AIM To evaluate left ventricular diastolic function and predict left ventricular ejection fraction (LVEF) recovery in children with dilated cardiomyopathy (DCM) using three-dimensional speckle tracking echocardiography (3D-STE) technology.
METHODS 172 children with DCM admitted to the hospital from February 2020 to May 2023 were selected as the research subjects. The left ventricular diastolic function and 3D-STE ventricular overall strain parameters of DCM children with different concentric functional grades were compared. Logistic regression and restricted cubic spline model were used to analyze the relationship between various ventricular overall strain parameters and ventricular diastolic function. According to the prognosis of LVEF, children with DCM were divided into a recovery group (n=73) and an unrecovered group (n=99). The correlation between overall strain parameters of each ventricle and LVEF recovery was analyzed, and ROC curves were drawn to analyze the predictive value of overall strain parameters of the ventricle on LVEF recovery.
RESULTS Comparing the left ventricular diastolic function of DCM patients with different concentric functional grades, there were no significant differences in age, gender, and BMI levels among the four groups; LVDd, LVPWT, and IVST of heart function grade IV are higher than those of grade I and II; LVDs, LAD, LVEDV, LVESV, and LVEDP with heart function levels III and IV are higher than those with heart function levels I and II; LVESV and LVEDP of heart function level IV are higher than those of level III; LVEF gradually decreased in stages, and the statistical differences were all P<0.05. Compared with cardiac function grade I, the absolute value of GAS in grade II decreased, and the absolute values of GLS, GCS, GAS, and GRS (%) in grade III and IV decreased. Moreover, the absolute value of grade IV was lower than that of grade III (all P<0.05); Logistic linear regression analysis showed no significant correlation between overall ventricular strain parameters and LVDd, LVDs, LAD, LVPWT, and IVST; The overall strain parameters of the ventricles were significantly correlated with LVEDV, LVESV, LVEF, and LVEDP (all P<0.05), among which GLS, GCS, and GAS were positively correlated with LVEDV, LVESV, and LVEDP, while GLS, GCS, and GAS were negatively correlated with LVEF, GRS was positively correlated with LVEF; GRS is negatively correlated with LVEDV, LVESV, and LVEDP (all P<0.05); The correlation strength between GLS, GCS, GAS, GRS and left ventricular diastolic dysfunction showed a non-linear dose-response relationship (P<0.05); Compared with the recovery group, the non recovery group had a lower proportion of young age, lower heart rate, lower proportion of heart function grades I and II, higher grades III and IV, higher LVDd, LVDs, LVEDV, LVESV, LVEF, and higher LVEDP (all P<0.01); Compared with the recovery group, the absolute values of GLS, GCS, GAS, and GRS in the non recovery group were significantly reduced (all P<0.01); After the final adjustment of the model, GLS (β=1.568, 95%CI: 1.055~2.082, P<0.01)、GCS (β=1.019, 95%CI: 0.592~1.446, P<0.01)、GAS (β=0.793, 95%CI: 0.345~1.242, P<0.01) There is an independent correlation between GRS (β=−0.571, 95% CI: −0.886~−0.255, P<0.01) and LVEF recovery; ROC curve analysis showed that the AUC values of GLS, GAS, GCS, GRS, and combined detection for predicting LVEF recovery were 0.836, 0.741, 0.814, 0.708, and 0.916, respectively, all of which have certain predictive value. The AUC for predicting LVEF recovery in children with DCM using joint detection is the highest, with sensitivity, specificity, and accuracy of 0.908, 0.778, and 0.843, respectively.
CONCLUSION The strain parameters measured by 3D-STE are closely related to the LVEDP level of children with DCM, which can be used to quantitatively evaluate the left ventricular diastolic function of children with DCM. All the global ventricular strain parameters were independently correlated with LVEF recovery, and GLS may be an important predictor of LVEF recovery in DCM children.
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