Echocardiographic Evaluation of Diastolic Function via Tissue Doppler Index, TDI, in Children with Heart Failure

Background and Aims : The diastolic function was previously less understood and rarely evaluated in children .But , in order to fully assess the function of the left ventricle, the diastolic function must be evaluated , as the increased filling pressures of the left ventricle is the final common pathway in all cases of heart failure. TDI has been proved to be an independent and accurate index in the evaluation of the left ventricle diastolic function in all studies that have been done in pediatrics . In this study , we are trying to understand the changes in diastolic function (via TDI ) starting from the early stages of heart failure regardless of the EF value . Methods : This prospective study has two major groups , the first group included 206 normal children who have a complete normal clinical and echocardiographic study of the heart . The second group (205 children ) contains two subgroups :Those with the first stage of HF according to ROSS classification, and the other subgroup with the II or III stage of HF. After dividing each group ( the normal and the pathological groups) into five age-groups. We measured the transmitral flow velocities E/A , and the TDI parameters at the level of the mitral annules . And then we compared the results in each age group between the normal children and the patients . Results : The E / A ratio did not show any statistical value since P value was always greater than 0.05 in all stages of heart failure and in all age groups. Whereas, TDI have shown a great value as a predictor index in heart failure in children . In the first HF stage , E/e’ ratio, have shown a significant statistical value as the P value was less than 0.05 in all age groups except in the age group ( 3-6 years ,with no obvious reason). On the other hand , all measurements of TDI including have shown significant changes in all age groups groups in the stages II and III s , despite the EF was normal in all patient except in 5 of them with stage III.