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Abstract
Objective To explore the value of two-dimensional speckle tracking imaging (2D-STI) technology combined with serum adrenomedullin (ADM) and growth differentiation factor-15 (GDF-15) in evaluating right ventricular function in children with severe pneumonia (SP). Methods A total of 105 children with SP admitted to the Seventh Medical Center of Chinese PLA General Hospital from February 2021 to June 2023 were prospectively enrolled as the study subjects. They were divided into the right heart failure (RHF) group (n=43) and non-RHF group (n=62) based on the presence of RHF. Additionally, 80 age- and gender-matched healthy children who underwent physical examinations during the same period were selected as the control group. Serum levels of cardiac troponin Ⅰ (cTnⅠ), N-terminal pro-brain natriuretic peptide (NT-proBNP), ADM, and GDF-15 were compared among the three groups. Tricuspid annular plane systolic excursion (TAPSE) and myocardial performance index (Tei index) were obtained by echocardiography. Free wall global longitudinal strain (FWGLS), interventricular septum global longitudinal strain (IVSGLS), and right ventricular global longitudinal strain (RVGLS) were measured using 2D-STI technology. The correlations between serum ADM, GDF-15 and cTnⅠ, NT-proBNP, as well as between 2D-STI parameters and conventional echocardiographic parameters, were analyzed by Pearson method. Statistical analysis was performed using one-way analysis of variance (ANOVA), LSD t-test and χ2 test. Results The serum levels of cTnⅠ, NT-proBNP, ADM, and GDF-15 in the RHF group were higher than those in the non-RHF group and the control group, the differences were statistically significant (all P<0.05). The serum levels of cTnⅠ, NT-proBNP, ADM, and GDF-15 in the non-RHF group were higher than those in the control group, the differences were statistically significant (all P<0.05). The values of TAPSE, FWGLS, IVSGLS, and RVGLS in the RHF group were significantly lower than those in the non-RHF group and the control group, while the Tei index was significantly higher than those in the non-RHF group and the control group, the differences were statistically significant (all P<0.05). However, there was no statistically significant difference in TAPSE, Tei index, FWGLS, IVSGLS, and RVGLS between the non-RHF group and the control group (all P>0.05). The results of Pearson correlation analysis showed that serum ADM in children with SP was positively correlated with cTnⅠ and NT-proBNP ( r values were 0.417, 0.559, all P<0.001), and GDF-15 was positively correlated with cTnⅠ and NT-proBNP (r values were 0.762, 0.635, all P<0.001). The results of Pearson correlation analysis showed that FWGLS, IVSGLS and RVGLS in children with SP were negatively correlated with TAPSE (r values were -0.545, -0.275, -0.527, all P<0.05), and positively correlated with Tei index (r values were 0.294, 0.315, 0.342, all P<0.05). The serum levels of ADM, GDF-15, and the values of FWGLS, IVSGLS, and RVGLS in children with RHF of different degrees of heart function showed statistically significant differences (all P<0.001). Among them, the serum levels of ADM and GDF-15 were classified as grade Ⅳ>grade Ⅲ>grade Ⅱ>gradeⅠ, while the values of FWGLS, IVSGLS, and RVGLS were classified as grade Ⅳ<grade Ⅲ<grade Ⅱ<gradeⅠ. Conclusion The serum levels of ADM and GDF- 15 are significantly increased in children with SP , while the values of FWGLS, IVSGLS and RVGLS are significantly decreased. 2D-STI technology combined with serum ADM and GDF-15 detection is helpful to evaluate right heart function in children with SP.
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2026, Vol. 14 
