Highlights
- •The cardiac impact of pectus excavatum has been mainly focused on the right ventricle.
- •Cardiac magnetic resonance using strain imaging revealed subtle left ventricular systolic function abnormalities commonly overlooked using the conventional assessment. Right ventricular systolic dysfunction, though mild, was evident using conventional analysis.
Abstract
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
Keywords
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Article info
Publication history
Published online: September 17, 2021
Accepted:
September 9,
2021
Received:
August 18,
2021
Identification
Copyright
© 2021 Elsevier Inc. All rights reserved.
