559Functional maturation of left and right atrial systolic and diastolic performance in infants, children and adolescents.


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Abstract

Purpose: Left atrial (LA) function is an important modulator of left ventricular filling, and has a prognostic role in adult heart failure, but pediatric data is limited. We sought to characterize the normal maturational changes in LA and right atrial (RA) deformation and volumetric indices in the neonatal and pediatric age group.Methods: We prospectively studied atrial function in 130 subjects using 2D speckle tracking deformation and area-length derived volumetrics. High frame rate, 3-beat acoustic captures of LA (15-segment model; 2, 3 and 4-chamber views), and RA (6-segment model; 4-chamber view) were analyzed (Vivid 7, EchoPac V11, GE). LA and RA deformation parameters including peak positive strain (ePos), peak negative strain (eNeg ), total strain (eTot) and peak strain rates (SR)- SR-Early Negative, SR-Positive and SR-Late Negative were measured. Linear and non-linear regressions of these parameters were performed with age and body surface area (BSA). Relationships of the global e and SR parameters with LA and RA indexed maximum volume, and with indices of LA conduit and reservoir function (passive and total emptying fractions) were evaluated.Results: Age range was 3 days to 20 years, and BSA 0.17 to 2.28 m2 for the study cohort. Mean ± SD for global (%) LA ePos, eNeg, eTot, RA global ePos, eNeg and eTot were 28 ± 9, -15 ± 6, 43 ± 9, 22 ± 9, -15 ± 6 and 37 ± 11 respectively. Positive correlations were found for global LA and RA ePos and eNeg with age and BSA (p<0.001). Correlation for eTot with age and BSA were slightly weaker. Mean ± SD for indexed maximum and minimum volumes (mL/m2) were 22 ± 6 and 6 ± 2 for the LA; respective values were 21 ± 10 and 9 ± 5 for the RA. Total and passive emptying fractions (%) for the LA were 75 ± 6 and 53 ± 9. For the RA, total emptying fraction was 59 ± 10%. Both LA and RA global ePos correlated linearly with indexed maximum LA and RA volumes. Marked rate of increase in LA and RA e and SR values was seen in the first year of life, and normal adult values were reached by late adolescence. LA and RA SR-Positive had strong negative correlation with age, and SR-Early Negative had strong positive correlation with age (P<0.001), whilst SR-Late Negative correlated non-linearly.Conclusions: Maturational changes in LA and RA deformation and volumetric indices occur in normal children, and are especially profound in infancy. Consequently, LA and RA performance parameters must be interpreted in light of patient age. Normal age related values for these parameters reported here provide a foundation for the study of pediatric atrial function in disease states.

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