Artikel
Long-term effects of pediatric burn injury on cardiac function
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Veröffentlicht: | 16. August 2017 |
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Background: Sparse data describes long-term sequelae of pediatric burn injury on cardiac function. In an ongoing prospective trial, cardiac function in long term pediatric burn survivors assessed.
Methods: Pediatric patients with history of severe burn injury that are >5 yrs post burn are prospectively enrolled for echocardiographic evaluation under resting conditions. Systolic function is assessed by 2D end-diastolic and end-systolic volume measurements. Ejection (EF%) is calculated from [EDV-ESV]/EDV. Diastolic function is determined by spectral Doppler interrogation across the mitral valve, measuring the E-wave and A-wave, respectively. Diastolic function is quantified using the ratio of E-wave / ventricular velocity measurement (e") - measured by tissue Doppler placement at the mitral annulus. Myocardial fibrosis is assessed through analysis of echoreflectance (integrated backscatter). Patients are stratified according to presence of normal or abnormal systolic (EF) and diastolic function (E/e"), and fibrosis. Aerobic fitness is assessed as maximal oxygen consumption (VO2max) during exercise. Data are presented as Mean ± SD or count.
Results: Thirty patients were enrolled. They were 8±5 years old at the time of injury, sustained burns of 59±20% TBSA, were 12±4 years post burn and 19±5 years old at study date. The EF% was < 50% in 50% (n=15) and <40% in 23% (n=7). The E/e" was abnormal [>8] in 67% (n=20) and in 20% (n=6), the ratio was >12 (severe diastolic dysfunction). In comparison to a healthy control group, systolic and diastolic function were significantly reduced (p<0.001). Patients with diastolic dysfunction (E/e">12) had increased myocardial fibrosis (p<0.05). VO2max was reduced in the study group compared to healthy controls (p<0.001).
Conclusion: There is a considerable rate of systolic and diastolic dysfunction in pediatric burn survivors, which may impede their aerobic fitness. Cardiac dysfunction could pose a threat to cardiovascular health in this patient population later in their life. Fibrosis of the myocardium likely plays a role in this process, especially in diastolic dysfunction. This undescribed phenomenon and the factors influencing it are subject of our ongoing research.