pulmonary arterial pressure in children. Int J Pediatr Otorhinolaryngol 72:1425–1429CrossRefPubMed

27.

Okuda N, Ito T, Emura N, Suwa M, Hayashi T, Yoneda H, Kitaura Y (2007) Depressed myocardial contractile reserve in patients with obstructive sleep apnea assessed by tissue Doppler imaging with dobutamine stress echocardiography. Chest 131:1082–1089CrossRefPubMed

28.

Ozer N, Yavuz B, Can I, Atalar E, Aksöyek S, Ovünç K et al (2005) Doppler tissue evaluation of intraatrial and interatrial electromechanical delay and comparison with P-wave dispersion in patients with mitral stenosis. J Am Soc Echocardiogr 18:945–948CrossRefPubMed

29.

Phillips B (2005) Sleep-disordered breathing and cardiovascular disease. Sleep Med Rev 9:131–140CrossRefPubMed

30.

Sengul C, Cevik C, Ozveren O, Sunbul A, Kilicarslan F, Oduncu V et al (2011) Assessment of atrial conduction time in patients with coronary artery ectasia. Pacing Clin Electrophysiol 34:1468–1474CrossRefPubMed

31.

Tavil Y, Kanbay A, Sen N, Ciftçi TU, Abaci A, Yalçin MR et al (2007) Comparison of right ventricular functions by tissue Doppler imaging in patients with obstructive sleep apnea syndrome with or without hypertension. Int J Cardiovasc Imaging 23:469–477CrossRefPubMed

32.

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

33.

Tei C, Nishimura RA, Seward JB, Tajik AJ (1997) Noninvasive Doppler-derived myocardial performance index: correlation with simultaneous measurements of cardiac catheterization measurements. J Am Soc Echocardiogr 10:169–178CrossRefPubMed

34.

Tugcu A, Guzel D, Yildirimturk O, Aytekin S (2009) Evaluation of right ventricular systolic and diastolic function in patients with newly diagnosed obstructive sleep apnea syndrome without hypertension. Cardiology 113:184–192CrossRefPubMed

35.

Uğur MB, Dogan SM, Sogut A, Uzun L, Cinar F, Altin R, Aydin M (2008) Effect of adenoidectomy and/or tonsillectomy on cardiac functions in children with obstructive sleep apnea. ORL J Otorhinolaryngol Relat Spec 70:202–208CrossRefPubMed

36.

Wormald PJ, Prescott CA (1992) Adenoids: comparison of radiological assessment methods with clinical and endoscopic findings. J Laryngol Otol 106:342–344CrossRefPubMed

37.

Yagmur J, Yetkin O, Cansel M, Acikgoz N, Ermis N, Karakus Y, Tasolar H (2012) Assessment of atrial electromechanical delay and influential factors in patients with obstructive sleep apnea. Sleep Breath 16:83–88CrossRefPubMed

38.

Yilmaz MD, Onrat E, Altuntaş A, Kaya D, Kahveci OK, Ozel O et al (2005) The effects of tonsillectomy and adenoidectomy on pulmonary arterial pressure in children. Am J Otolaryngol 26:18–21CrossRefPubMed

Title: Evaluation of Cardiac Functions and Atrial Electromechanical Delay in Children With Adenotonsillar Hypertrophy
Authors: Abdullah Kocabaş
Nergis Salman
Filiz Ekici
İlker Çetin
Fatih Alper Akcan
Publication date: 01-06-2014
Publisher: Springer US
Published in: Pediatric Cardiology / Issue 5/2014
Print ISSN: 0172-0643
Electronic ISSN: 1432-1971
DOI: https://doi.org/10.1007/s00246-013-0853-7

ACC 2024 Congress Coverage

Heart Failure Video

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Evaluation of Cardiac Functions and Atrial Electromechanical Delay in Children With Adenotonsillar Hypertrophy

Abstract

ACC 2024 Congress Coverage

Year in Review: Heart failure and cardiomyopathies

Semaglutide benefits people with type 2 diabetes and obesity-related heart failure

Incentivised to exercise

New intervention for STEMI-related cardiogenic shock

» View more highlights on the ACC 2024 congress hub page

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Please log in to get access to this content

Other articles of this Issue 5/2014

Atrial Flutter Demonstrated by M-Mode Echocardiography

Risk for Sleep-Disordered Breathing in Adults after Atrial Switch Repairs for d-Looped Transposition of the Great Arteries

Clinical Course and Interstage Monitoring After the Norwood and Hybrid Procedures for Hypoplastic Left Heart Syndrome

Systemic Arterial Endothelial Function in Children and Young Adults with Idiopathic Pulmonary Arterial Hypertension: Is there a Relation to Pulmonary Endothelium-Dependent Relaxation?

Echocardiographic Evaluation of Ventricular Function in Children With Pulmonary Hypertension

Identification of Differently Expressed Genes and Small Molecule Drugs for Tetralogy of Fallot by Bioinformatics Strategy

ACC 2024 Congress Coverage

Year in Review: Heart failure and cardiomyopathies

Semaglutide benefits people with type 2 diabetes and obesity-related heart failure

Incentivised to exercise

New intervention for STEMI-related cardiogenic shock

» View more highlights on the ACC 2024 congress hub page