Corrigendum: Comparison of cardiac function between single left ventricle and tricuspid atresia: assessment using echocardiography combined with computational fluid dynamics.

[This corrects the article DOI: 10.3389/fped.2023.1159342.].

Prediabetes is associated with a higher serum neurofilament light chain level in adolescents.

Objective: Serum neurofilament light chain (sNfL) level, which is a biomarker indicative of neuroaxonal damage and cognitive impairment, has been reported in several neurological diseases. There has been a lack of studies on the association between sNfL levels and prediabetes in adolescents. This study investigated whether sNfL levels were higher in adolescents with prediabetes undergoing elective orthopedic surgery. Methods: The sNfL level was measured in 149 adolescents aged from 12 to 18 years who underwent elective orthopedic surgery at the Hunan Children's Hospital (18 with and 131 without prediabetes). We evaluated the association between prediabetes and sNfL level after adjusting for age, sex, and triglycerides using a multivariable linear regression model. Results: The prevalence of prediabetes in adolescents was 12.08%. Univariate logistic regression analysis showed that prediabetes was related to sNfL. In multivariate logistic regression analysis, the association between prediabetes with sNfL levels remained significant after adjustment for age, sex, and triglyceride. The relationship between the two was further visualized by a smoothed curve. Conclusions: Prediabetes is associated with a higher sNfL. Further large-scale and prospective studies are needed to verify the clinical application of sNfL as a monitoring biomarker for adolescent prediabetes in adolescents and to evaluate the performance of sNfL in predicting the incidence of neuropathy and cognitive dysfunction in adolescents with prediabetes.

Comparison of cardiac function between single left ventricle and tricuspid atresia: assessment using echocardiography combined with computational fluid dynamics.

Patients with single left ventricle (SLV) and tricuspid atresia (TA) have impaired systolic and diastolic function. However, there are few comparative studies among patients with SLV, TA and children without heart disease. The current study includes 15 children in each group. The parameters measured by two-dimensional echocardiography, three-dimensional speckle tracking echocardiography (3DSTE), and vortexes calculated by computational fluid dynamics were compared among these three groups. Twist is best correlated with ejection fraction measured by 3DSTE. Twist, torsion, apical rotation, average radial strain, peak velocity of systolic wave in left lateral wall by tissue Doppler imaging (sL), and myocardial performance index are better in the TA group than those in the SLV group. sL by tissue Doppler imaging in the TA group are even higher than those in the Control group. In patients with SLV, blood flow spreads out in a fan-shaped manner and forms two small vortices. In the TA group, the main vortex is similar to the one in a normal LV chamber, but smaller. The vortex rings during diastolic phase are incomplete in the SLV and TA groups. In summary, patients with SLV or TA have impaired systolic and diastolic function. Patients with SLV had poorer cardiac function than those with TA due to less compensation and more disordered streamline. Twist may be good indicator for LV function.

Predictive Value of Glycosylated Hemoglobin for Post-operative Acute Kidney Injury in Non-cardiac Surgery Patients.

Objective: Recent studies have indicated that patients (both with and without diabetes) with elevated hemoglobin A1c (HbA1c) have a higher rate of acute kidney injury (AKI) following cardiac surgery. However, whether HbA1c could help to predict post-operative AKI in patients after non-cardiac surgery is less clear. This study aims to explore the predictive value of pre-operative HbA1c for post-operative AKI in non-cardiac surgery. Methods: We reviewed the medical records of patients (≥ 18 years old) who underwent non-cardiac surgery between 2011 and 2020. Patient-related variables, including demographic and laboratory and procedure-related information, were collected, and univariable and multivariable logistic regression analyses were performed to determine the association of HbA1c with AKI. The area under the receiver operating curve (AUC), net reclassification improvement index (NRI), and integrated discriminant improvement index (IDI) were used to evaluate the predictive ability of the model, and decision curve analysis was used to evaluate the clinical utility of the HbA1c-added predictive model. Results: A total of 3.3% of patients (94 of 2,785) developed AKI within 1 week after surgery. Pre-operative HbA1c was an independent predictor of AKI after adjustment for some clinical variables (OR comparing top to bottom quintiles 5.02, 95% CI, 1.90 to 13.24, P < 0.001 for trend; OR per percentage point increment in HbA1c 1.20, 95% CI, 1.07 to 1.33). Compared to the model with only clinical variables, the incorporation of HbA1c increased the model fit, modestly improved the discrimination (change in area under the curve from 0.7387 to 0.7543) and reclassification (continuous net reclassification improvement 0.2767, 95% CI, 0.0715 to 0.4818, improved integrated discrimination 0.0048, 95% CI, -5e-04 to 0.0101) of AKI and non-AKI cases, NRI for non-AKI improvement 0.3222, 95% CI, 0.2864 to 0.3580 and achieved a higher net benefit in decision curve analysis. Conclusion: Elevated pre-operative HbA1c was independently associated with post-operative AKI risk and provided predictive value in patients after non-cardiac surgery. HbA1c improved the predictive power of a logistic regression model based on traditional clinical risk factors for AKI. Further prospective studies are needed to demonstrate the results and clinical application.

