Right ventricular function in children with asthma: tissue doppler and two-dimensional speckle-tracking echocardiography
Main Article Content
Keywords
two-dimensional speckle-tracking echocardiography, tissue doppler imaging, pediatric asthma
Abstract
Background: Asthma-related cardiopulmonary interactions may affect right ventricular (RV) performance even when children are clinically stable. Two-dimensional speckle-tracking echocardiography (2D-STE) may detect subclinical myocardial dysfunction beyond conventional indices. This study aims to investigate the effects of childhood asthma on RV function by using 2D-STE.
Methods: In this prospective case–control study, children aged 6–18 years with physician-diagnosed asthma (n = 70) and age-matched healthy controls (n = 30) underwent standard transthoracic echocardiography, tissue Doppler imaging (TDI), and 2D-STE. Primary outcomes were RV global longitudinal strain (RV GLS) and strain rate. Conventional RV systolic indices and RV diastolic indices were also assessed. Clinical characteristics and spirometry were recorded. Results: RV systolic mechanics were largely preserved in the asthma group. RV GLS, RV strain rate, and tricuspid annular plane systolic excursion (TAPSE) did not differ significantly between asthmatic children and controls. In contrast, tricuspid annular E′ velocity was significantly lower in the asthma group (p = 0.007), and tricuspid E/E′ ratio was significantly higher (p < 0.001). Interventricular septal diastolic thickness was also significantly increased among children with asthma (p = 0.027). Within the asthma cohort, TAPSE showed positive correlations with age (r = 0.478, p < 0.001), BMI (r = 0.398, p = 0.001), asthma duration (r = 0.431, p < 0.001), and FEV1 (r = 0.301, p = 0.011), whereas RV strain parameters were not significantly associated with demographic or respiratory variables.
References
2. Martin J, Townshend J, Brodlie M. Diagnosis and management of asthma in children. BMJ Paediatr Open. 2022;6:e001277. https://doi.org/10.1136/bmjpo-2021-001277
3. Dharmage SC, Perret JL, Custovic A. Epidemiology of asthma in children and adults. Front Pediatr. 2019;7:246. https://doi. org/10.3389/fped.2019.00246
4. Fleming M, Fitton CA, Steiner MFC, McLay JS, Clark D, King A et al. Educational and health outcomes of children treated for asthma: Scotland-wide record linkage study of 683 716 children. Eur Respir J. 2019;54(3):1802309. https://doi. org/10.1183/13993003.02309-2018
5. FitzGerald JM, Barnes PJ, Chipps BE, Jenkins CR, O’Byrne PM, Pavord ID et al. The burden of exacerbations in mild asthma: a systematic review. ERJ Open Res. 2020;6(3):00359-2019. https://doi.org/10.1183/23120541.00359-2019
6. Healy F, Hanna BD, Zinman R. Clinical practice. The impact of lung disease on the heart and cardiac disease on the lungs. Eur J Pediatr. 2010;169(1):1-6. https://doi.org/10.1007/ s00431-009-1027-8
7. Harkness LM, Kanabar V, Sharma HS, Westergren-Thorsson G, Larsson-Callerfelt AK. Pulmonary vascular changes in asthma and COPD. Pulm Pharmacol Ther. 2014;29(2):144-55. https://doi.org/10.1016/j.pupt.2014.09.003
8. Onufrak SJ, Abramson JL, Austin HD, Holguin F, McClellan WM, Vaccarino LV. Relation of adult-onset asthma to coronary heart disease and stroke. Am J Cardiol. 2008;101(9):1247-52.
9. Lee HM, Truong ST, Wong ND. Association of adult-onset asthma with specific cardiovascular conditions. Respir Med. 2012;106(7):948-53.
10. Baysal SS, Has M. Assessment of biventricular function with speckle tracking echocardiography newly-diagnosed adult-onset asthma. J Asthma. 2022;59(2):306-14. https://doi.org/10.1080/02770903.2020.1847928
11. Özde Ş, Kayapınar O, Doğru M, Aktüre G, Kaya A, Coşkun G et al. Evaluation of the early effects of childhood asthma and its treatment on cardiac function as revealed by two-dimensional speckle-tracking echocardiography. Pediatr Cardiol. 2024;45(4):858-66. https://doi.org/10.1007/ s00246-022-02941-w
12. Abbas AM, Mousa HH, Biomy R, Elagamy O. Can speckle tracking of right ventricle add value for evaluation of asthma severity in children? J Pak Med Assoc. 2023;73(Suppl 4) (4):S156-S160. https://doi.org/10.47391/JPMA.EGY-S4-32
13. Zeybek C, Yalcin Y, Erdem A, Polat TB, Aktuglu-Zeybek AC, Bayoglu V, et al. Tissue Doppler echocardiographic assessment of cardiac function in children with bronchial asthma. Pediatr Int. 2007;49(6):911-17.
