Objectives: This study aimed to evaluate the predicting value of quantitative and qualitative dyssynchrony parameters as assessed by two-dimensional speckle tracking echocardiography (STE) on outcome in children with dilated cardiomyopathy (DCM). Furthermore, the reproducibility of these parameters was investigated. Background: In previous studies in adults with heart failure, several dyssynchrony parameters have been shown to be a valuable predictor of clinical outcome. Methods: This multicenter, prospective study included 75 children with DCM and 75 healthy age-matched controls. Using STE, quantitative (time to global peak strain and parameters describing intraventricular time differences) and qualitative dyssynchrony parameters (pattern analysis) of the apical four-chamber, three-chamber, two-chamber views, and the short axis of the left ventricle were assessed. Cox regression was used to identify risk factors for the primary endpoints of death or heart transplantation. Inter-observer and intra-observer variability were described. Results: During a median of 21 months follow-up, 10 patients (13%) reached an endpoint. Although quantitative dyssynchrony measures were higher in patients as compared to controls, the inter-observer and intra-observer variability were high. Pattern analysis showed mainly reduced strain, instead of dyssynchronous patterns. Conclusions: In this study, quantitative dyssynchrony parameters were not reproducible, precluding their use in children. Qualitative pattern analysis showed predominantly reduced strain, suggesting that in children with DCM dyssynchrony may be a minor problem.

Additional Metadata
Keywords Dilated cardiomyopathy, Myocardial strain
Persistent URL dx.doi.org/10.1111/echo.13548, hdl.handle.net/1765/99869
Journal Echocardiography: a journal of cardiovascular ultrasound and allied techniques
den Boer, S.L, Du Marchie Sarvaas, G.J, Klitsie, L.M, van Iperen, G.G, Tanke, R, Helbing, W.A, … ten Harkel, A.D.J. (2017). Distribution of strain patterns in children with dilated cardiomyopathy. Echocardiography: a journal of cardiovascular ultrasound and allied techniques, 34(6), 881–887. doi:10.1111/echo.13548