Ventricular function and dyssynchrony in children with a functional single right ventricle using real time three-dimensional echocardiography after fontan operation.

BACKGROUND: This study aimed to evaluate the feasibility and clinical value of real time three-dimensional echocardiography (RT-3DE) for assessing ventricular systolic dysfunction and dyssynchrony in children with an functional single right ventricle (FSRV) having undergone the Fontan procedure. METHODS: Twenty-five children with an FSRV and 25 healthy children were enrolled in our study. RV volume analysis was performed compared with magnetic resonance imaging (MRI) as the reference standard in FSRV patients. The patients were divided into wide and narrow QRS interval groups. Global and regional functions of the RV in three compartments (inflow, body, and outflow) were compared between FSRV and control subjects, including RV systolic dyssynchrony indices of maximal difference of time to minimal volume (Tmsv-Dif), standard deviation of time to minimal volume (Tmsv-SD), maximal difference of time to minimal volume corrected by R-R interval (Tmsv-Dif%), and standard deviation of time to minimal volume corrected by R-R interval (Tmsv-SD%). RESULTS: RT-3DE measurements were significantly lower than MRI measurements for RV-EDV, RV-ESV, RV-SV, and RVEF (p < 0.01).Compared with controls, patients with an FRSV had significantly higher dyssynchrony indices and significantly lower global EF in both narrow QRS interval and wide QRS interval groups. Tmsv-SD% was shown to be most strongly correlated with MRI-RVEF (r = -.570, p = 0.003). CONCLUSIONS: RT-3DE tended to underestimate RV ventricular volume in children with FSRV. Children with an FSRV and either a wide or narrow QRS interval had reduced ventricular function and higher dyssynchrony than normal subjects. Worsening RV dyssynchrony is associated with overall decline in function after the Fontan operation.

Association of Overlapped and Un-overlapped Comorbidities with COVID-19 Severity and Treatment Outcomes: A Retrospective Cohort Study from Nine Provinces in China.

OBJECTIVE: Several COVID-19 patients have overlapping comorbidities. The independent role of each component contributing to the risk of COVID-19 is unknown, and how some non-cardiometabolic comorbidities affect the risk of COVID-19 remains unclear. METHODS: A retrospective follow-up design was adopted. A total of 1,160 laboratory-confirmed patients were enrolled from nine provinces in China. Data on comorbidities were obtained from the patients' medical records. Multivariable logistic regression models were used to estimate the odds ratio ( OR) and 95% confidence interval (95% CI) of the associations between comorbidities (cardiometabolic or non-cardiometabolic diseases), clinical severity, and treatment outcomes of COVID-19. RESULTS: Overall, 158 (13.6%) patients were diagnosed with severe illness and 32 (2.7%) had unfavorable outcomes. Hypertension (2.87, 1.30-6.32), type 2 diabetes (T2DM) (3.57, 2.32-5.49), cardiovascular disease (CVD) (3.78, 1.81-7.89), fatty liver disease (7.53, 1.96-28.96), hyperlipidemia (2.15, 1.26-3.67), other lung diseases (6.00, 3.01-11.96), and electrolyte imbalance (10.40, 3.00-26.10) were independently linked to increased odds of being severely ill. T2DM (6.07, 2.89-12.75), CVD (8.47, 6.03-11.89), and electrolyte imbalance (19.44, 11.47-32.96) were also strong predictors of unfavorable outcomes. Women with comorbidities were more likely to have severe disease on admission (5.46, 3.25-9.19), while men with comorbidities were more likely to have unfavorable treatment outcomes (6.58, 1.46-29.64) within two weeks. CONCLUSION: Besides hypertension, diabetes, and CVD, fatty liver disease, hyperlipidemia, other lung diseases, and electrolyte imbalance were independent risk factors for COVID-19 severity and poor treatment outcome. Women with comorbidities were more likely to have severe disease, while men with comorbidities were more likely to have unfavorable treatment outcomes.

