Cardiac insufficiency: early diagnosis with ultrasound

Interview with Dr. Johannes Krämer, Pediatric Cardiology, University Medical Center Ulm


Heart failure or cardiac insufficiency presents an extra strain on patients because it severally limits everyday performance and deprives them of energy. Due to their intense need for movement, children are particularly strongly affected. However, the disease is frequently not detected until the physical performance is already declining. An early diagnosis could prevent this.

Photo: Three men pose for a picture during an award ceremony

Prof. Dr. Christian Apitz, Dr. Johannes Krämer, Prof. Dr. Klaus-Michael Debatin (left to right); ©Universitätsklinikum Ulm

In this interview with, Dr. Johannes Krämer explains how Speckle Tracking Echocardiography generates a fingerprint of the myocardial motion and the importance of this forboth children undergoing chemotherapy and adult patients.

Dr. Krämer, you are currently researching cardiac insufficiency in children including diagnosis. What exactly are you working on?

Dr. Johannes Krämer: We want to capture the early stages of the different types of heart failure or cardiac insufficiency in children that presently still escape clinical diagnostics. By using functional ultrasound imaging, we want to detect minor irregularitiesin wall motion during cardiac stress tests.We are currently conducting a clinical trial with children here in Ulm. Later on, we could extend it to other patient groups.

What type of disease is cardiac insufficiency actually?

Krämer: The disease pattern represents a wide range. It primarily means that the heart is no longer able to pump sufficient blood to adequately support the organs. Once heart failure is at an advanced stage, it restricts a patient’s everyday life. Patients no longer have enough energy to walk or ride a bike or even simply to play.

This affects children who take anthracyclines during chemotherapy, for example, children who have congenital or acquired heart disease or children who needed heart surgery.

What types of symptoms are you able to detect by combining ultrasound and stress testing?

Krämer: We use a so-called Speckle Tracking Echocardiography software. It allows us to track very minorabnormalities during the cardiac cycle that are normal during ultrasound testing. We are able to see how well the individual points of the cardiac muscle move in various wall segments. When this test is done understress – the children have to use a bicycle ergometer – we are able to detect very subtle irregularities that could be an indication of heart failure.

Photo: Young girl during an ECG examination

Early stages of the different types of cardiac insuffiency currently still escape clinical diagnostics. The new ultrasound-bases method is supposed to change this; © HOMONSTOCK

How does this technique differ from current diagnostic methods?

Krämer: The typical procedure right now is a cardiac ultrasound without inducing stress and this special software. Tests, where the cardiac muscle is stimulated by drugs, are more common in adulthood.Obviously, this is not as easy to do in children with pre-existing medical conditions.Physiologically, it also makes far more sense for us to use the cycle ergometer. This reflects the type of stress the heart is subjected to in everyday life.

Do you also use a specific ultrasound system?

Krämer: This is a conventional system.What makes this test unique is the software. In a manner of speaking, it is able to create a fingerprint of the cardiac muscle using the images of the segments and subsequently, track these segments during their motion. This software has not become common clinical practice yet but it is already available from various producers.

The goal of your research is an early diagnosis. How could cardiac insufficiency in affected children be treated or prevented?

Krämer: Especially in the case of children undergoing chemotherapy, you could either change the drug dosage at an early stage or use a different drug from the start. Our long-term plan with this method is to identify children who have an increased risk of heart failure before they begin the treatment.

Could this technique also be used to diagnose heart failure in adults?

Krämer: Tests with drug stimulants are already conducted more frequently in adults than in children. Chemical stress tests can be induced easier in adults. Having said that, functional imaging is also not used as frequently in this case. In light of that, our method could also provide an added benefit for tests at an advanced age.

Photo: Timo Roth; Copyright: B. Frommann

© B. Frommann

The interview was conducted by Timo Roth and translated from German by Elena O'Meara.