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Geisinger R, Rios DR, McNamara PJ, Levy PT. Asphyxia, Therapeutic Hypothermia, and Pulmonary Hypertension. Clin Perinatol 2024; 51:127-149. [PMID: 38325938 DOI: 10.1016/j.clp.2023.11.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2024]
Abstract
Neonates with a perinatal hypoxic insult and subsequent neonatal encephalopathy are at risk of acute pulmonary hypertension (aPH) in the transitional period. The phenotypic contributors to aPH following perinatal asphyxia include a combination of hypoxic vasoconstriction of the pulmonary vascular bed, right heart dysfunction, and left heart dysfunction. Therapeutic hypothermia is the standard of care for neonates with moderate-to-severe hypoxic ischemic encephalopathy. This review summarizes the underlying risk factors, causes of aPH in neonates with perinatal asphyxia, discusses the unique phenotypical contributors to disease, and explores the impact of the initial insult and subsequent therapeutic hypothermia on aPH.
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Affiliation(s)
- Regan Geisinger
- Division of Neonatology, Department of Pediatrics, University of Iowa, 200 Hawkins Drive, Iowa City, IA 52242, USA
| | - Danielle R Rios
- Division of Neonatology, Department of Pediatrics, University of Iowa, 200 Hawkins Drive, Iowa City, IA 52242, USA
| | - Patrick J McNamara
- Division of Neonatology, Department of Pediatrics, University of Iowa, 200 Hawkins Drive, Iowa City, IA 52242, USA
| | - Philip T Levy
- Division of Newborn Medicine, Department of Pediatrics, Boston Children's Hospital, Harvard Medical School, 300 Longwood Avenue, Hunnewell 436, Boston, MA 02115, USA.
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Gözde Kanmaz Kutman H, Kadıoğlu Şimşek G, Ceran B, Beşer E, Emre Canpolat F. Troponin I, CK-MB, and inotropic score in hypoxic-ischemic encephalopathy and associated infant mortality. BMC Pediatr 2023; 23:511. [PMID: 37845609 PMCID: PMC10578001 DOI: 10.1186/s12887-023-04311-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2023] [Accepted: 09/14/2023] [Indexed: 10/18/2023] Open
Abstract
PURPOSE Cardiovascular dysfunction is common in hypoxic-ischemic encephalopathy (HIE), which is one of the leading causes of multi-organ failure in neonates. We aimed to assess troponin I and creatine kinase myocardial band (CK-MB) levels, inotropic score (IS) in HIE patients, and their associations with HIE staging and mortality. METHOD The medical records of all HIE infants admitted to our unit between 2016 and 2018 were retrospectively analyzed. Demographic characteristics of the infants, seizures, anticonvulsive therapies, maximum inotrope doses, and the derived IS (dopamine dose [µg/kg/min] + dobutamine dose [µg/kg/min] + 100 × epinephrine dose [µg/kg/min]) and CK-MB and troponin-I levels obtained in the first six hours of life were compared according to HIE staging. Comparisons between survivors and non-survivors were made. RESULTS The study included data from 195 patients. Twenty-five patients were classified as stage 3, 116 as stage 2, and 54 as stage 1 HIE. Median Troponin-I, CK-MB level, and IS significantly differed by HIE staging (p < 0.01). The deceased infants had significantly higher median troponin I level [0.36 (0.02-3) vs. 0.16 (0.01-1.1) ng/ml; p = 0.006], median IS [20 (5-120) vs. 5 (5-10); p < 0.001], however, CK-MB values were comparable with survivors [129 (51-300) vs. 60.7 (31-300) ng/ml; p = 0.57]. The area under the curve was 0.93 for IS and 0.81 for Troponin I to predict mortality. CONCLUSION Troponin I, CK-MB, and IS could be successfully used as disease severity markers in HIE furthermore, troponin I and IS, are good predictors of mortality. These results need to be confirmed with larger prospective multi-center studies.
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Affiliation(s)
- Hayriye Gözde Kanmaz Kutman
- Department of Neonatology, University of Health Sciences, Ankara City Hospital MH5, 06800, Çankaya, Ankara, Turkey.
| | - Gülsüm Kadıoğlu Şimşek
- Department of Neonatology, University of Health Sciences, Ankara City Hospital MH5, 06800, Çankaya, Ankara, Turkey
| | - Burak Ceran
- Department of Neonatology, University of Health Sciences, Ankara City Hospital MH5, 06800, Çankaya, Ankara, Turkey
| | - Esra Beşer
- Department of Neonatology, University of Health Sciences, Ankara City Hospital MH5, 06800, Çankaya, Ankara, Turkey
| | - Fuat Emre Canpolat
- Department of Neonatology, University of Health Sciences, Ankara City Hospital MH5, 06800, Çankaya, Ankara, Turkey
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Saha AK, Ghosh M, Sardar S, Pal S. Assessment of myocardial function in late preterm and term infants with transient tachypnea of the newborn using tissue Doppler imaging - a pilot observational study. Eur J Pediatr 2023:10.1007/s00431-023-04941-1. [PMID: 36959315 DOI: 10.1007/s00431-023-04941-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 03/08/2023] [Accepted: 03/19/2023] [Indexed: 03/25/2023]
Abstract
The aim of this study was to compare conventional and tissue Doppler echocardiography parameters between transient tachypnea of the newborn (TTN) and healthy control infants. This cross sectional pilot observational study was conducted in a level 3 neonatal care unit of India. Consecutively born late preterm and term infants (LPTI) with TTN were eligible for enrollment. Control group was selected from healthy LPTI. Conventional and tissue Doppler (myocardial velocities, myocardial performance index (MPI)) echocardiography was done within first 12 h (D1) and 48-72 h (D3) of life. Conventional echocardiography parameters were fractional shortening (FS), ejection fraction (EF), ventricular output, E/A ratio, fractional area change (FAC), tricuspid annular plane systolic excursion (TAPSE), pulmonary artery systolic pressure (PASP), and pulmonary artery acceleration to ejection time ratio (PATET). Baseline characteristics and echocardiography images were compared between TTN and control groups. Out of 60 infants enrolled, 34 from TTN and 20 from control group were finally analyzed. Mean (SD) gestational age and birth weight of the study population was 366/7(1.8) weeks and 2398(376) g respectively. Left ventricular (LV) parameters were similar between both groups. On D1, right ventricular (RV)e' was smaller (6.42(1) cm/s vs. 7.68(1.68) cm/s, p 0.022), and E/e' (7.79(1.51) vs. 6.08(2.59), p 0.037) was larger in TTN group, indicating RV diastolic dysfunction. RV MPI (0.61(0.11) vs. 0.44(0.12), p < 0.001) was also larger, signifying RV global myocardial dysfunction. Similar findings were observed on D3. PATET was lower in TTN group on both D1 (0.34 (0.05) vs. 0.42 (0.05), p < 0.001) and D3 (0.38 (0.05) vs. 0.43 (0.02), p 0.004) suggesting persistently raised pulmonary arterial pressure, although only 2 infants developed pulmonary hypertension identified by standard echocardiography. Conclusion: Myocardial tissue Doppler imaging of TTN infants revealed occult right ventricular diastolic dysfunction secondary to persistently raised pulmonary arterial pressure. What is Known: •Transient tachypnea of the newborn may be associated with pulmonary arterial hypertension. What is New: •Tissue Doppler imaging in infants with transient tachypnea of the newborn revealed occult right ventricular diastolic dysfunction secondary to raised pulmonary arterial pressure, not detected by standard echocardiography.
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Affiliation(s)
- Anindya Kumar Saha
- Department of Neonatology, IPGME&R, 244 AJC Bose Road, Kolkata-700020, India
| | - Moumita Ghosh
- Department of Pediatrics, Medical College & Hospital, Kolkata, India
| | - Syamal Sardar
- Department of Neonatology, IPGME&R, 244 AJC Bose Road, Kolkata-700020, India
| | - Somnath Pal
- Department of Neonatology, IPGME&R, 244 AJC Bose Road, Kolkata-700020, India.