Diagnosis of anomalous origin of the right coronary artery from the pulmonary artery by echocardiography.

PURPOSE: To review the imaging characteristics and evaluate the diagnostic value of echocardiography for diagnosing anomalous origin of the right coronary artery from the pulmonary artery (ARCAPA). METHODS: We retrospectively reviewed the echocardiographic records and compared these images with operative findings in six children with ARCAPA. RESULTS: ARCAPA was characterized by dilation of the left coronary artery, inappropriate origin of the right coronary artery from the pulmonary artery, and collaterals within the interventricular septum. The associated malformations included atrial septal defect in four cases. Four of six cases were diagnosed correctly, while the remaining two cases were misdiagnosed: one of fistula between the pulmonary artery and the left coronary artery and another of ARCAPA diagnosed intraoperatively in one case of atrial septal defect. CONCLUSION: ARCAPA can be diagnosed by echocardiography but is prone to misdiagnosis. This malformation should be distinguished from coronary artery fistula.

Regression equations for calculation of z scores for echocardiographic measurements of left heart structures in healthy Han Chinese children.

OBJECTIVE: Clinical decision making in children with heart disease relies on detailed measurements of cardiac structures using two-dimensional and M-mode echocardiography. However, no echocardiographic reference values are available for the Chinese children. We aimed to establish z-score regression equations for left heart structures in a population-based cohort of healthy Chinese Han children. METHOD: Echocardiography was performed in 545 children with a normal heart. The dimensions of the aortic valve annulus (AVA), aortic sinuses of Valsalva (ASV), sinotubular junction (STJ), ascending aorta (AAO), left atrium (LA), mitral valve annulus (MVA), interventricular septal end-diastolic thickness (IVSd), interventricular septal end-systolic thickness (IVSs), left ventricular end-diastolic diameter (LVIDd), left ventricular end-systolic diameter (LVIDs), left ventricular posterior wall end-diastolic thickness (LVPWd), left ventricular posterior wall end-systolic thickness (LVPWs) were measured. Regression analyses were conducted to relate the measurements of left heart structures to body surface area (BSA). Left ventricular ejection fraction (LVEF) and left ventricular fractional shortening (LVFS) were calculated. Several models were used, and the adjusted R2 values were compared for each model. RESULTS: AVA, ASV, STJ, AAO, LA, MVA, IVSd, IVSs, LVIDd, LVIDs, LVPWd, and LVPWs had a cubic relationship with BSA. LVEF and LVFS fell within a narrow range. CONCLUSIONS: Our results provide reference values for z scores and regression equations for left heart structures in Han Chinese children. These data may help make a quick and accurate judgment of the routine clinical measurement of left heart structures in children with heart disease.

Regression equations for calculation of z scores for echocardiographic measurements of right heart structures in healthy Han Chinese children.

OBJECTIVE: Clinical decision making in children with congenital and acquired heart disease relies on measurements of cardiac structures using two-dimensional echocardiography. We aimed to establish z-score regression equations for right heart structures in healthy Chinese Han children. METHODS: Two-dimensional and M-mode echocardiography was performed in 515 patients. We measured the dimensions of the pulmonary valve annulus (PVA), main pulmonary artery (MPA), left pulmonary artery (LPA), right pulmonary artery (RPA), right ventricular outflow tract at end-diastole (RVOTd) and at end-systole (RVOTs), tricuspid valve annulus (TVA), right ventricular inflow tract at end-diastole (RVIDd) and at end-systole (RVIDs), and right atrium (RA). Regression analyses were conducted to relate the measurements of right heart structures to 4body surface area (BSA). Right ventricular outflow-tract fractional shortening (RVOTFS) was also calculated. Several models were used, and the best model was chosen to establish a z-score calculator. RESULTS: PVA, MPA, LPA, RPA, RVOTd, RVOTs, TVA, RVIDd, RVIDs, and RA (R2 = 0.786, 0.705, 0.728, 0.701, 0.706, 0.824, 0.804, 0.663, 0.626, and 0.793, respectively) had a cubic polynomial relationship with BSA; specifically, measurement (M) = ß0 + ß1 × BSA + ß2 × BSA2 + ß3 × BSA.3 RVOTFS (0.28 ± 0.02) fell within a narrow range (0.12-0.51). CONCLUSIONS: Our results provide reference values for z scores and regression equations for right heart structures in Han Chinese children. These data may help interpreting the routine clinical measurement of right heart structures in children with congenital or acquired heart disease. © 2016 Wiley Periodicals, Inc. J Clin Ultrasound 45:293-303, 2017.