14. Shedeed SA. Right ventricular function in children with bronchial asthma: a tissue Doppler echocardiographic study. Pediatr Cardiol. 2010;31:1008-15.
15. Blessberger H, Binder T. Two dimensional speckle tracking echocardiography: basic principles. Heart. 2010;96(9):716-22. https://doi.org/10.1136/hrt.2007.141002
16. Abdelmohsen G, Mohamed H, Mohsen M, Abdelaziz O, Ahmed D, Abdelsalam M et al. Evaluation of cardiac function in pediatric patients with mild to moderate bronchial asthma in the era of cardiac strain imaging. Pediatr Pulmonol. 2019;54(12):1905-13. https://doi.org/10.1002/ppul.24485
17. Global Initiative for Asthma (GINA). Global Strategy for Asthma Management and Prevention. Updated 2024. Available from: ginasthma.org. Accessed 2026 Mar 9.
18. Liu AH, Zeiger R, Sorkness C, Mahr T, Ostrom N, Burgess S et al. Development and cross-sectional validation of the Childhood Asthma Control Test. J Allergy Clin Immunol. 2007;119(4):817-25. https://doi.org/10.1016/j.jaci.2006.12.662
19. Nathan RA, Sorkness CA, Kosinski M, Schatz M, Li JT, Marcus P et al. Development of the asthma control test: a survey for assessing asthma control. J Allergy Clin Immunol. 2004;113(1):59-65. https://doi.org/10.1016/j.jaci.2003.09.008
20. Lang RM, Badano LP, Mor-Avi V, Afilalo J, Armstrong A, Ernande L et al. Recommendations for cardiac chamber quantification by echocardiography in adults: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. Eur Heart J Cardiovasc Imaging. 2015;16(3):233-70. https://doi.org/10.1093/ehjci/ jev014
21. Nagueh SF, Smiseth OA, Appleton CP, Byrd BF 3rd, Dokainish H, Edvardsen T et al. Recommendations for the evaluation of left ventricular diastolic function by echocardiography: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. J Am Soc Echocardiogr. 2016;29(4):277-314. https://doi.org/10.1016/j.echo.2016.01.011
22. Teichholz LE, Kreulen T, Herman MV, Gorlin R. Problems in echocardiographic volume determinations: echocardiographic-angiographic correlations in the presence or absence of asynergy. Am J Cardiol. 1976;37(1):7-11. https://doi. org/10.1016/0002-9149(76)90491-4
23. Miller D, Farah MG, Liner A, Fox K, Schluchter M, Hoit BD. The relation between quantitative right ventricular ejection fraction and indices of tricuspid anular motion and myocardial performance. J Am Soc Echocardiogr. 2004;17:443-47
24. Di Raimondo D, Musiari G, Rizzo G, Pirera E, Benfante A, Battaglia S et al. Echocardiographic evaluation of the cardiac chambers in asthmatic patients: the BADA study-ECO. J Pers Med. 2022;12(11):1847. https://doi.org/10.3390/jpm12111847
25. Akyüz Özkan E, Khosroshahi HE. Evaluation of the left and right ventricular systolic and diastolic function in asthmatic children. BMC Cardiovasc Disord. 2016;16:145. https://doi. org/10.1186/s12872-016-0328-x
26. Wagdy R, El-Deriny G. Evaluation of cardiac function in asthmatic children by tissue Doppler echocardiography. Egypt Heart J. 2023;75(1):38. https://doi.org/10.1186/s43044-023-00363-4
27. De Paula CR, Magalhães GS, Jentzsch NS, Botelho CF, Mota CCC, Murça TM et al. Echocardiographic assessment of ventricular function in young patients with asthma. Arq Bras Cardiol. 2018;110(3):231-39. https://doi.org/10.5935/ abc.20180052
28. Elmeazawy R, Razaky OE, El Amrousy D, Badreldeen AS. Evaluation of biventricular function in asthmatic children with different severity by new echocardiographic modalities. BMC Pediatr. 2025;25(1):677. https://doi.org/10.1186/ s12887-025-06028-2
29. Levy PT, Sanchez Mejia AA, Machefsky A, Fowler S, Holland MR, Singh GK. Normal ranges of right ventricular systolic and diastolic strain measures in children: a systematic review and meta-analysis. J Am Soc Echocardiogr. 2014;27(5):549-560. e3. https://doi.org/10.1016/j.echo.2014.01.015
30. Joosen RS, Meulblok EAM, Mauritz-Fuite EH, Slieker MG, Breur JMPJ. Right ventricular strain in healthy children: insights from speckle-tracking echocardiography. J Cardiovasc Dev Dis. 2025;12(9):322. https://doi.org/10.3390/ jcdd12090322