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Brunets N, Brunets V, Bokiniec R. Echocardiographic and ultrasound evaluation of haemodynamic parameters in hypoxic neonates treated with hypothermia: Study protocol. Front Pediatr 2023; 11:1122738. [PMID: 37144150 PMCID: PMC10152999 DOI: 10.3389/fped.2023.1122738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Accepted: 03/23/2023] [Indexed: 05/06/2023] Open
Abstract
Background Episodes of ischaemia-hypoxia in the perinatal period as well as the changes in the redistribution of blood may lead to decreased perfusion and ischaemia of the cardiac muscle. Additionally, there is a negative impact from the reduced contractility of the cardiac muscle secondary to acidosis and hypoxia. Therapeutic hypothermia (TH) improves the late effects in moderate and severe cases of hypoxia-ischaemia encephalopathy (HIE). The direct impact of TH on the cardiovascular system includes moderate bradycardia, increased pulmonary vascular resistance (PVR), inferior filling of the left ventricle (LV) and LV stroke volume. The above-mentioned consequences of TH and episodes of HI in the perinatal period are therefore exacerbation of respiratory and circulatory failure. The impact of the warming phase on the cardiovascular system is not well researched and currently few data has been published on this topic. Physiologically, warming increases heart rate, improves cardiac output and increases systemic pressure. The effect of TH and the warming phase on the cardiovascular values has a decisive impact on the metabolism of drugs, including vasopressors/inotropics, which in turn affects the choice of medication and fluid therapy. Method The study is a multi-centre, prospective, case-control, observational study. The study will include 100 neonates (50 subjects and 50 controls). Echocardiography and cerebral and abdominal ultrasound will be performed in the first 1/2 days after birth as well as during warming i.e., on day 4/7 of life. In neonatal controls these examinations will be performed for indications other than hypothermia, most frequently because of poor adaptation. Ethics and dissemination The Ethics Committee of the Medical University of Warsaw approved the study protocol prior to recruitment (KB 55/2021). Informed consent will be obtained from the carers of the neonates at the time of enrolment. Consent for participation in the study can be withdrawn at any time, without consequences and without obligation to justify the decision. All data will be stored in a secure, password-protected Excel file that is only accessible to researchers involved in the study. Findings will be published in a peer-reviewed journal and disseminated at relevant national and international conferences. Clinical Trial Registration NCT05574855.
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Affiliation(s)
- Natalia Brunets
- ŻELAZNA Medical Center Ltd St. Sophia’s Specialist Hospital, Warsaw, Poland
| | | | - Renata Bokiniec
- Department of Neonatology and Intensive Care, Medical University of Warsaw, Warsaw, Poland
- Correspondence: Renata Bokiniec ;
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Rodriguez MJ, Martinez-Orgado J, Corredera A, Serrano I, Arruza L. Diastolic Dysfunction in Neonates With Hypoxic-Ischemic Encephalopathy During Therapeutic Hypothermia: A Tissue Doppler Study. Front Pediatr 2022; 10:880786. [PMID: 35692972 PMCID: PMC9174686 DOI: 10.3389/fped.2022.880786] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Accepted: 04/21/2022] [Indexed: 11/13/2022] Open
Abstract
UNLABELLED Diastolic dysfunction often complicates myocardial ischemia with increased mortality rates. However, less is known about diastolic function after perinatal asphyxia in neonates with hypoxic-ischemic encephalopathy (HIE) during therapeutic hypothermia (TH) and rewarming. AIM The aim of this study was to assess diastolic function with tissue Doppler imaging (TDI) in neonates with moderate-severe HIE during TH and rewarming. METHOD Newborns at >36 weeks' gestation with moderate-severe HIE treated with TH were evaluated with targeted neonatal echocardiography (TNE), including TDI, within 24 h of TH initiation (T1), at 48-72 h of treatment (T2), and after rewarming (T3). These retrospective data were collected and compared with a control group of healthy babies at >36 weeks' gestation that was prospectively evaluated following the same protocol. RESULTS A total of 21 patients with HIE + TH and 15 controls were included in the study. Myocardial relaxation before the onset of biventricular filling was prolonged in the HIE + TH group during TH with significantly longer isovolumic relaxation time (IVRT') in the left ventricle (LV), the septum, and the right ventricle (RV). This was associated with slower RV early diastolic velocity (e') and prolonged filling on T1. Total isovolumic time (t-IVT; isovolumic contraction time [IVCT'] + IVRT') and myocardial performance index (MPI') were globally increased in asphyxiated neonates. All these differences persisted after correction for heart rate (HR) and normalized after rewarming. TDI parameters assessing late diastole (a' velocity or e'/a' and E/e' ratios) did not differ between groups. CONCLUSION TDI evaluation in our study demonstrated a pattern of early diastolic dysfunction during TH that normalized after rewarming, whereas late diastole seemed to be preserved. Our data also suggest a possible involvement of impaired twist/untwist motion and dyssynchrony. More studies are needed to investigate the impact and therapeutic implication of diastolic dysfunction in these babies, as well as to clarify the role of TH in these findings.
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Affiliation(s)
- Maria Jose Rodriguez
- Division of Neonatology, Instituto del Niño y del Adolescente, Hospital Clinico San Carlos-IdISSC, Madrid, Spain
| | - Jose Martinez-Orgado
- Division of Neonatology, Instituto del Niño y del Adolescente, Hospital Clinico San Carlos-IdISSC, Madrid, Spain
| | - Araceli Corredera
- Division of Neonatology, Instituto del Niño y del Adolescente, Hospital Clinico San Carlos-IdISSC, Madrid, Spain
| | - Irene Serrano
- Research Methodology Unit, Hospital Clínico San Carlos-IdISSC, Madrid, Spain
| | - Luis Arruza
- Division of Neonatology, Instituto del Niño y del Adolescente, Hospital Clinico San Carlos-IdISSC, Madrid, Spain
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Karpuz D, Çelik Y, Duman D, Durak F, Bozlu G, Giray D, Kara B, Hallıoğlu Kılınç O. Hipoksik iskemik ensefalopatili infantlarda tam kan sayımı parametreleri ve ekokardiyografi bulgularının prognostik değeri. CUKUROVA MEDICAL JOURNAL 2020. [DOI: 10.17826/cumj.645596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Giesinger RE, El Shahed AI, Castaldo MP, Breatnach CR, Chau V, Whyte HE, El-Khuffash AF, Mertens L, McNamara PJ. Impaired Right Ventricular Performance Is Associated with Adverse Outcome after Hypoxic Ischemic Encephalopathy. Am J Respir Crit Care Med 2020; 200:1294-1305. [PMID: 31251076 DOI: 10.1164/rccm.201903-0583oc] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Rationale: Asphyxiated neonates with hypoxic ischemic encephalopathy (HIE) are at risk of myocardial dysfunction; however, echocardiography studies are limited and little is known about the relationship between hemodynamics and brain injury.Objectives: To analyze the association between severity of myocardial dysfunction and adverse outcome as defined by the composite of death and/or abnormal magnetic resonance imaging.Methods: Neonates with HIE undergoing therapeutic hypothermia were enrolled. Participants underwent echocardiography at 24 hours, 72 hours (before rewarming), and 96 hours (after rewarming). Cerebral hemodynamics were monitored by near-infrared spectroscopy and middle cerebral artery Doppler.Measurements and Main Results: Fifty-three patients with a mean gestation and birthweight of 38.8 ± 2.0 weeks and 3.33 ± 0.6 kg, respectively, were recruited. Thirteen patients (25%) had mild encephalopathy, 27 (50%) had moderate encephalopathy, and 13 (25%) had severe encephalopathy. Eighteen patients (34%) had an adverse outcome. Severity of cardiovascular illness (P < 0.001) and severity of neurologic insult (P = 0.02) were higher in neonates with adverse outcome. Right ventricle (RV) systolic performance at 24 hours was substantially lower than published normative data in all groups. At 24 hours, lower tricuspid annular plane systolic excursion (P = 0.004) and RV fractional area change (P < 0.001), but not pulmonary hypertension, were independently associated with adverse outcome on logistic regression. High brain regional oxygen saturation (P = 0.007) and low middle cerebral artery resistive index (P = 0.04) were associated with RV dysfunction on post hoc analysis.Conclusions: RV dysfunction is associated with the risk of adverse outcome in asphyxiated patients with HIE undergoing hypothermia. Echocardiography may be a valuable diagnostic and prognostic tool in this vulnerable population.