Coronary artery indexed diameter and z score regression equations in healthy Chinese Han children.

OBJECTIVE: In children with coronary disease, clinical decision should be based on detailed measurements of the coronary arteries by two-dimensional echocardiography. We aimed to establish coronary artery reference indexed diameter and z scores regression equations in a large cohort of Chinese Han children. METHODS: We measured the diameter of the proximal right (RCA), left main (LMCA), left anterior descending, and left circumflex coronary artery, and of the aortic annulus, and calculated the coronary-aorta index (coronary artery-to-aortic annulus ratio) in 506 Chinese Han children with normal hearts whose ages ranged from 1 day to 18 years. Regression analyses were performed, relating the coronary artery dimensions to body surface area (BSA). Several models were used, and the best model (yielding the maximum adjusted R(2) ) was chosen to establish a z score calculator. RESULTS: Based on cubic regression, (M) = ß0 + ß1 × BSA + ß2 × BSA(2) + ß3 × BSA(3) , the adjusted R(2) values were 0.515, 0.553, 0.505, and 0.518 for the RCA, LMCA, left anterior descending, and left circumflex coronary artery models, respectively. RCA/aortic annulus was 0.14 ± 0.02 (range, 0.07-0.24) and LMCA/AOA was 0.15 ± 0.03 (range, 0.10-0.28). CONCLUSIONS: Our results provide reference values of coronary artery z scores, regression equation, and coronary-aorta index as a quick guide to determine coronary dilation in Chinese Han children.

Echocardiographic assessment of juxtaposition of the right atrial appendage in children with congenital heart disease.

The objective of this study was to analyze the echocardiographic characteristics of juxtaposition of the atrial appendages and to determine its prevalence in children with congenital heart disease. From June 1998 to December 2008, 10,880 children underwent selective angiocardiography, magnetic resonance imaging (MRI), and echocardiography for evaluation of congenital heart disease. Juxtaposition of the atrial appendages was diagnosed based on the results of angiocardiography and MRI; the echocardiographic characteristics of this anomaly were analyzed retrospectively. There were 33 patients diagnosed with juxtaposition of the right atrial appendage (JRAA); no patient was diagnosed with juxtaposition of the left atrial appendage. The prevalence of JRAA in children with congenital heart disease was 0.30%. JRAA and abnormal spatial orientation of the atrial septum were visualized by Doppler echocardiography in 28 cases. In the remaining five cases, three cases with suspected JRAA could not be determined by echocardiography and the diagnosis was missed in two cases. The most common associated anomalies were conotruncal malformations (16 cases with double outlet of the right ventricle, 9 cases with pulmonary atresia, 6 cases with transposition of the great arteries, 1 case with tetralogy of Fallot) and tricuspid malformations (6 cases with tricuspid straddling, 3 cases with tricuspid atresia, 2 cases with tricuspid valve stenosis). Based on the characteristic alteration of the plane of the atrial septum and visualization of the malpositioned right atrial appendage, JRAA can be accurately diagnosed by Doppler echocardiography.

Echocardiographic assessment of conjoined twins with congenital heart disease in Shanghai.

