transmedТрансляционная медицинаTranslational Medicine2311-44952410-5155Almazov National Medical Research Centre, Saint Petersburg, Russia10.18705/2311-4495-2021-8-2-23-36transmed-594Research ArticleПЕДИАТРИЯPEDIATRICSДеформация эндокардиального, эпикардиального слоев левого желудочка в продольном направлении и ремоделирование левого желудочка у детей в возрасте от одного года до пяти лет, рожденных с очень низкой и экстремально низкой массой телаLeft ventricle longitudinal strain of the endocardial and epicardial layers and left ventricle remodelling in children born with low and extremely low body weight aged from one to five years oldПавлюковаЕ. Н.PavlyukovaE. N.

Павлюкова Елена Николаевна, д.м.н., профессор, заведующий отделением атеросклероза и хронической ишемической болезни сердца НИИ кардиологии

Киевская ул., д. 111а, Томск, 634012 

Pavlyukova Elena N., Dr. Sci., Professor, Head of Department of Atherosclerosis and Chronic Ischemic Heart Disease 

Kievskaya str., 111a, Tomsk, 634012 

pavluk@cardio-tomsk.ruhttps://orcid.org/0000-0002-5550-5925КолосоваМ. В.KolosovaM. V.

Колосова Марина Владимировна, д.м.н., профессор кафедры детских болезней 

Томск

Kolosova Marina V., Dr. Sci., Professor, Head of Department of Children Diseases 

Tomsk

kolosova_mv@inbox.ruhttps://orcid.org/0000-0002-7556-9379НеклюдоваГ. В.NeklyudovaG. V.

Неклюдова Галина Владимировна, аспирант 

Томск

Neklyudova Galina V., PhD Student 

Tomsk

lv-gal@mail.ruhttps://orcid.org/0000-0002-7011-4316КарповР. С.KarpovR. S.

Карпов Ростислав Сергеевич, академик РАН, научный руководитель  

Томск

Karpov Rostislav S., Academician, Scientific Director 

Tomsk

tvk@cardio-tomsk.ruФедеральное государственное бюджетное научное учреждение «Томский национальный исследовательский медицинский центр Российской академии наук», Научно-исследовательский институт кардиологииРоссияTomsk National Research Medical Center of the Russian Academy of Sciences, Cardiology Research InstituteRussian FederationФедеральное государственное бюджетное образовательное учреждение высшего образования «Сибирский государственный медицинский университет» Министерства здравоохранения Российской ФедерацииРоссияSiberia State Medical UniversityRussian Federation202103062021822336Copyright © Павлюкова Е.Н., Колосова М.В., Неклюдова Г.В., Карпов Р.С., 20212021Павлюкова Е.Н., Колосова М.В., Неклюдова Г.В., Карпов Р.С.Pavlyukova E.N., Kolosova M.V., Neklyudova G.V., Karpov R.S.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://transmed.almazovcentre.ru/jour/article/view/594

Актуальность. В последние десятилетия число детей, рожденных недоношенными, значительно увеличилось. Дети, рожденные раньше срока, в отдаленной перспективе сильнее подвержены сердечно-сосудистым заболеваниям. Для выявления «субклинических» нарушений контрактильности миокарда у недоношенных детей может быть использована оценка глобальной деформации левого желудочка (ЛЖ).Цель. Изучить деформацию эндокардиального, среднего и эпикардиального слоев ЛЖ в продольном направлении у детей, рожденных с очень низкой и экстремально низкой массой тела, в возрасте от одного года до пяти лет.Материалы и методы. В исследование включено 88 детей в возрасте от одного года до пяти лет, рожденных глубоконедоношенными с очень низкой и экстремально низкой массой тела. Группу сравнения составили 43 здоровых ребенка аналогичного возраста, рожденные доношенными. Деформация эндокардиального, среднего и эпикардиального слоев в продольном направлении изучена с применением технологии «след пятна» (Speckle Tracking Imaging-2D Strain).Результаты. У детей в возрасте от одного года до пяти лет, рожденных с очень низкой и экстремально низкой массой тела, изменения градиента трансмуральной деформации стенки и снижение сегментарной деформации ЛЖ в продольном направлении выявлены в 15,90 % и в 14,77 % случаев соответственно. Матери детей, рожденных недоношенными и с регистрировавшимися впоследствии нарушениями трансмурального градиента деформации левого желудочка, в 10 случаях (71,43 %) имели в анамнезе угрозу прерывания беременности. Угроза прерывания беременности отмечена у всех женщин, дети которых имели снижение сегментарной деформации ЛЖ. У детей, не имевших нарушений сегментарной деформации ЛЖ, угроза прерывания беременности у матерей зарегистрирована в 16 случаях (26,23 %). Ремоделирование ЛЖ наблюдается у детей с изменением градиента трансмуральной деформации и со снижением сегментарной деформации ЛЖ в продольном направлении. Заключение. Изменения трансмурального градиента деформации стенки или снижения сегментарной деформации ЛЖ в продольном направлении у недоношенных детей требуют коррекции традиционного алгоритма диспансерного наблюдения в амбулаторных условиях.

Background. In last decades, the number of babies born preterm has increased significantly. Premature newborns are more susceptible to cardiovascular disease in the long-term. To identify subclinical myocardial impairment in premature infants, an assessment of of the left ventricle (LV) deformation could be used.Objective. The aim of the study was to study the left ventricle (LV) Longitudinal Strain of the endocardial, middle and epicBardial layers in children born with very low and extremely low body weight, at the age from one to five years.Design and methods. The study included 88 children aged from one to 5 years old, born very premature with very low and extremely low body weight. The comparison group consisted of 43 healthy children of the same age, born full-term. The LV Longitudinal Strain of the endocardial, middle and epicardial layers was studied using the Speckle Tracking Imaging-2D Strain.Results. In children aged 1 to 5 years, born with very low and extremely low body weight, changes in the gradient of transmural wall Strain and a decrease in LV segments longitudinal strain were detected in 15.90 % and 14.77 % of cases, respectively. Mothers of children born prematurely and who subsequently registered disturbance of the transmural gradient of left ventricular strain in 10 cases (71.43 %) had a history of threatened termination of pregnancy. The threat of termination of pregnancy was noted in all women whose children had a decrease in LV segmental strain. In children who have normal of LV segmental strain, the threat of termination of pregnancy in mothers was registered in 16 cases (26.23 %). LV remodeling is observed in children with a change in the gradient of transmural wall strain or and with a decrease in LV longitudinal segment strain. Conclusion. Changes in the transmural gradient of wall deformation or reduction of segmental LV deformation in the longitudinal direction in premature infants require correction of the conventional algorithm of dispensary observation in an outpatient setting.

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The authors declare that there are no conflicts of interest present.