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"Child`s Health" 8 (68) 2015

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Dysfunction of Right Heart in Attack Period of Bronchial Asthma in Children

Authors: Kondratiev V.А., Reznik А.V. - SI «Dnipropetrovsk Medical Academy of Ministry of Health of Ukraine»; Kunak Ye.V. - MI «Dnipropetrovsk Regional Children Clinical Hospital of Dnipropetrovsk Regional Council», Dnipropetrovsk, Ukraine

Categories: Pediatrics/Neonatology

Sections: Clinical researches

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Summary

Проведено допплерехокардіографічні дослідження функціонального стану правих відділів серця в 42 дітей віком від 5 до 17 років у період нападу середньотяжкої й тяжкої бронхіальної астми. Зміни внутрішньосерцевої гемодинаміки правих відділів серця в дітей у період нападу бронхіальної астми характеризувались порушенням систолічної й діастолічної функції правого шлуночка й правого передсердя. Для періоду нападу астми в дітей був характерним комбінований систолодіастолічний варіант дисфункції правого шлуночка, який розвивався в 95,5 % випадків. Підвищення тиску в легеневій артерії було характерним і значно частіше розвивалося в нападі тяжкої астми, при цьому переважала легенева гіпертензія другого ступеня.

Проведены допплерэхокардиографические исследования функционального состояния правых отделов сердца у 42 детей в возрасте от 5 до 17 лет в приступном периоде среднетяжелой и тяжелой бронхиальной астмы. Изменения внутрисердечной гемодинамики правых отделов серца у детей в приступном периоде бронхиальной астмы характеризовались нарушением систолической и диастолической функции правого желудочка и правого предсердия. Для приступного периода астмы у детей был характерным комбинированный систолодиастолический вариант дисфункции правого желудочка, который развивался в 95,5 % случаев. Повышение давления в легочной артерии было характерным и значительно чаще развивалось в период приступа тяжелой астмы, при этом преобладала легочная гипертензия второй степени.

There were performed Doppler echocardiography investigations of functional state of the right heart in 42 children aged 5–17 years old in attack period of bronchial asthma of moderate to severe degree. Changes of intra-cardiac hemodynamics of the right heart in children in attack period of bronchial asthma were characterized by disturbance of systolic and diastolic function of the right ventricle and right atrium. Combined systolic-diastolic variant of the right ventricle dysfunction was typical for attack period of bronchial asthma in children and developed in 95.5 % of cases. Elevation of pressure in pulmonary artery was typical and significantly more often occurred in severe asthma attack, herewith pulmonary hypertension of the second degree predominated.


Keywords

правий шлуночок серця, допплерехокардіографія, бронхіальна астма, діти.

правый желудочек сердца, допплерэхокардиография, бронхиальная астма, дети.

right ventricle, Doppler echocardiography, bronchial asthma, children.

Disturbances of cardio-vascular system functioning in bronchial asthma (BA) in children have certain peculiarities depending on period, disease severity, presence of concomitant pathology, attack period of bronchial asthma and are linked with medications taken. Initial clinical manifestations of cardiac insufficiency in attack period of bronchial asthma in children are absconded by phenomena of bronchial obstruction and respiratory insufficiency; that is why for revealing early myocardial dysfunction of the right heart it is expedient to use Doppler echocardiography (DopplerEchoCG) method. Aim of the investigation was to study development of systolic and diastolic dysfunction of right heart in children in attack period of bronchial asthma depending on disease severity.

Materials and methods.

To assess functional state of the right heart depending on asthma severity with DopplerEchoCG there were examined 42 patients aged 5 – 17 years with persistent BA in attack period.   First group included 20 children with moderately-severe BA, second - 22 children with severe BA. Control group included 40 healthy children-peers.

Echometric heart findings and parameters of intra-cardiac hemodynamic were measured by means one- and two-dimension echocardiography, impulse DopplerEchoCG by standard procedure. To assess systolic function of the right ventricle there was calculated time parameter of its isovolumic contraction and Tei-index. Diastolic function of the right ventricle was assessed by findings of velocity of early and late diastolic filling, their ratio, time of slowing down of blood-flow velocity in the phase of early diastolic filling and time of isovolumic relaxation of the right ventricle. Functional state of the right atrium was assessed by the time of its systole; this corresponded to finding of late diastolic filling of the right ventricle. State of pulmonary hemodynamics was assessed by findings of maximal velocity of flow through pulmonary artery valve, time of acceleration, ejection time, their ratio, as well as by the finding of median pressure in pulmonary artery, calculated by A.Kitabatake formula.