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Affiliation(s)
| | | | | | - Colm R Breatnach
- Department of Paediatrics, The Rotunda Hospital, Dublin, Ireland; and
| | | | - Hilary E Whyte
- Division of Neonatology and.,Department of Paediatrics and
| | - Afif F El-Khuffash
- Department of Paediatrics, The Rotunda Hospital, Dublin, Ireland; and.,Department of Paediatrics, School of Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Luc Mertens
- Division of Cardiology, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Patrick J McNamara
- Division of Neonatology and.,Department of Paediatrics and.,Department of Physiology, The University of Toronto, Toronto, Ontario, Canada
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Sobeih AA, El-Baz MS, El-Shemy DM, Abu El-Hamed WA. Tissue Doppler imaging versus conventional echocardiography in assessment of cardiac diastolic function in full term neonates with perinatal asphyxia. J Matern Fetal Neonatal Med 2020; 34:3896-3901. [PMID: 31906753 DOI: 10.1080/14767058.2019.1702640] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Background and objective: Limited number of studies evaluated cardiac diastolic function in neonates with perinatal asphyxia using tissue Doppler imaging. The aim of this study was to evaluate the echocardiographic parameters in full-term neonates with perinatal asphyxia compared to healthy full-term neonates. Diagnostic value of echocardiographic parameters of diastolic dysfunction in predicting mortality in asphyxiated neonates was assessed.Setting: Neonatal intensive care unit at the Obstetric and Gynecology Hospital, Cairo University, Egypt (a tertiary care center).Patients and methods: This study included 20 neonates with perinatal asphyxia (cases) and 20 healthy full-term nonasphyxiated neonates (as controls). The studied groups were assessed by conventional pulsed wave Doppler and tissue Doppler imaging.Results: Among pulsed wave Doppler parameters, cases had statistically significant lower values (denoting more diastolic dysfunction) than controls as regards mitral E velocity (p = .04) and mitral E/A ratio (p = .04). Similarly, among tissue Doppler parameters, cases had statistically significant lower values (denoting more diastolic dysfunction) than controls as regards septal E'/A' ratio (p = .019), left ventricular E' velocity (p = .001), and E'/A' ratio (p < .001). Septal E'/A' ratio and right ventricular E'/A' ratio were significantly lower (p = .012 and p = .025, respectively) among nonsurvivors (denoting more diastolic dysfunction) compared to survivors. Moreover, cases had statistically significant higher values (denoting more diastolic dysfunction) than controls as regards septal (p < .001), left ventricular (p < .001), and right ventricular (p < .001) tissue Doppler-based myocardial performance indices. Asphyxiated neonates showed statistically significant higher evidence of left ventricular diastolic dysfunction than controls in both pulsed wave Doppler and tissue Doppler with p < .001 and p = .001, respectively; while there was no difference as regards right ventricular diastolic dysfunction. Tissue Doppler was able to detect higher number of neonates with left ventricular diastolic dysfunction than conventional pulsed wave Doppler.Conclusions: Tissue Doppler imaging was found to be able to detect diastolic dysfunction early in neonates with perinatal asphyxia specifically as regards the left ventricle. Assessment of myocardial function is important in asphyxiated neonates. Tissue Doppler imaging should be considered an integral part of assessment of cardiac function in asphyxiated neonates.
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Affiliation(s)
- Alaa A Sobeih
- Pediatric Cardiology Unit, Department of Pediatrics, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Mohamed S El-Baz
- Department of Pediatrics, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Doaa M El-Shemy
- Neonatal Intensive Care Unit, Om El-Atebaa Hospital, Cairo, Egypt
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Bhasin H, Kohli C. Myocardial dysfunction as a predictor of the severity and mortality of hypoxic ischaemic encephalopathy in severe perinatal asphyxia: a case-control study. Paediatr Int Child Health 2019; 39:259-264. [PMID: 30810512 DOI: 10.1080/20469047.2019.1581462] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Background: In perinatal asphyxia, hypoxia often leads to myocardial ischaemia. Few studies have assessed the degree of myocardial dysfunction in severely asphyxiated term neonates. Aim: To assess the extent of myocardial damage in newborns with severe perinatal asphyxia. Methods: A case-control study was conducted in asphyxiated newborns with hypoxic ischaemic encephalopathy (HIE) and in controls who were term non-asphyxiated newborns. Total (T) creatinine kinase (CK), CK-MB, troponin-T and 12-lead electrocardiography (ECG) and echocardiography were performed in both groups within 24-48 h after birth. The proportions of asphyxiated neonates with myocardial dysfunction and its relationship between severity of HIE and immediate outcome was compared. Results: Five of 23 asphyxiated neonates developed stage I, 10 stage II and eight stage III HIE. Serum levels of CK-T and CK-MB were raised in all 23 cases and troponin-T was raised in 13 (56.5%) HIE cases. ECG was abnormal in all cases and echocardiography in three (13%). Left ventricular ejection fraction (LVEF) and right ventricular ejection fraction (RVEF) were significantly decreased in all asphyxiated neonates. Eight (35%) patients died. Enzyme levels were higher and ECG and echocardiography abnormalities were common in infants with more severe HIE (p <0.05). Mean serum levels of CK-T and MB (p <0.001) and troponin-T (p =0.002) were higher in non-survivors. Mean LVEF and RVEF values were higher in survivors (p <0.001). All the controls had normal enzyme levels and echocardiography. ECG was abnormal in one control. Conclusion: Cardiac enzymes, ECG and echocardiography changes were associated with increasing severity of HIE and mortality.
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Affiliation(s)
- Himani Bhasin
- Department of Pediatrics, Shree Guru Gobind Singh Tricentenary Medical College , Delhi , India
| | - Charu Kohli
- Department of Community Medicine, Geetanjali Medical College and Hospital , Udaipur , India
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Jiang L, Li Y, Zhang Z, Lin L, Liu X. Use of high-sensitivity cardiac troponin I levels for early diagnosis of myocardial injury after neonatal asphyxia. J Int Med Res 2019; 47:3234-3242. [PMID: 31189368 PMCID: PMC6683911 DOI: 10.1177/0300060519831187] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Objective Low-cost diagnostic and prognostic biomarkers could help guide clinical management of neonates with myocardial injury after asphyxia. This study aimed to assess the utility of creatine kinase (CK)-MB, high-sensitivity cardiac troponin I (hs-cTnI), brain natriuretic peptide (BNP), and myoglobin in the early diagnosis of myocardial injury following neonatal asphyxia. Methods Eighteen neonates with asphyxia and myocardial injury, 22 neonates with asphyxia and no myocardial injury, and 19 neonates without asphyxia (controls) were enrolled consecutively at the Neonatology Department, First Hospital of Lanzhou University (August 2013 to December 2014). Serum CK-MB, hs-cTnI, BNP, and myoglobin levels were evaluated at 12 hours and 7 days after birth. Their diagnostic value for myocardial injury was assessed by receiver operating characteristic (ROC) curve analysis. Results Levels of all four markers were higher in neonates with asphyxia and myocardial injury than in neonates with asphyxia and no myocardial injury or controls 12 hours after birth. The marker hs-cTnI had the highest diagnostic value. Using a cutoff value of 0.087 µg/L for hs-cTnI, the sensitivity, specificity, and diagnostic accuracy for asphyxia-induced myocardial injury were 55.6%, 95.5%, and 77.5%, respectively. Conclusions Serum hs-cTnI levels can predict myocardial injury caused by neonatal asphyxia at an early stage.
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Affiliation(s)
- Li Jiang
- 1 Pediatrics, The First Hospital of Lanzhou University, Lanzhou, Gansu Province, China
| | - Yuning Li
- 1 Pediatrics, The First Hospital of Lanzhou University, Lanzhou, Gansu Province, China
| | - Zhi Zhang
- 2 Physical Examination Center, The First Hospital of Lanzhou University, Lanzhou, Gansu Province, China
| | - Lixing Lin
- 1 Pediatrics, The First Hospital of Lanzhou University, Lanzhou, Gansu Province, China
| | - Xiaoli Liu
- 3 Pediatrics, Maternal and Child Care Service Center, Liuzhou, Guangxi Province, China
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Karlén J, Karlsson M, Eliasson H, Bonamy AKE, Halvorsen CP. Cardiac Troponin T in Healthy Full-Term Infants. Pediatr Cardiol 2019; 40:1645-1654. [PMID: 31489446 PMCID: PMC6848050 DOI: 10.1007/s00246-019-02199-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Accepted: 08/23/2019] [Indexed: 11/26/2022]
Abstract
In this prospective cohort study of healthy full-term infants, we hypothesized that high-sensitivity cardiac troponin T (hs-cTnT) would be elevated in cord blood, compared with adult reference values, and that it would further increase over the first days of age. Cardiac troponin T has been shown to be significantly increased in healthy full-term newborns compared with adult reference values, but there is no established reference range. Most studies of cTnT in newborns have been performed before the introduction of high-sensitivity cTnT (hs-cTnT) assay. We conducted a study including 158 full-term newborns, at Stockholm South General Hospital. High-sensitivity cTnT was analyzed in umbilical cord blood and at 2-5 days of age. Median hs-cTnT (interquartile range) in cord blood was 34(26-44) ng/L; 99th percentile 88 ng/L. Median hs-cTnT at 2-5 days of age was 92(54-158) ng/L; 99th percentile 664 ng/L. We conclude that hs-cTnT is elevated in cord blood in healthy, full-term newborn infants compared with adult reference values, and that it increases significantly during the first days of life. Our findings further underline the need of caution when using hs-cTnT as a measurement of cardiac impact in newborns.
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Affiliation(s)
- Jonna Karlén
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Sjukhusbacken 10, 118 83, Stockholm, Sweden.
