Clinical Application of Speckle Tracking Echocardiography in Pediatric Heart Diseases

Abstract

Conventional assessment of cardiac function in children with congenital and acquired heart disease has relied on two-dimensional and M-mode echocardiographic quantification of ventricular size and ejection fraction and Doppler assessment of haemodynamics. Nonetheless, the need for geometric assumptions, the largely qualitative assessment of regional wall motion abnormalities, and the sensitivity of these conventional parameters to loading conditions are well recognized. These conventional indices of cardiac function are, in essence, indirect indices of myocardial deformation. Deformation of myocardium can be quantified in terms of strain and strain rate. In the past decade, advances in speckle tracking echocardiography have enabled direct evaluation of regional and global myocardial deformation. By the use of two- and three-dimensional speckle tracking echocardiographic techniques, quantification of ventricular global and regional strain and strain rate, twist mechanics, and mechanical dyssynchrony has become feasible by the bedside. Clinical applications in pediatric congenital and acquired heart disease include the quantification of global and regional performance of the systemic left and right ventricles, subpulmonary right ventricle, and functional single ventricles, assessment of ventricular-ventricular interaction, tracking of the impact of cardiac interventions, and detection of subclinical cardiac dysfunction with therapeutic and prognostic implications. In conclusion, the application of speckle tracking echocardiography to assess myocardial deformation in pediatric cardiac patients has shed important new light on myocardial