Right Ventricular Strain in Healthy Children: Insights from Speckle-Tracking Echocardiography

BACKGROUND: Right ventricular (RV) strain using two-dimensional speckle tracking is a reliable and clinically significant tool for detecting RV systolic dysfunction, but it varies by age, vendor, and software.

OBJECTIVES: To establish pediatric age-specific normal values and Z-score equations for biventricular strain using GE Healthcare equipment and software.

METHODS: Children 0-18 years with structurally and functionally normal hearts, who visited the Wilhelmina Children's Hospital Utrecht between October 2020 and December 2023, were retrospectively included and divided into age groups: 0 years, 1-4 years, 5-9 years, 10-13 years, and 14-18 years. Left ventricular (LV) and RV global longitudinal strain (GLS) and RV free wall longitudinal strain (FWGLS) were analyzed.

RESULTS: We included 129 subjects (57% male) (0 years: n = 17; 1-4 years: n = 22; 5-9 years: n = 34; 10-13 years: n = 35; 14-18 years: n = 20). Low R 2 values were strain-adjusted for age, height, and body surface area (all < 0.3), and the sample size limited Z-score equation reliability. Therefore, data are presented as mean ± SD or median [IQR] stratified by age. LV GLS, RV GLS, and RV FWGLS showed a nonlinear relationship with age, peaking at the 1-4 years age group and decreasing with age.

CONCLUSIONS: LV GLS, RV GLS, and RV FWGLS showed age-related differences in children using GE equipment and software, which highlights the importance of age-specific normal strain values, including Z-score equations as a function of age.