Results.

Peculiarities of remodeling of myocardium of the right heart in attack period of BA in children were characterized bу the increase of right ventricular cavity, and in case of tricuspid regurgitation  of the 1-2 degree – by increase of right atrium cavity. Disturbances of systolic function of the right atrium in assessing time index of late diastolic filling of the right ventricle, which corresponded to duration of right atrium systole, more often were revealed in patients with severe BA (77,3%) and only in every third child with moderate-severe BA. Systolic dysfunction of the right ventricle in attack period of BA in assessing time indices of its isovolumic contraction and Tei-index was revealed in the majority of patients with severe BA  (90,9%) and significantly rare in patients with moderately-severe BA  (45,0%,  p<0,01).

Diastolic dysfunction of the right ventricle of the first type in attack period of BA by time indices of slowing down of blood-flow velocity in the phase of early diastolic filling and time of isovolumic relaxation of the right ventricle was typical for patients with severe BA (90,9%) and was revealed in more than one half of patients (55,0%) with moderately-severe BA. Among findings of tricuspid blood flow which characterized diastolic dysfunction of the right ventricle, depending on BA severity, velocity of late diastolic filling of the right ventricle – toward increase and ratio of velocities of early and late diastolic filling – towards decrease changed more significantly as compared with normal findings. In accordance with revealed deviations of DopplerEchoCG findings, combined systolic-diastolic variant of right ventricle dysfunction developed in 40,0% of patients  in attack period of moderately-severe BA and in 95,5% of patients with severe BA (p<0,001).

Individual analysis of median pressure index in pulmonary artery showed that pulmonary hypertension developed more often in attack period of BA in patients with severe BA  - 68,2% and 20,0%, correspondingly (p<0,001).

Conclusion.

Performed investigations of intra-cardiac hemodynamics of the right heart in attack period of BA showed presence of disturbances both of systolic and diastolic function of the right ventricle and right atrium. Combined systolic-diastolic variant of right ventricle dysfunction which developed in 95,5% of cases was typical for attack period of BA. Elevation of pressure in the pulmonary artery was typical and significantly more often developed in case of severe BA attack, herewith pulmonary hypertension of the 2-d degree prevailed (60% of cases).


Bibliography

1. Баранов В.Л. Сравнительная характеристика допплерографических исследований в оценке диастолической функции у больных бронхиальной астмой / В.Л. Баранов, М.А. Харитонов, М.И. Хрусталева // Пульмонология. — 2008. — № 2. — С. 20-24.

2. Воробьев А.С. Амбулаторная эхокардиография у детей: Рук-во для врачей / А.С. Воробьев. — СПб.: СпецЛит, 2010. — 543 с.

3. Гаврисюк В.К. Нарушения сердечно-сосудистой системы у больных бронхиальной астмой / В.К. Гаврисюк // Укр. пульмон. журн. — 2000. — № 2, дополнение. — С. 31-32.

4. Гацаева Л.Б. Состояние сердечно-сосудистой системы и влияние на нее бронхолитической терапии у детей раннего возраста с бронхиальной астмой: Автореф. дис... канд. мед. наук: спец. 14.00.09 «Педиатрия» / Л.Б. Гацаева. — М., 2005. — 24 с.

5. Григорьев К.И. Бронхиальная астма: GINA, новые инициативы и детская пульмонологическая практика / К.И. Григорьев, М.А. Хан, О.К. Григорьева // Медицинская помощь. — 2007. — № 3. — С. 3-8.

6. Кадымов Н.А. Клинико-ультразвуковая характеристика сердечно-сосудистой системы при бронхиальной астме у детей: Автореф. дис... канд. мед. наук: спец. 14.00.09 «Педиатрия» / Н.А. Кадымов. — М., 2009. — 24 с.

7. Pыбaкoва M.К. Пpaктичeскoe pyкoвoдствo пo yльтpазвyкoвoй диaгнoстикe. Эxoкapдиoгpафия / M.К. Pыбaкoва, M.H. Aлexин, B.B. Mитькoв. — M.: Bидap-M, 2008. — 512 c.