- Neonatal Unit at Sachs' Children's and Youth Hospital, Hjalmar Cederströms gata 14, 118 61, Stockholm, Sweden.
| | - Mathias Karlsson
- Department of Medical Sciences, Biomedical Structure and Function, Uppsala University, 751 85, Uppsala, Sweden
| | - Håkan Eliasson
- Department of Women's and Children's Health, Karolinska Institutet, Widerströmska huset, Tomtebodavägen 18A, 171 77, Stockholm, Sweden
- Pediatric Cardiology Department, Astrid Lindgrens Children's Hospital, Eugeniavägen 23, 171 64, Solna, Sweden
| | - Anna-Karin Edstedt Bonamy
- Neonatal Unit at Sachs' Children's and Youth Hospital, Hjalmar Cederströms gata 14, 118 61, Stockholm, Sweden
- Clinical Epidemiology Division, Karolinska Institutet, Karolinska vägen, 171 76, Stockholm, Sweden
| | - Cecilia Pegelow Halvorsen
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Sjukhusbacken 10, 118 83, Stockholm, Sweden
- Neonatal Unit at Sachs' Children's and Youth Hospital, Hjalmar Cederströms gata 14, 118 61, Stockholm, Sweden
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Joseph S, Kumar S, Ahamed M Z, Lakshmi S. Cardiac Troponin-T as a Marker of Myocardial Dysfunction in Term Neonates with Perinatal Asphyxia. Indian J Pediatr 2018; 85:877-884. [PMID: 29654572 DOI: 10.1007/s12098-018-2667-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2017] [Accepted: 03/15/2018] [Indexed: 12/24/2022]
Abstract
OBJECTIVES To describe the diagnostic test properties of Cardiac Troponin-T (cTnT) in predicting myocardial dysfunction in asphyxiated term neonates by taking echocardiography as the gold standard and to establish the optimum cut-off values of cTnT for myocardial dysfunction, shock, severe hypoxic ischemic encephalopathy (HIE) and mortality by receiver operator characteristic (ROC) curve analysis. METHODS This was a prospective study based on diagnostic test evaluation. The study included 120 term asphyxiated neonates in a tertiary care neonatal intensive care unit (NICU) in Southern India from June 2011 through June 2015. All the neonates were clinically evaluated. Venous blood was taken at 4 h of life for cTnT estimation. Echocardiography was done within 24 h of birth. RESULTS The mean cTnT level of asphyxiated term neonates was 0.207±0.289 ng/ml (mean ± SD). Asphyxiated neonates with myocardial dysfunction had higher cTnT levels (0.277±0.231) as compared to those without myocardial dysfunction (0.061±0.036, p = 0.0001). Using ROC curve, the cut-off cTnT values for myocardial dysfunction was 0.1145 ng/ml with sensitivity 92.4% and specificity 94.1%. Cardiac Troponin-T levels were significantly higher among asphyxiated neonates with shock (0.378±0.348, p = 0.0001) and the levels also correlated positively with increasing grades of HIE. The cut-off cTnT value for mortality was 0.2505 ng/ml with sensitivity 83.9% and specificity 96.6%. CONCLUSIONS In asphyxiated term neonates, early cTnT elevation is a marker for predicting myocardial dysfunction and elevated cTnT levels had high sensitivity and specificity. There was significant relation with increasing cTnT values and increasing grades of HIE.
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Affiliation(s)
- Susy Joseph
- Department of Pediatrics, SATH, Govt. Medical College, Thiruvananthapuram, Kerala, 695011, India.
| | - Sobha Kumar
- Department of Pediatrics, SATH, Govt. Medical College, Thiruvananthapuram, Kerala, 695011, India
| | - Zulfikar Ahamed M
- Department of Pediatric Cardiology, SATH, Govt. Medical College, Thiruvananthapuram, Kerala, India
| | - S Lakshmi
- Department of Pediatric Cardiology, SATH, Govt. Medical College, Thiruvananthapuram, Kerala, India
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Neves AL, Henriques-Coelho T, Leite-Moreira A, Areias JC. Cardiac injury biomarkers in paediatric age: Are we there yet? Heart Fail Rev 2018; 21:771-781. [PMID: 27255332 DOI: 10.1007/s10741-016-9567-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
The aim of this article is to evaluate the clinical utility of cardiac injury biomarkers in paediatric age. In December 2015, a literature search was performed (PubMed access to MEDLINE citations; http://www.ncbi.nlm.nih.gov/PubMed/ ). The search strategy included the following medical subject headings and text terms for the key words: "cardiac injury biomarkers", "creatine kinase-MB", "myoglobin", "troponin", "children", "neonate/s", "newborn/s", "infant/s" and echocardiography. In the paediatric population, troponins show a good correlation with the extent of myocardial damage following cardiac surgery and cardiotoxic medication and can be used as predictors of subsequent cardiac recovery and mortality. Elevation of cardiac injury biomarkers may also have diagnostic value in cases when cardiac contusion or pericarditis is suspected. Cardiac injury biomarkers are very sensitive markers for the detection of myocardial injury and have been studied in healthy newborns, after tocolysis, intrauterine growth restriction, respiratory distress and asphyxia. The proportion of newborns with elevated troponin was higher than that in ill infants, children, and adolescents and in healthy adults, suggesting that myocardial injury, although clinically occult, is common in this young age group. Results suggest that significant elevation of cord troponin is an excellent early predictor of severity of hypoxic-ischaemic encephalopathy and mortality in term infants. Cardiac biomarkers may also benefit centres without on-site echocardiography with evidence showing good correlation with echo-derived markers of myocardial function. Further studies are needed to better clarify the role of cardiac biomarkers in paediatric age and their correlation with echocardiographic parameters.
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Affiliation(s)
- Ana L Neves
- Department of Paediatric Cardiology, São João Hospital, Porto, Portugal. .,Department of Physiology and Cardiothoracic Surgery, Cardiovascular Research Centre, Faculty of Medicine, University of Porto, Porto, Portugal. .,Department of Paediatrics, Faculty of Medicine, University of Porto, Porto, Portugal.
| | - Tiago Henriques-Coelho
- Department of Paediatrics, Faculty of Medicine, University of Porto, Porto, Portugal.,Department of Paediatric Surgery, São João Hospital, Porto, Portugal
| | - Adelino Leite-Moreira
- Department of Physiology and Cardiothoracic Surgery, Cardiovascular Research Centre, Faculty of Medicine, University of Porto, Porto, Portugal.,Department of Cardiothoracic Surgery, São João Hospital, Porto, Portugal
| | - José C Areias
- Department of Paediatric Cardiology, São João Hospital, Porto, Portugal.,Department of Physiology and Cardiothoracic Surgery, Cardiovascular Research Centre, Faculty of Medicine, University of Porto, Porto, Portugal.,Department of Paediatrics, Faculty of Medicine, University of Porto, Porto, Portugal
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Nestaas E, Schubert U, de Boode WP, El-Khuffash A. Tissue Doppler velocity imaging and event timings in neonates: a guide to image acquisition, measurement, interpretation, and reference values. Pediatr Res 2018; 84:18-29. [PMID: 30072806 PMCID: PMC6257218 DOI: 10.1038/s41390-018-0079-8] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Neonatologists can use echocardiography for real-time assessment of the hemodynamic state of neonates to support clinical decision-making. There is a large body of evidence showing the shortcomings of conventional echocardiographic indices in neonates. Newer imaging modalities have evolved. Tissue Doppler imaging is a new technique that can provide measurements of myocardial movement and timing of myocardial events and may overcome some of the shortcomings of conventional techniques. The high time resolution and its ability to assess left and right cardiac function make tissue Doppler a favorable technique for assessing heart function in neonates. The aim of this review is to provide an up-to-date overview of tissue Doppler techniques for the assessment of cardiac function in the neonatal context, with focus on measurements from the atrioventricular (AV) plane. We discuss basic concepts, protocol for assessment, feasibility, and limitations, and we report reference values and give examples of its use in neonates.