BACKGROUND: The aim of this study is to improve the diagnosis of congenital heart disease in conjoined twins using echocardiography. METHODS: Six sets of conjoined twins at Shanghai Children's Medical Center and Xin-Hua Hospital from 1980 to 2006 were assessed retrospectively. Cardiac anomalies of varying degrees of severity were first evaluated using 2D echocardiography. Tissue Doppler imaging (TDI) was then performed if fused ventricles were suspected. Peak systolic velocities, peak systolic strain rates, and peak systolic strains at the fused myocardium were quantitatively measured using strain rate imaging (SRI). If the M-mode echocardiographic image was poor or difficult to measure, the myocardial performance index (MPI) of the left ventricle was calculated. RESULTS: Intracardiac anomalies were diagnosed correctly using echocardiography and confirmed by surgical findings. Cardiac functional assessment using MPI demonstrated heart failure in three out of the eight individuals. Subtle conjunction of the ventricles, however, were more difficult to visualize and two sets of conjoined twins with fused hearts could not be clearly demonstrated by echocardiography. In one case of suspected ventricular wall conjunction, TDI showed separate ventricular myocardia which was confirmed at surgery. CONCLUSIONS: Intracardiac anomalies and ventricular function can be readily demonstrated by echocardiography, but subtle conjunction of the ventricles may be more difficult to visualize. TDI may be required if there is uncertainty about the degree of cardiac fusion.

Doppler myocardial performance index in assessment of ventricular function in children with single ventricles.

BACKGROUND: Quantitative assessment of ventricular function in children with single ventricles is both difficult and subjective because of asymmetric ventricular geometry. The Doppler myocardial performance index (MPI) allows the assessment regardless of ventricular shape. This study was designed to evaluate the feasibility of MPI in assessing ventricular function in children with single ventricles before and after total cavopulmonary connection (TCPC). METHODS: Subjects consisted of 161 pediatric patients with single ventricles and 80 normal children without heart disease. The maximum positive rate of ventricular pressure change (Max dp/dt) was obtained in 58 patients by cardiac catheterization. Sixty-eight children with single ventricles received TCPC. MPI was calculated from Doppler tracings of ventricular inflow and outflow, then MPI of single ventricles before and after surgery and normal heart were compared. RESULTS: Normal MPI value was 0.30+/-0.08 in the left ventricle and 0.26+/-0.08 in the right ventricle. Compared to normal children, MPI was significantly higher in 161 children with single ventricles (0.54+/-0.11, P<0.001). MPI correlated inversely with Max (dp/dt) (r=-0.77, P<0.01), and was positively related to age (r=0.54, P<0.01) in patients with single ventricles. MPI did not differ significantly before and after surgery in 68 patients with single ventricles (0.55+/-0.21 vs 0.51+/-0.20, P>0.05). However, MPI in 48 patients of <6 years old decreased significantly (0.55+/-0.21 vs 0.48+/-0.18, P<0.05), suggesting improved ventricular function. CONCLUSIONS: Compared to normal children, ventricular function is impaired in patients with single ventricles and may worsen with age. MPI provides an accurate method for assessing ventricular function in children with single ventricles before and after TCPC.

[Clinical diagnosis of anomalous origin of the left coronary artery from the pulmonary artery in 22 cases].

OBJECTIVE: To discuss the diagnostic methods and features of anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA). METHODS: A total of 22 cases of ALCAPA hospitalized between 2000 and 2007 were recruited and divided into infant group (age < or = 1 year, n = 10) and older children group (age > 1 year, n = 12). The patients' history, electrocardiography (ECG) and echocardiography were reviewed and analyzed retrospectively. ECGs were analyzed as follows: (1) Q wave and T wave inversion in lead I, (2) Abnormal Q wave and T wave inversion in lead aVL, (3) Q wave in lead V(5-6), (4) T wave inversion and ST changes in lead V(4-6), (5) LV hypertrophy. Echocardiograms were analyzed as follows: (1) Continuity of the left coronary artery (LCA) and pulmonary artery (PA), (2) Retrograde shunt into PA, (3) Increased papillary muscle echodensity, (4) Right coronary artery (RCA) dilation, (5) Collateral signals within the ventricular septum. RESULTS: The presence of cardiomegaly in X-ray film (18/22), aVL QT pattern in ECG (17/22), retrograde color Doppler flow into pulmonary artery (20/22), anterior lateral papillary echogenic (17/22) and collateral vessel signals (16/22) in echocardiography were high in both groups (P > 0.05). The presence of clinical symptoms and abnormal Q wave in leads Iand V(5-6) in ECG were significantly higher in the infant group than in the older children group (P < 0.05). But the presence of right coronary artery dilation was significantly lower in the infant group than in the older children group (P < 0.05). CONCLUSION: Different diagnostic features were found in infant and older children patients. With combination of patient history, electrocardiogram and echocardiogram, accurate diagnosis could be obtained in most pediatric patients with ALCAPA.