Pediatric Left Atrioventricular Coupling Assessed by Three-Dimensional Echocardiography

Objectives: Pediatric parameters of the left atrioventricular (AV) coupling can give insight into heart function, especially the diastolic function. Three-dimensional echocardiography (3DE) offers noninvasive assessment of those parameters. We sought to measure parameters of atrioventricular coupling in a large cohort of healthy children and establish reference values.

Methods: 3DE datasets of 345 healthy children (0 days–18 years) where analyzed by TomTec 4D LV-Analysis software 3.1. Volume-time curves of the left atrium (LA) and left ventricle (LV) were generated. Conduit volume was calculated as LV stroke volume – LA emptying volume. Moreover, we investigated the contribution of passive, active, and conduit emptying of the LA to the filling of the LV.

Result: Contribution of passive emptying of the LA to the filling of LV was highest in higher heart rates and decreased with decreasing heart rate as a possible sign for progressive stiffness. In contrast, contribution of active emptying of the LA to the filling of LV increased with decreasing heart rate. Conduit volume contributed most to the filling of LV. This contribution did not change with heart rate (Table 1).

Conclusion: Measuring parameters of AV coupling in children by 3DE was feasible. Although active emptying volume increase with decreasing heart rate, we saw that the conduit volume, which contributed most to the filling of LV, remained constant. Reference values for AV coupling obtained by 3DE can provide the basis for further noninvasive evaluation of the diastolic function of the left heart. It was supported by Fördergemeinschaft Deutsche Kinderherzzentren e.V.

Table 1 Conduit volume increased with increasing body surface area (BSA)

BSA (m2)	0.1–0.7	0.71–0.93	0.94–1.2	1.21–1.54	1.55–2.2
n	68	71	68	72	66
Conduit volumen (mL)Mean ± SD	18.32 ± 8.96	32.63 ± 10.04	39.99 ± 11.42	59.04 ± 19.32	82.39 ± 27.7

Publication History

Article published online:
21 February 2021