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Affiliation(s)
- Eirik Nestaas
- 0000 0004 1936 8921grid.5510.1Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway ,0000 0004 0389 8485grid.55325.34Department of Cardiology and Center for Cardiological Innovation, Oslo University Hospital, Rikshospitalet, Oslo, Norway ,0000 0004 0627 3659grid.417292.bDepartment of Paediatrics, Vestfold Hospital Trust, Tønsberg, Norway
| | - Ulf Schubert
- 0000 0004 1937 0626grid.4714.6Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
| | - Willem P. de Boode
- grid.461578.9Department of Neonatology, Radboud University Medical Center, Radboud Institute for Health Sciences, Amalia Children’s Hospital, Nijmegen, The Netherlands
| | - Afif El-Khuffash
- 0000 0004 0617 7587grid.416068.dDepartment of Neonatology, The Rotunda Hospital, Dublin, Ireland ,0000 0004 0488 7120grid.4912.eDepartment of Pediatrics, The Royal College of Surgeons in Ireland, Dublin, Ireland
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15
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Application of Neonatologist Performed Echocardiography in the Assessment and Management of Neonatal Heart Failure unrelated to Congenital Heart Disease. Pediatr Res 2018; 84:78-88. [PMID: 30072802 PMCID: PMC6257223 DOI: 10.1038/s41390-018-0075-z] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Neonatal heart failure (HF) is a progressive disease caused by cardiovascular and non-cardiovascular abnormalities. The most common cause of neonatal HF is structural congenital heart disease, while neonatal cardiomyopathy represents the most common cause of HF in infants with a structurally normal heart. Neonatal cardiomyopathy is a group of diseases manifesting with various morphological and functional phenotypes that affect the heart muscle and alter cardiac performance at, or soon after birth. The clinical presentation of neonates with cardiomyopathy is varied, as are the possible causes of the condition and the severity of disease presentation. Echocardiography is the selected method of choice for diagnostic evaluation, follow-up and analysis of treatment results for cardiomyopathies in neonates. Advances in neonatal echocardiography now permit a more comprehensive assessment of cardiac performance that could not be previously achieved with conventional imaging. In this review, we discuss the current and emerging echocardiographic techniques that aid in the correct diagnostic and pathophysiological assessment of some of the most common etiologies of HF that occur in neonates with a structurally normal heart and acquired cardiomyopathy and we provide recommendations for using these techniques to optimize the management of neonate with HF.
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16
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Aggarwal S, Natarajan G. Biventricular function on early echocardiograms in neonatal hypoxic-ischaemic encephalopathy. Acta Paediatr 2017; 106:1085-1090. [PMID: 28374415 DOI: 10.1111/apa.13866] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2016] [Revised: 01/30/2017] [Accepted: 03/30/2017] [Indexed: 11/30/2022]
Abstract
AIM To compare early (<24 hours) echocardiograms (ECHOs) in infants with perinatal hypoxic-ischaemic encephalopathy (HIE) undergoing (i) therapeutic hypothermia (TH), (ii) normothermia and (iii) normal controls. METHODS This was a single-centre retrospective review of clinical early ECHOs of term infants with moderate or severe HIE and controls (with a normal ECHO <72 hours of age). Right (RVO) and left ventricular output (LVO), RV and LV myocardial performance index (MPI), systolic to diastolic duration ratio (S/D) and eccentricity indices (EI) in systole and diastole were compared using ANOVA. RESULTS Among infants with HIE (n = 56, 38 in the TH and 18 in normothermia groups), 14 (25%) infants died and 42 survived. Significantly elevated biventricular MPI, lower RVO and LVO and pulmonary hypertension (abnormal EI, higher RV S/D and bidirectional or right-to-left ductal shunt) were found in groups with HIE, compared to controls (n = 35). LV MPI was lower in HIE-TH, compared to the HIE-normothermia group. Infants with HIE who died (n = 14) had a significantly lower EId [0.77 (0.09) vs. 0.83 (0.08), p = 0.021] compared to survivors (n = 42). CONCLUSION Infants with perinatal HIE have ventricular dysfunction; those who died had significantly lower EId than survivors; this association needs to be further validated.
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Affiliation(s)
- Sanjeev Aggarwal
- Department of Pediatrics; Wayne State University, Children's Hospital of Michigan; Detroit MI USA
| | - Girija Natarajan
- Department of Pediatrics; Wayne State University, Children's Hospital of Michigan; Detroit MI USA
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17
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Breatnach CR, El-Khuffash A, James A, McCallion N, Franklin O. Serial measures of cardiac performance using tissue Doppler imaging velocity in preterm infants <29weeks gestations. Early Hum Dev 2017; 108:33-39. [PMID: 28388489 DOI: 10.1016/j.earlhumdev.2017.03.012] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2016] [Revised: 02/14/2017] [Accepted: 03/19/2017] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Tissue Doppler imaging (TDI) is a useful marker of myocardial performance in preterm infants. We aimed to demonstrate serial changes in TDI velocity in preterm infants <29weeks gestation, to assess the impact of inotropes and a haemodynamically significant patent ductus arteriosus (hsPDA). METHODS This was a prospective observational study of preterm infants <29weeks gestation. Echocardiography was performed at days 1, 2, 5-7 and at 36weeks, or before hospital discharge. Infants with hsPDA's on day 5-7 and those who received inotropes in the first week of life were not included in the Reference Cohort. Systolic (s`) and diastolic (e` and a`) velocity waves were assessed at the mitral and tricuspid annulus and basal septum. RESULTS One hundred and thirty nine infants with a mean (SD) gestation and birthweight of 26.7 (1.5) weeks and 946 (247) grams were enrolled. The 66 infants (47%) in the Reference Cohort demonstrated an increase in functional parameters with increasing age [LV s`, Septal s`, and RV s`, Day 1-36weeks: 2.8 (0.6) to 4.7 (1.0), 2.4 (0.6) to 4.6 (0.8), 3.6 (0.6) to 6.9 (1.0) cm/s respectively; all p<0.05). The 24 infants who received inotropes had lower LV e` [2.9 vs. 3.6cm/s], Septal e` [2.3 vs. 2.8cm/s] and a` [3.2 vs. 3.9cm/s], and lower RV a` [3.3 vs. 3.9cm/s] on Day 1 (all p<0.05). Fifty five infants had a hsPDA on Day 5-7, demonstrating higher LV [4.7 vs. 4.0cm/s] and Septal e` [3.9 vs. 3.3cm/s], and a higher LV E/e` [13 vs. 10] (all p<0.05). CONCLUSION Extremely preterm infants display a gradual increase in tissue Doppler velocities from birth until 36weeks corrected age. The presence of a hsPDA increases diastolic TDI velocities. Infants requiring inotropes have lower diastolic myocardial velocities on Day 1.
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Affiliation(s)
- Colm R Breatnach
- Department of Neonatology, The Rotunda Hospital, Dublin, Ireland.
| | - Afif El-Khuffash
- Department of Neonatology, The Rotunda Hospital, Dublin, Ireland; School of Medicine (Department of Paediatrics), Royal College of Surgeons in Ireland, Dublin, Ireland.
| | - Adam James
- Department of Neonatology, The Rotunda Hospital, Dublin, Ireland
| | - Naomi McCallion
- Department of Neonatology, The Rotunda Hospital, Dublin, Ireland; School of Medicine (Department of Paediatrics), Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Orla Franklin
- Department of Cardiology, Our Lady's Children's Hospital Crumlin, Dublin, Ireland
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18
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Murase M. Assessing ventricular function in preterm infants using tissue Doppler imaging. Expert Rev Med Devices 2016; 13:325-38. [DOI: 10.1586/17434440.2016.1153966] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
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Breatnach CR, Levy PT, James AT, Franklin O, El-Khuffash A. Novel Echocardiography Methods in the Functional Assessment of the Newborn Heart. Neonatology 2016; 110:248-260. [PMID: 27287615 DOI: 10.1159/000445779] [Citation(s) in RCA: 60] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2016] [Accepted: 03/24/2016] [Indexed: 11/19/2022]
Abstract
Echocardiography in the neonatal intensive care unit has led to improvements in our ability to assess the neonatal heart in health and disease. Advances in neonatal cardiac imaging have provided the capability to obtain quantitative information that often supersedes the qualitative information provided by conventional methods. Novel quantitative measures of function include the assessment of the velocity of muscle tissue movement during systole and diastole using tissue Doppler velocity imaging, and evaluation of deformation and rotational characteristics of the myocardium utilizing speckle tracking echocardiography or tissue Doppler-derived strain imaging. A comprehensive understanding of these novel functional modalities, their predictive value, and limitations can greatly assist in managing both the normal and maladaptive responses in the newborn period. This article discusses the novel and emerging methods for assessment of left and right heart function in the neonatal population.
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Affiliation(s)
- Colm R Breatnach
- Department of Neonatology, The Rotunda Hospital, Dublin, Ireland
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Abstract
Neonatal encephalopathy (NE) is a major contributor to neurodevelopmental deficits including cerebral palsy in term and near-term infants. The long-term neurodevelopmental outcome is difficult to predict with certainty in first few days of life. Multiorgan involvement is common but not part of the diagnostic criteria for NE. The most frequently involved organs are the heart, liver, kidneys and hematological system. Cerebral and organ involvement is associated with the release of organ specific biomarkers in cerebrospinal fluid, urine and blood. These biomarkers may have a role in the assessment of the severity of asphyxia and long-term outcome in neonates with NE.