8. Шумна Т.Є. Взаємозв’язок порушень бронхолегеневої й серцево-судинної системи у дітей з бронхіальною астмою: багатогранність та невичерпаність вивчення проблеми / Т.Є. Шумна, С.М. Недельська, О.М. Даценко // Здоровье ребенка. — 2014. — № 8. — С. 8-11.

9. Юнкеров В.И. Математико-статистическая обработка данных медицинских исследований / В.И. Юнкеров, С.Г. Григорьев. — СПб.: ВМедА, 2002. — 266 с.

10. GINA REPORT, Global Strategy for Asthma Management and Prevention. Revised 2014. — P. 1-132.

11. Right ventricular diastolic dysfunction and the acute effects of sildenafil in pulmonary hypertension patients / C.T. Gan, S. Holverda, J.T. Marcus, W.J. Paulus et al. // Chest. — 2007. — Vol. 132, №.1. — P. 11-17. doi: 10.1378/chest.06-1263


1.     Baranov V.L. Sravnitelnaya harakterisitika dopplerogaficheskih issledovaniy v otsenke diastolicheskoy funktsii u bolnyh bronhialnoy astmoy /V.L.Baranov, М.А.Haritonov, Hrustalyova//Pulmonologiya.-2008.-№2.-S.20-24.

2.     Vorobyov А.S. Ambulatornaya ehokardiografiya u detey: rukovodstvo dlya vrachey / А.S. Vorobyov .– SPb. : SpetsLlit, 2010. - 543 s.

3.    Gavrisuyk V.К. Narusheniya serdechno-sosudistoy sistemy u bolnyh bronhialnoy astmoy /V.К. Gavrisuyk //Ukr. Pulmon. Zhurn.-2000.-№2, dopolneniye.-S.31-32.

4.  Gatsayeva L.B. Sostoyanie serdechno-sosudistoy sistemy  i vliyanie na neyo bronholiticheskoy terapii u detey rannego vozrasta s  bronhialnoy astmoy: avtoref. dis. nа soiskanie uch. stepeni kand. med. nauk: spets. 14.00.09 «Pediatriya»/ L.B Gatsayeva.-М., 2005.-24 s.

5. Grigoriev К.I. Bronhialnaya astma: GINA, novye initsiqativy i detskaya pulmonologichskaya praktika /К.I.Grigoriev, М.А.Han, О.К.Grigorieva//Meditsinskaya pomosch.-2007.-№3.-S.3-8.

6.     Каdymov N.А. Kliniko-ultrazvukovaya harakteristika serdechno-sosudistoy sistemy  pri bronhialnoy astme u dyetey: avtoref. dis. nа soiskanie uch. stepeni kand. med. nauk: spets. 14.00.09 «Pediatriya» / N.А.Kadympv.-М., 2009.-24 s.

7.     Rybakova M.К.  Prakticheskoye rukovodstvo po ultrazvukovoy diagnostike. Ehografiya / M.К. Rybakova, M.N. Alehin, V.V. Mitkov.-M.: Izdat. dom «Vidar-M», 2008. – 512 s.

8.     Shumna Т.Ye. Vzaimozvyazok porushen bronholehenevoi y sertsevo-sudynnoi systemy u ditey z bronhialnoyu astmoyu: bahatohrannist ta nevycherpnist vyvchennya problem /Т.Ye.Shumna, S.М.Nedelska, О.М.Datsenkо// Zdorovye rebuonka.-2014.-№8.-S.8-11.

9.     Yunkerov V.I. Маtematiko-statisticheskaya obrabotka dannyh meditsinskih issledovaniy / V. I. Yunkerov, S. G. Grigoriev. – SPb. :  VМеdА, 2002. – 266 s.

10.   GINA REPORT, Global Strategy for Asthma Management and Prevention/ revised 2014.-P.1-132.

11.  Right ventricular diastolic dysfunction and the acute effects of sildenafil in pulmonary hypertension patients/ C.T.Gan, S.Holverda, J.T. Marcus, W.J. Paulus [et al.]// Chest.-2007.-V.132, N.1.-P.11-17. doi: 10.1378/chest.06-1263

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