Search

Background: Echocardiography education for pediatric cardiology fellows has been a recent focus leading to the implementation of "boot camps." Less is described about continuing education through fellowship and improving image quality. We noticed practice variation in echocardiograms assessing ventricular function performed on nights and weekends. Thus, we implemented a standardized protocol and assessed its impact on imaging and reporting completeness., Methods: We created an imaging protocol for the assessment of ventricular function in the acute setting. The protocol included demographic information, a list of images to be obtained, and the methods to quantify ventricular function. The protocol was explained to first-year fellows and distributed on an electronic quick reference card. Echocardiograms independently performed by first-year fellows during their first 4 months of on-call time were assessed pre- and postintervention using a standard rubric., Results: Compliance with demographic reporting was high pre- and postintervention, but significantly improved after the standardized protocol (P < 0.001). Use of the protocol increased the median number of unique images obtained per echocardiogram from 13 to 17 (out of 23 required views, P < 0.001). Particularly improved was the performance of quantitative evaluations of function, including Simpson's method for left ventricular ejection fraction (four chamber: 40% vs 67%, P < 0.001; two chamber: 33% vs 67%, P < 0.001) and tricuspid annular plane systolic excursion (45% vs 80%, P < 0.001)., Conclusions: The introduction of a standardized imaging protocol and its distribution to first-year fellows resulted in improvements in echocardiographic reporting completeness and increased the quality of information obtained by providing more quantitative assessments of ventricular function., (© 2019 Wiley Periodicals, Inc.)

Background: Echocardiographic follow-up after pediatric heart transplantation is important because of the lifelong risk for rejection and resultant ventricular dysfunction. Although adult studies have shown that echocardiographic measures of right ventricular function are changed after transplantation, similar results have not been reported in the pediatric population., Methods: A single-center retrospective study of echocardiograms obtained among pediatric heart transplant recipients was conducted. All echocardiograms were selected remote from transplantation, rejection, or graft vasculopathy. These criteria identified 127 patients. Right ventricular systolic function was measured using tricuspid annular plane systolic excursion, fractional area change (FAC), and peak systolic tricuspid annular tissue velocity (S'). Results were compared with those in 380 healthy age-matched echocardiographic control subjects., Results: Tricuspid annular plane systolic excursion values in pediatric heart transplant recipients were significantly lower than in control subjects at all ages (P < .0001), with a mean Z score of -3.38. FAC and S' did not vary by age in control patients >6 months of age. FAC values in transplantation patients were significantly decreased compared with those in control subjects (P < .0001), but 83% of transplantation patients had FAC values within the control-derived normal range. S' values were also significantly lower in transplantation patients than control subjects (P < .0001)., Conclusions: Heart transplantation patients have significantly decreased quantitative metrics of right ventricular function relative to healthy control subjects; longitudinal shortening (tricuspid annular plane systolic excursion and S') is particularly affected. FAC is relatively preserved and may be a better metric in this population. These results establish nomograms of RV function in pediatric heart transplantation patients and in normal pediatric control subjects, which may allow quantification of changes in this vulnerable population., (Copyright © 2019 American Society of Echocardiography. Published by Elsevier Inc. All rights reserved.)

Introduction: The timing and etiology of diastolic impairment in pediatric-onset systemic lupus erythematosus (pSLE) are poorly understood. We compared left ventricular diastolic function at pSLE diagnosis with controls. Hypothesis: Effects of pSLE on echocardiographic measures of diastolic function are present at diagnosis. Methods: Echocardiograms of children with pSLE ages 5-18 years performed within 1 year of diagnosis and age- and sex-matched controls were re-read by two blinded cardiologists. Baseline characteristics, SLE disease activity index (SLEDAI) and symptoms/signs were abstracted from charts. Diastolic indices (E/A ratio, e', E/e', isovolumetric relaxation time (IVRT)) were compared using linear mixed effects models adjusted for hypertension. Pericardial effusion and valvular disease were also evaluated. Pearson's correlation was used to identify factors associated with worse diastolic indices. Results: 85 children with incident pSLE had baseline echocardiograms, of which 72% were asymptomatic. Median time from diagnosis to echocardiogram was 6 days (IQR 1-70). Prior prednisone exposure was minimal. Diastolic indices were significantly worse in pSLE cases compared to controls (with lower E/A, lower e', higher E/e' and longer IVRT) (Table). 6 pSLE cases (7%) had abnormal e' and 32 (47%) had prolonged IVRT, though none met criteria for diastolic dysfunction. Mild/moderate effusions, aortic and mitral insufficiency were found in 15%, 17%, and 6% of cases, respectively. SLE disease activity, but not effusion, was correlated with worse E/e' (ρ 0.31, p=0.02), septal e' (-0.30, p<0.01), and IVRT (0.50, p<0.01). Conclusion: Children with pSLE have worse diastolic indices at diagnosis compared to peers without SLE, independent of glucocorticoid use or hypertension. Longitudinal studies using echocardiography will determine whether these measures of diastolic function worsen over time and if they are prognostic of cardiac complications. [ABSTRACT FROM AUTHOR]