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Affiliation(s)
- Saima Aslam
- Department of Paediatrics, National Maternity Hospital, Holles Street, Dublin, Ireland
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21
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Matter M, El-Sherbiny E, Elmougy A, Abass M, Aldossary S, Ali WA. Myocardial function in Saudi adolescents with vitamin D deficiency: Tissue Doppler imaging study. J Saudi Heart Assoc 2015; 28:22-30. [PMID: 26778902 PMCID: PMC4685207 DOI: 10.1016/j.jsha.2015.06.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2015] [Revised: 06/03/2015] [Accepted: 06/17/2015] [Indexed: 12/20/2022] Open
Abstract
Vitamin D deficiency is a common health problem in Saudi Arabia especially in children and adolescents. Many studies have reported the relation between low 25-Hydroxyvitamin D (25(OH)D) levels with cardiovascular diseases risk factors as well as cardiovascular events, including stroke, myocardial infarction, and congestive heart failure. This study was conducted to evaluate the effect of 25(OH)D deficiency on the myocardial function and other echocardiographic variables in adolescent, using tissue Doppler imaging (TDI) and to correlate these parameters with 25(OH)D level. The study included 84 healthy adolescents, consecutively selected from adolescents attending the outpatient clinic of Saad Specialist Hospital, KSA between September 2013 and October 2014. The study population was classified into two groups; vitamin D deficient group with 25(OH)D level less than 20 ng/mL and normal vitamin D (control group) with 25(OH)D equal or more than 30 ng/mL. Both groups were subjected to measuring hemoglobin level, serum albumin, creatinine, total calcium, Phosphorous, intact parathyroid hormone (iPTH), B-type natriuretic peptide (BNP), and 25(OH)D levels. Both conventional and pulsed wave TDI were done for all participants. TDI measurements showed significant higher LV Tei Index and RV Tei index when compared to the control group (0.61 ± 0.11 Vs 0.32 ± 0.05 p < 0.0001), (0.54 ± 0.14 Vs 0.40 ± 0.06 p < 0.0001) respectively. Mitral and tricuspid annular systolic velocities were significantly lower in vitamin D deficient group (6.99 ± 1.92 Vs 10.69 ± 0.31 cm/sec p < 0.0001 and 12.30 ± 2.14 Vs 13.89 ± 0.29 p < 0.0001 respectively). The mitral and tricuspid E/Em ratio was significantly higher in vitamin D deficient group than control group (p < 0.0001, p 0.005) respectively. Left ventricular internal diameter at end-diastole (LVIDd) was significantly higher in vitamin D deficient group (44.72 ± 6.33 Vs 40.36 ± 6.21 p 0.003). Serum 25(OH)D level showed significant negative correlation with LV Tei index (r = −0.668, p < 0.0001), RV Tei index (r = −0.421, p < 0.0001). Vitamin D deficiency is associated with subtle systolic and diastolic myocardial dysfunction in Saudi adolescents. TDI is a useful tool for detecting early changes in the myocardium in this particular group.
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Affiliation(s)
- Mohamed Matter
- Pediatric Department, Mansoura University Children Hospital, Mansoura Faculty of Medicine, Mansoura City, Egypt
| | - Enas El-Sherbiny
- Community Medicine Department, Mansoura Faculty of Medicine, Mansoura City, Egypt
| | - Atef Elmougy
- Pediatric Department, Mansoura University Children Hospital, Mansoura Faculty of Medicine, Mansoura City, Egypt
| | - Mohamed Abass
- Pediatric Department, Mansoura University Children Hospital, Mansoura Faculty of Medicine, Mansoura City, Egypt
| | - Sahar Aldossary
- Pediatric Department, Saad Specialist Hospital, Alkhobar, Saudi Arabia
| | - Waleed Abu Ali
- Pediatric Department, King Fahad University Hospital, Medical College Dammam University, Dammam, Saudi Arabia
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Serial assessment of right ventricular function using tissue Doppler imaging in preterm infants within 7 days of life. Early Hum Dev 2015; 91:125-30. [PMID: 25617862 DOI: 10.1016/j.earlhumdev.2014.12.013] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2014] [Revised: 12/26/2014] [Accepted: 12/28/2014] [Indexed: 11/23/2022]
Abstract
BACKGROUND We aimed to evaluate right ventricular (RV) function longitudinally using tissue Doppler imaging (TDI) echocardiography in preterm infants. METHODS We selected 101 very-low-birth-weight (VLBW) infants for the study. Echocardiographic examinations including TDI were performed serially within 7days of life. Pulsed-Doppler TDI waveforms were recorded at the tricuspid valve annulus, and peak systolic velocities (Sa), early diastolic velocities (Ea), and late diastolic velocities (Aa) were measured. RESULTS Sa, Ea and Aa were all reduced significantly from 3h to 12h, and then increased gradually thereafter. These three velocities also increased with gestational age in the early neonatal period. The ratio of Ea to Aa (Ea/Aa) did not change significantly within the first week of life. The ratio of E to Ea (E/Ea) in VLBW infants also seemed to remain stable from birth to day 7. The values of Sa appeared to be associated with cardiac output in the early neonatal period. Both Sa and Aa in intubated infants were significantly higher than in non-intubated infants. CONCLUSION RV TDI velocities of preterm infants in the early neonatal period are influenced by gestational age, postnatal age, and respiratory status, although the RV E/Ea ratio appears to be almost stable throughout the neonatal period. Our findings may provide some basis for assessment of RV function in critically ill preterm infants.
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Nestaas E, Skranes JH, Støylen A, Brunvand L, Fugelseth D. The myocardial function during and after whole-body therapeutic hypothermia for hypoxic-ischemic encephalopathy, a cohort study. Early Hum Dev 2014; 90:247-52. [PMID: 24612933 DOI: 10.1016/j.earlhumdev.2014.01.014] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2013] [Revised: 01/23/2014] [Accepted: 01/31/2014] [Indexed: 10/25/2022]
Abstract
BACKGROUND Therapeutic hypothermia has become standard treatment for moderate and severe neonatal hypoxic-ischemic encephalopathy (HIE) to reduce cerebral morbidity and mortality. The effect on the heart is incompletely explored. AIM To assess the myocardial function during and after whole-body therapeutic hypothermia for HIE. STUDY DESIGN Observational cohort study. SUBJECTS Forty-four infants with HIE cooled for 72hours were compared with 48 healthy term infants and 20 normothermic infants with HIE. OUTCOME MEASURES Tissue Doppler deformation indices of myocardial function (peak systolic strain, peak systolic strain-rate, early diastole strain-rate and strain-rate in atrial systole) during (days 1 and 3) and after (day 4) therapeutic hypothermia. RESULTS On days one and three all indices in both HIE groups were lower than the corresponding indices in the healthy infants. The two HIE groups had similar indices, except peak systolic strain-rate on days 1 and 3 and strain-rate in atrial systole on day 1. All strain-rate indices improved from day 3 to 4 (after rewarming) in the cooled group and achieved similar values to those in healthy infants on day 3. All indices were higher in the cooling-group after rewarming than in the normothermic infants with HIE on day 3, except early diastolic strain-rate. CONCLUSIONS Infants with HIE had similarly impaired myocardial function during days 1-3 whether normothermic or hypothermic. The myocardial function improved significantly at day 4 (after rewarming), approaching the day 3 levels in the healthy neonates.
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Affiliation(s)
- Eirik Nestaas
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Norway; Department of Paediatrics, Vestfold Hospital Trust, Norway.
| | - Janne Helen Skranes
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Norway; Department of Neonatal Intensive Care, Oslo University Hospital, Ullevål, Norway
| | - Asbjørn Støylen
- Department of Circulation and Medical Imaging, Faculty of Medicine, Norwegian University of Science and Technology, Norway; Department of Cardiology, St. Olavs Hospital, Norway
| | - Leif Brunvand
- Department of Paediatrics, Oslo University Hospital, Rikshospitalet, Norway
| | - Drude Fugelseth
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Norway; Department of Neonatal Intensive Care, Oslo University Hospital, Ullevål, Norway
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Fouzas S, Karatza AA, Davlouros PA, Chrysis D, Alexopoulos D, Mantagos S, Dimitriou G. Neonatal cardiac dysfunction in intrauterine growth restriction. Pediatr Res 2014; 75:651-7. [PMID: 24522102 DOI: 10.1038/pr.2014.22] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2013] [Accepted: 11/04/2013] [Indexed: 02/08/2023]
Abstract
BACKGROUND The early postnatal cardiovascular consequences of intrauterine growth restriction (IUGR) have not been completely elucidated. This study aimed to evaluate the effect of IUGR on neonatal myocardial function and cardiovascular adaptation to extrauterine life. METHODS Conventional and tissue Doppler echocardiographic parameters were compared on the second and fifth postnatal day between 30 IUGR and 30 appropriate-for-gestational age (AGA) neonates. RESULTS IUGR neonates presented relative interventricular septum (IVS) hypertrophy (IVS to left ventricular (LV) posterior wall diastolic ratio: median IUGR-AGA difference of 0.05 (interquartile range: 0.04-0.06); P = 0.020), relative LV dilatation (wall thickness to end-diastolic LV dimension difference of 0.12 (0.06-0.16); P = 0.012), and increased left myocardial performance index (MPI difference of 0.19 (0.05-0.28); P = 0.012). Repeated measurements ANOVA revealed a different pattern of change in LV stroke volume (LVSV; P < 0.001), LV cardiac output (LVCO; P < 0.001), MPI (P < 0.001), and heart rate (HR; P = 0.025) between AGA and IUGR infants. From the second to the fifth postnatal day, AGA neonates presented a decrease in MPI and HR with an increase in LVSV and LVCO. IUGR neonates failed to achieve similar changes in MPI, HR, and LVSV, whereas their LVCO decreased. CONCLUSION IUGR neonates present changes in cardiac morphology and subclinical myocardial dysfunction, which may result in an altered pattern of cardiovascular adaptation to extrauterine life.
