Background

Systolic dysfunction in pectus excavatum (PEX) is usually very subtle and mainly focused on the right ventricle (RV), leading to normal or unremarkable cardiac imaging findings unless involving exercise stress.

Objectives

We evaluated systolic function in PEX using longitudinal strain cardiac magnetic resonance (CMR), a validated parameter for the assessment of the systolic deformation of subendocardial fibers.

Methods

This prospective registry comprised consecutive patients with PEX who were referred to CMR to define treatment strategies or to establish surgical candidacy. We also included a control group of 15 healthy volunteers without chest wall abnormalities. Using dedicated software, we evaluated the endocardial global longitudinal strain (GLS) of both ventricles and the endocardial global circumferential strain (GCS) of the left ventricle (LV).

Results

A total of 50 patients with PEX comprised the study population, with a mean age of 19.9 ± 8.0 years. The right ventricular ejection fraction (RVEF) of patients with PEX was significantly lower compared to the control group both at end-expiration (59.5 ± 6.8 vs. 64.7 ± 4.7%, p = 0.008) and end-inspiration (56.7 ± 7.2%, vs. 62.7 ± 4.4, p = 0.004); as well as the pulmonary stroke distance (12.6 ± 2.5, vs. 15.0 ± 2.0 cm, p = 0.001). The LV volumetric analysis revealed no differences between PEX and the control group (p > 0.05 for all) regardless of the respiratory cycle, with a mean expiratory LV ejection fraction (LVEF) of 61.4 ± 6.0%. In contrast, the GLS of the LV was significantly lower in PEX compared to controls (-21.2 ± 3.2 vs. -23.7 ± 3.0%, p = 0.010), whereas GCS was similar either at expiration (-28.5 ± 4.0%, vs. -29.5 ± 2.8, p = 0.38) or inspiration (-29.3 ± 4.1%, vs.-28.9 ± 2.3, p = 0.73).

Conclusions

In this study, we demonstrated that longitudinal strain analysis might enable the detection of very subtle left ventricular systolic function abnormalities in patients with PEX, that are commonly overlooked using the conventional assessment.

Level of evidence

II

中文翻译：

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应变心脏磁共振对漏斗胸轻度左心室收缩异常暴露的有用性

背景

漏斗胸 (PEX) 的收缩功能障碍通常非常微妙，主要集中在右心室 (RV)，导致心脏影像学检查结果正常或不显着，除非涉及运动压力。

目标

我们使用纵向应变心脏磁共振 (CMR) 评估了 PEX 的收缩功能，这是一个用于评估心内膜下纤维收缩变形的经过验证的参数。

方法

该前瞻性登记包括连续的 PEX 患者，这些患者被转诊至 CMR 以确定治疗策略或确定手术候选资格。我们还纳入了 15 名没有胸壁异常的健康志愿者组成的对照组。使用专用软件，我们评估了两个心室的心内膜整体纵向应变 (GLS) 和左心室 (LV) 的心内膜整体环向应变 (GCS)。

结果

研究人群共有 50 名 PEX 患者，平均年龄为 19.9 ± 8.0 岁。PEX 患者的右心室射血分数 (RVEF) 在呼气末 (59.5 ± 6.8 vs. 64.7 ± 4.7%, p  = 0.008) 和吸气末 (56.7 ± 7.2%,与 62.7 ± 4.4，p  = 0.004）；以及肺卒中距离（12.6 ± 2.5，对 15.0 ± 2.0 cm，p  = 0.001）。LV 体积分析显示 PEX 和对照组之间没有差异（p > 0.05 for all)，无论呼吸周期如何，平均呼气左室射血分数 (LVEF) 为 61.4 ± 6.0%。相比之下，与对照组相比，PEX 中 LV 的 GLS 显着降低（-21.2 ± 3.2 对 -23.7 ± 3.0%，p  = 0.010），而 GCS 在呼气时相似（-28.5 ± 4.0%，对-29.5 ± 2.8, p  = 0.38) 或吸气 (-29.3 ± 4.1%, vs.-28.9 ± 2.3, p  = 0.73)。

结论

在这项研究中，我们证明了纵向应变分析可能能够检测出 PEX 患者中非常细微的左心室收缩功能异常，这些异常在使用传统评估时通常被忽略。

证据级别

二