Evaluation of Left Diastolic Function in Paediatric Intensive Care Unit: Which Indications and Which Parameters?

Abstract

The incidence of patients with a diagnosis of diastolic heart failure has been increased over the years. Several epidemiological, physiopathological, clinical or prognostic studies have been conducted to understand this new entity. Study and analysis of the diastolic function of the heart have become essential during echocardiographic examination. The evaluation of left ventricular diastolic function (LVFD) is complex, in full swing and still poorly performed in pediatrics, especially in intensive care unit. In addition, tachycardia in children and pediatric particularities make it difficult. Echocardiography is the essential complementary test for evaluating LVFD, but being studied in children. The assessment of LVFD should be an integral part of the echocardiographic evaluation in certain situations (evaluation of the response to vascular filling, severability of mechanical ventilation and adjustment of treatments…), in order to better understand its measurement and to use it in clinical routine. We retain for echocardiographic assessment in pediatric intensive care unit: firstly evaluate the systolic function, then evaluate the evolution of LVFD by the filling pressures by simple parameters (mitral pulse Doppler and mitral tissue Doppler) adjusted to Z-score (http://www.parameterz.com), such as the E / E’ and E / A ratios, the indexed volume of the left atrium, all connected to the clinical context and the kinetics of biological parameters (BNP, NT pro-BNP).