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Affiliation(s)
- Sotirios Fouzas
- 1] Neonatal Intensive Care Unit, University Hospital of Patras, University of Patras Medical School, Patras, Greece [2] Department of Pediatrics, University Hospital of Patras, University of Patras Medical School, Patras, Greece
| | - Ageliki A Karatza
- 1] Neonatal Intensive Care Unit, University Hospital of Patras, University of Patras Medical School, Patras, Greece [2] Department of Pediatrics, University Hospital of Patras, University of Patras Medical School, Patras, Greece [3] Pediatric Cardiology Unit, University Hospital of Patras, University of Patras Medical School, Patras, Greece
| | - Periklis A Davlouros
- Department of Cardiology, University Hospital of Patras, University of Patras Medical School, Patras, Greece
| | - Dionisios Chrysis
- Department of Pediatrics, University Hospital of Patras, University of Patras Medical School, Patras, Greece
| | - Dimitrios Alexopoulos
- Department of Cardiology, University Hospital of Patras, University of Patras Medical School, Patras, Greece
| | - Stefanos Mantagos
- 1] Neonatal Intensive Care Unit, University Hospital of Patras, University of Patras Medical School, Patras, Greece [2] Department of Pediatrics, University Hospital of Patras, University of Patras Medical School, Patras, Greece
| | - Gabriel Dimitriou
- 1] Neonatal Intensive Care Unit, University Hospital of Patras, University of Patras Medical School, Patras, Greece [2] Department of Pediatrics, University Hospital of Patras, University of Patras Medical School, Patras, Greece
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Nestaas E, Fugelseth D, Støylen A. Automated, objective and expert-independent assessment of the analyzability of strain and strain rate in tissue Doppler images in term neonates by analysis of beat-to-beat variation. ULTRASOUND IN MEDICINE & BIOLOGY 2014; 40:637-642. [PMID: 24412174 DOI: 10.1016/j.ultrasmedbio.2013.10.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/10/2013] [Revised: 09/05/2013] [Accepted: 10/30/2013] [Indexed: 06/03/2023]
Abstract
The variation in longitudinal strain and strain rate (SR) between two consecutive heartbeats (beat-to-beat-variation, BBV) was used to evaluate the analyzability of longitudinal strain and SR in tissue Doppler images in term neonates. Strain and SR BBV analysis and visual evaluation of analyzability were performed in 2394 segments; 1739 segments (73%) were deemed to be analyzable by visual evaluation, with an intra-rater κ score of 0.87 and inter-rater κ score of 0.61 (p < 0.001). Compared against visual evaluation, the κ scores for identification of analyzable segments were 0.57 based on SR BBV and 0.58 based on strain BBV (p < 0.001). The areas under the receiver operating characteristic curves for identification of analyzable segments were 0.87 (0.85-0.88) for strain BBV and 0.87 (0.85-0.89) for SR BBV (p < 0.001). For both BBVs, the sensitivity for identification of analyzable segments was 77% at a specificity of 80%. Analysis of BBV can be used for automated, objective and expert-independent assessment of analyzability.
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Affiliation(s)
- Eirik Nestaas
- Department of Pediatrics, Vestfold Hospital Trust, 3103 Tønsberg, Norway.
| | - Drude Fugelseth
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway; Department of Neonatal Intensive Care, Oslo University Hospital, Oslo, Norway
| | - Asbjørn Støylen
- Department of Cardiology, St. Olav's Hospital, Trondheim, Norway; Department of Circulation and Medical Imaging, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway
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Serial assessment of left-ventricular function using tissue Doppler imaging in premature infants within 7 days of life. Pediatr Cardiol 2013; 34:1491-8. [PMID: 23475256 DOI: 10.1007/s00246-013-0675-7] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2012] [Accepted: 02/13/2013] [Indexed: 01/02/2023]
Abstract
Although many echocardiographic parameters can assess cardiac function noninvasively in preterm infants, it has not been determined what indices are the best. We assessed left-ventricular performance in 101 very low-birth weight (VLBW) infants using tissue Doppler imaging (TDI) echocardiography. Echocardiographic examinations, including TDI, were performed serially within 7 days of life. Pulsed-Doppler TDI waveforms were recorded at the mitral valve annulus, and peak systolic velocities (Sa), early diastolic velocities (Ea), and late diastolic velocities (Aa) were measured. Sa and Aa velocities were both decreased significantly from 3 to 12 h and then gradually increased. Ea velocities showed no significant, longitudinal changes, but Ea values in premature groups appeared to be significantly lower than those in mature groups. The ratio of E to Ea (E/Ea) of VLBW infants seemed to be almost stable from birth to day 7, and this also showed no significant differences between different gestational age groups. E/Ea values in infants with patent ductus arteriosus (PDA) appeared to be greater than those in non-PDA infants. Our present findings suggest that TDI assessment in the early neonatal period might be useful in detecting latent systolic/diastolic failure of critically ill preterm infants.
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Junno J, Bruun E, Gutierrez JH, Erkinaro T, Haapsamo M, Acharya G, Räsänen J. Fetal sheep left ventricle is more sensitive than right ventricle to progressively worsening hypoxemia and acidemia. Eur J Obstet Gynecol Reprod Biol 2012; 167:137-41. [PMID: 23266204 DOI: 10.1016/j.ejogrb.2012.11.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2012] [Accepted: 11/24/2012] [Indexed: 01/15/2023]
Abstract
OBJECTIVE In a sheep model we tested the hypothesis that the fetal left ventricle is less tolerant to worsening acidemia than the right ventricle. STUDY DESIGN At 106-124/145 days of gestation, 12 fetuses were instrumented. After a 4-day recovery, placental vascular resistance was increased by fetal angiotensin (AT) II infusion. After a 2h ATII infusion, to further deteriorate fetal oxygenation, maternal hypoxemia was induced. Fetal cardiac function and hemodynamics were assessed by tissue Doppler imaging (TDI) and pulsed Doppler imaging. Ultrasonography was performed at baseline, at 1 and 2h after the beginning of ATII infusion and during the ATII+hypoxemia phase. RESULTS Fetal pH and pO₂ decreased significantly and progressively during the experiment. Left ventricular TDI-derived isovolumic relaxation velocity (IVRV) was lower during ATII 2h and ATII+hypoxemia phases than at baseline. The IVRV deceleration was significantly less during the ATII+hypoxemia phase than at baseline. Right ventricular IVRV was significantly lower during the ATII+hypoxemia phase than at baseline. IVRV deceleration did not change. Only left ventricular IVRV deceleration correlated with fetal pO₂ (R=0.36, p<0.05). Fetal right and left ventricular cardiac outputs, as well as umbilical artery, aortic isthmus and ductus venosus pulsatility indices remained unchanged during the experiment. CONCLUSION Our results show that signs of cardiac dysfunction develop earlier in the left ventricle than in the right ventricle. The fetal left ventricle seems to be more sensitive to progressively worsening hypoxemia and acidemia than the right ventricle.
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Affiliation(s)
- Juulia Junno
- Department of Obstetrics and Gynecology, University of Oulu, Oulu, Finland
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Koestenberger M. Transthoracic echocardiography in children and young adults with congenital heart disease. ISRN PEDIATRICS 2012; 2012:753481. [PMID: 22778987 PMCID: PMC3384910 DOI: 10.5402/2012/753481] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/05/2012] [Accepted: 04/19/2012] [Indexed: 11/23/2022]
Abstract
Transthoracic echocardiography (TTE) is the first-line tool for diagnosis and followup of pediatric and young adult patients with congenital heart disease (CHD). Appropriate use of TTE can reduce the need for more invasive modalities, such as cardiac catheterization and cardiac magnetic resonance imaging. New echocardiographic techniques have emerged more recently: tissue Doppler imaging, tissue tracking (strain and strain rate), vector velocity imaging (VVI), myocardial performance index, myocardial acceleration during isovolumic acceleration (IVA), the ratio of systolic to diastolic duration (S/D ratio), and two dimensional measurements of systolic right ventricular (RV) function (e.g., tricuspid annular plane systolic excursion, TAPSE). These may become valuable indicators of ventricular performance, compliance, and disease progression. In addition, three-dimensional (3D) echocardiography when performed for the assessment of valvular function, device position, and ventricular volumes is being integrated into routine clinical care. In this paper, the potential use and limitations of these new echocardiographic techniques in patients with CHD are discussed. A particular focus is on the echocardiographic assessment of right ventricular (RV) function in conditions associated with increased right ventricular volume (e.g., pulmonary regurgitation after tetralogy of Fallot repair) or pressure (e.g., pulmonary hypertension) in children and young adults.
