Neonatology · 2024
Characterizing the Role of Left Ventricular Indices and Biventricular Interaction in Bronchopulmonary Dysplasia-Associated Pulmonary Hypertension in Extreme Prematurity.
СтатьяНаблюдательное исследованиеНазвание и аннотация: Перевод в очереди
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Gopagondanahalli Krishna Revanna, Sundararaghavan Sreekanthan, Tan Teng Hong, Yeo Kee Thai, Vora Shrenik Jitendrakumar, Ng Wei Di, Choo Jonathan Tze Liang, Ang Wai Lin, Binte Mohamad Taib Nur Qaiyimah, Han Ying Nishanthi Wijedasa, Rajadurai Victor Samuel, Abdul Haium Abdul Alim
Аннотация
INTRODUCTION: Bronchopulmonary dysplasia (BPD) is a common respiratory morbidity in preterm infants. The onset of pulmonary hypertension leads to worse respiratory outcomes. The contribution of left ventricular diastolic dysfunction in BPD-PH is well reported. We evaluated the serial left ventricular function and possible ventricular interdependence among BPD-PH.
METHODS: This is a single-center, prospective observational study. Infants <28 weeks of gestation are included.
RESULTS: Eighty infants were enrolled. The incidence of BPD-PH was 23%. The BPD-PH group had a high incidence of hemodynamically significant ductus arteriosus (83% vs. 56%, p < 0.018), longer oxygen days (96.2 ± 68.1 vs. 59.35 ± 52, p < 0.008), and prolonged hospital stay (133.8 ± 46 vs. 106.5 ± 38 days, p < 0.005). Serial tissue Doppler imaging showed prolonged left ventricle (LV) isovolumetric contraction time (IVCT) (31.05 ± 3.3 vs. 26.8 ± 4.4 ms, p < 0.001) and myocardial performance index (MPI) (0.43 ± 0.03 vs. 0.37 ± 0.04, p < 0.001) from 33 weeks. The changes in IVCT (35.9 ± 6.7 vs. 27.9 ± 4.5 ms, p < 0.001), isovolumetric relaxation time (IVRT) (50 ± 6.5 vs. 39.9 ± 5.8 ms, p < 0.001), and MPI (0.48 ± 0.05 vs. 0.36 ± 0.03, p < 0.001) persisted at 36 weeks. The receiver operator characteristic curve showed LV MPI >40 has 83% sensitivity and 65% specificity (AUC: 0.77, p < 0.001) in the diagnosis of PH. The BPD-PH group had a higher LV E/E' ratio (13.1 ± 4.4 vs. 11.4 ± 3.4, p < 0.02). Pearson correlation test showed a moderate positive correlation between RV MPI and LV MPI (r = 0.585, p < 0.001).
CONCLUSIONS: Significant LV diastolic dysfunction was observed in BPD-PH. This is the first study to show biventricular strain and possible ventricular interdependence in BPD-PH. The prolonged LV IVRT and MPI may be a novel echocardiographic indicator of BPD-PH.
METHODS: This is a single-center, prospective observational study. Infants <28 weeks of gestation are included.
RESULTS: Eighty infants were enrolled. The incidence of BPD-PH was 23%. The BPD-PH group had a high incidence of hemodynamically significant ductus arteriosus (83% vs. 56%, p < 0.018), longer oxygen days (96.2 ± 68.1 vs. 59.35 ± 52, p < 0.008), and prolonged hospital stay (133.8 ± 46 vs. 106.5 ± 38 days, p < 0.005). Serial tissue Doppler imaging showed prolonged left ventricle (LV) isovolumetric contraction time (IVCT) (31.05 ± 3.3 vs. 26.8 ± 4.4 ms, p < 0.001) and myocardial performance index (MPI) (0.43 ± 0.03 vs. 0.37 ± 0.04, p < 0.001) from 33 weeks. The changes in IVCT (35.9 ± 6.7 vs. 27.9 ± 4.5 ms, p < 0.001), isovolumetric relaxation time (IVRT) (50 ± 6.5 vs. 39.9 ± 5.8 ms, p < 0.001), and MPI (0.48 ± 0.05 vs. 0.36 ± 0.03, p < 0.001) persisted at 36 weeks. The receiver operator characteristic curve showed LV MPI >40 has 83% sensitivity and 65% specificity (AUC: 0.77, p < 0.001) in the diagnosis of PH. The BPD-PH group had a higher LV E/E' ratio (13.1 ± 4.4 vs. 11.4 ± 3.4, p < 0.02). Pearson correlation test showed a moderate positive correlation between RV MPI and LV MPI (r = 0.585, p < 0.001).
CONCLUSIONS: Significant LV diastolic dysfunction was observed in BPD-PH. This is the first study to show biventricular strain and possible ventricular interdependence in BPD-PH. The prolonged LV IVRT and MPI may be a novel echocardiographic indicator of BPD-PH.