Age-related changes in left ventricular vortex and energy loss patterns: from newborns to adults

• Published in: American journal of physiology. Heart and circulatory physiology Vol. 324; no. 5; pp. H624 - H629
• Main Authors: Becker, Kristian C., Cohen, Jennifer, Nyce, Jon D., Yau, Jen Lie, Uppu, Santosh C., Sengupta, Partho P., Srivastava, Shubhika
• Format: Journal Article
• Language: English
• Published: United States American Physiological Society 01.05.2023
• Subjects: Adolescent; Adolescents; Age; Age groups; Blood Flow Velocity - physiology; Blood volume; Child; Children; Diastole; Diastole - physiology; Echocardiography; Energy loss; Flow distribution; Flow mapping; Fluid flow; Heart; Heart Ventricles - diagnostic imaging; Humans; Infant, Newborn; Neonates; Newborn babies; Pediatrics; Prospective Studies; Systole; Ventricle; Ventricular Function, Left - physiology; Vortices; Young Adult; Young adults; pediatric cardiology; left ventricle; vector flow mapping; hemodynamics; echocardiography
• ISSN: 0363-6135; 1522-1539; 1522-1539
• DOI: 10.1152/ajpheart.00002.2023

This research article demonstrates, for the first time, echocardiographic evidence of a transition in left ventricular vortex patterns from the newborn to the adult period, with an associated change in cardiac efficiency, marked by increased energy loss, during infancy. Left ventricular vortex formation optimizes the effective transport of blood volume while minimizing energy loss (EL). Vector flow mapping (VFM)-derived EL patterns have not been described in children, especially in those less than 1 yr of age. A prospective cohort of 66 (0 days–22 yr, 14 patients ≤ 2 mo) cardiovascularly normal children was used to determine left ventricular (LV) vortex number, size (mm 2 ), strength (m 2 /s), and energy loss (mW/m/m 2 ) in systole and diastole and compared across age groups. One early diastolic (ED) vortex at the anterior mitral leaflet and one late diastolic (LD) vortex at the LV outflow tract (LVOT) were seen in all newborns ≤ 2 mo. At >2 mo, two ED vortices and one LD vortex were seen, with 95% of subjects > 2 yr demonstrating this vortex pattern. Peak and average diastolic EL acutely increased in the same 2 mo–2-yr period and then decreased within the adolescent and young adult age groups. Overall, these findings suggest that the growing heart undergoes a transition to adult vortex flow patterns over the first 2 yr of life with a corresponding acute increase in diastolic EL. These findings offer an initial insight into the dynamic changes of LV flow patterns in pediatric patients and can serve to expand our understanding of cardiac efficiency and physiology in children. NEW & NOTEWORTHY This research article demonstrates, for the first time, echocardiographic evidence of a transition in left ventricular vortex patterns from the newborn to the adult period, with an associated change in cardiac efficiency, marked by increased energy loss, during infancy. Listen to this article’s corresponding podcast at https://ajpheart.podbean.com/e/lv-vortex-patterns-change-from-newborns-to-adults/ .