Prognostic value of fetal left ventricular myocardial performance index for mortality or ECMO in congenital diaphragmatic hernia.

BACKGROUND

We aimed to determine whether fetal left ventricular myocardial performance index (LV MPI) at 30-34 weeks' gestation predicts mortality or need for extracorporeal membrane oxygenation (ECMO) in congenital diaphragmatic hernia (CDH), and whether it adds predictive value beyond the observed-to-expected lung-to-head ratio (O/E LHR).

METHODS

Retrospective single-center cohort (2017-2024) of prenatally diagnosed CDH with LV MPI measured at 30-34 weeks. The primary outcome was death before NICU discharge or ECMO. Multivariable logistic regression evaluated LV MPI adjusted for O/E LHR and liver herniation; discrimination was quantified by area under the ROC curve (AUC). An RV MPI subset assessed incremental value.

RESULTS

Among 114 infants, 36 (31.6 %) had death/ECMO. LV MPI was higher in infants who died or required ECMO than in survivors without ECMO (0.538 ± 0.05 vs 0.480 ± 0.05; p < 0.001). In multivariable analysis, each 0.1-unit increase was associated with greater odds of death/ECMO (adjusted OR 9.42, 95 % CI 2.26-39.18; p = 0.002). AUCs were 0.78 for LV MPI and 0.85 for O/E LHR; combined, 0.89. Adding liver herniation improved discrimination (O/E LHR + liver herniation, 0.93; LV MPI + O/E LHR + liver herniation, 0.95). The optimal LV MPI threshold for mortality was 0.53. In the RV-MPI subset (n = 66), RV MPI alone had an AUC of 0.74; adding RV MPI to LV MPI + O/E LHR increased AUC from 0.83 to 0.87.

CONCLUSIONS

Fetal LV MPI at 30-34 weeks independently predicts death/ECMO in CDH. Combining LV MPI with O/E LHR-particularly with liver herniation-enhances prenatal risk stratification.

LEVEL OF EVIDENCE: III.