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Affiliation(s)
- Martin Koestenberger
- Division of Pediatric Cardiology, Department of Pediatrics, Medical University of Graz, Auenbruggerplatz 30, 8036 Graz, Austria
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Abstract
OBJECTIVES To assess myocardial performance in septic full-term infants and to correlate it with serum cardiac troponin T concentrations. DESIGN Prospective, case-control, clinical study. SETTING Neonatal intensive care unit in a university hospital. PATIENTS Twenty septic and 20 nonseptic full-term neonates. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Conventional echocardiography, tissue Doppler imaging, and serum cardiac troponin T concentration tests were performed as soon as diagnosis was made. On tissue Doppler imaging measurements, right ventricular and left ventricular Tei indexes were significantly higher in septic neonates compared to nonseptic neonates (mean ± SD: 0.51 ± 0.09 vs. 0.28 ± 0.05, p < .001, and 0.56 ± 0.07 vs. 0.39 ± 0.04, p < .001, respectively). Mitral and tricuspid peak annular systolic velocities were significantly lower in septic neonates (mean ± SD: 4.35 ± 0.68 vs. 6.89 ± 0.94 cm/sec, p < .0001, and 5.55 ± 0.66 vs. 6.69 ± 0.87 cm/second, p < .0001, respectively). On conventional echocardiography measurements, left ventricular internal diameter at end-diastole was significantly higher in septic neonates (p = .04), whereas cardiac index and left ventricular and right ventricular diastolic functions were not significantly different between septic and nonseptic neonates. Cardiac troponin T concentrations were significantly higher in septic neonates (median [range], 0.19 [0.12- 0.32] vs. 0.03 [0-0.07] mg/L, p < .0001), and they correlated positively with left ventricular Tei index (r = .80; p < .0001) and right ventricular Tei index (r = .73; p < .0001), and correlated negatively with mitral peak annular systolic velocity (r = -.70; p < .0001) and tricuspid peak annular systolic (r = -.39, p = .012). Nonsurvivors had significantly higher serum cardiac troponin T concentrations and left ventricular Tei index. CONCLUSIONS Neonatal sepsis is associated with systolic and diastolic myocardial dysfunction. This study provides proof-of-concept data for the use of tissue Doppler imaging in assessment of myocardial dysfunction in septic neonates. Tissue Doppler imaging appears to be more sensitive than conventional echocardiography in the detection of this dysfunction. Serum cardiac troponin T and left ventricular Tei index may have prognostic value in these patients.
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Cetin I, Kantar A, Unal S, Cakar N. The assessment of time-dependent myocardial changes in infants with perinatal hypoxia. J Matern Fetal Neonatal Med 2012; 25:1564-8. [PMID: 22122298 DOI: 10.3109/14767058.2011.644365] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE The aim of the study was to assess myocardial damage in infants due to perinatal hypoxia. METHODS The findings of 29 infants with perinatal hypoxia and 20 healthy infants were compared. Blood gas analysis, serum lactate, cardiac troponin I (cTnI), troponin T (cTnT), creatine kinase-MB (CK-MB) and B-type natriuretic peptide (BNP) were evaluated. Echocardiography together with tissue Doppler imaging was performed. RESULTS cTnT, CK-MB and BNP were higher in patients at the first day. There were positive correlations between the left ventricular (LV) myocardial performance index (MPI) and cTnT at first day and also at first month. LV ejection fraction and fractional shortening were lower at first day and at first month in patients. Myocardial systolic (Sm) and diastolic (Em and Am) velocities at all segments were lower at first day, and interventricular septum Sm, LV Sm, LV Em, right ventricular Em and LV Am were still lower at first month in patients. Isovolumic relaxation time at all segments together with LV MPI was higher at first day, ejection time values were lower and MPI values were higher at all segments at first month in patients. CONCLUSIONS These findings demonstrated that the signs of myocardial damage due to perinatal hypoxia still present at first month.
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Affiliation(s)
- Ilker Cetin
- Ankara Child Health, Hematology, Oncology Education and Research Hospital, Ankara, Turkey
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Nestaas E, Støylen A, Fugelseth D. Myocardial performance assessment in neonates by one-segment strain and strain rate analysis by tissue Doppler - a quality improvement cohort study. BMJ Open 2012; 2:bmjopen-2012-001636. [PMID: 22923633 PMCID: PMC3432842 DOI: 10.1136/bmjopen-2012-001636] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
OBJECTIVES To investigate one-segment strain and strain rate indices as measures of myocardial performance in asphyxiated term neonates. DESIGN Quality improvement cohort study. SETTING Newborns admitted to a neonatal intensive care unit at a Norwegian University Hospital for perinatal asphyxia and non-asphyxiated newborn recruited from the maternity ward at the same hospital. PARTICIPANTS Twenty asphyxiated and 48 non-asphyxiated term neonates. PRIMARY OUTCOME MEASURE Strain and strain rate indices and repeatability measures. One-segment longitudinal strain and strain rate by tissue Doppler were assessed on days 1, 2 and 3 of life in nine heart walls. Repeatability was compared against measurements from two-segment analyses previously performed in the same images. RESULTS The 95% limits of agreement were significantly better for the one-segment than two-segment repeatability analyses, the inter-rater peak systolic strain (PSS) was (-3.1, 3.3) vs (-11.4, 18.3)%, the inter-rater peak systolic strain rate (PSSR) was (-0.38, 0.40) vs (-0.79, 1.15)/s, the intra-rater PSS was (-2.5, 2.6) vs (-8.0, 9.8)% and the intra-rater PSSR was (-0.23, 0.25) vs (-0.75, 0.80)/s (p<0.05). The myocardial performance was lower in the asphyxiated neonates (indices closer to zero) than in the non-asphyxiated neonates, PSS was -17.8 (0.6) (mean (SEM)) vs -21.2 (0.3)%, PSSR -1.43 (0.08) vs -1.61 (0.03)/s, early diastolic strain rate 1.72 (0.11) vs 2.00 (0.11)/s and strain rate during the atrial systole 1.92 (0.17) vs 2.27 (0.10)/s (p<0.05), despite no difference in fractional shortening (29.0 (0.5) vs 29.1 (1.0)%) (p>0.05). CONCLUSIONS One-segment strain and strain rate assessed the reduced myocardial performance in asphyxiated neonates with significantly improved reproducibility as compared with two-segment analysis and was therefore more feasible than two-segment analyses for assessment of myocardial performance after perinatal asphyxia.
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Affiliation(s)
- Eirik Nestaas
- Department of Paediatrics, Vestfold Hospital Trust, Tønsberg, Norway
| | - Asbjørn Støylen
- Department of Cardiology, St Olavs Hospital, Trondheim, Norway
- Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway
| | - Drude Fugelseth
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Department of Neonatal Intensive Care, Oslo University Hospital, Ullevål, Oslo, Norway
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Koestenberger M, Friedberg MK, Ravekes W, Nestaas E, Hansmann G. Non-Invasive Imaging for Congenital Heart Disease: Recent Innovations in Transthoracic Echocardiography. ACTA ACUST UNITED AC 2012; Suppl 8:2. [PMID: 24163784 DOI: 10.4172/2155-9880.s8-002] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Transthoracic echocardiography (TTE) is an important tool for diagnosis and follow-up of patients with congenital heart disease (CHD). Appropriate use of TTE can reduce the need for more invasive and complex modalities, such as cardiac catheterization and cardiac magnetic resonance imaging. New echocardiographic techniques have emerged for the assessment of ventricular systolic and diastolic function: Tissue Doppler imaging, tissue tracking, strain and strain rate imaging, vector velocity imaging (VVI), myocardial performance index, myocardial acceleration during isovolumic contraction (IVA), the ratio of systolic to diastolic duration (S/D ratio), and other measurements of systolic right ventricular (RV) function like tricuspid annular plane systolic excursion (TAPSE). These modalities may become valuable indicators of ventricular performance, compliance and disease progression, with the caveat of preload-dependency of the variables measured. In addition, three-dimensional (3D) echocardiography for the assessment of cardiac anatomy, valvular function, device position, ventricular volumes and ejection fraction is integrated into routine clinical care. In this review, we discuss the potential use and limitations of these new echocardiographic techniques in patients with CHD. A particular focus is on the echocardiographic assessment of right ventricular (RV) function by means of tissue Doppler imaging, tissue tracking, and three-dimensional imaging, in conditions associated with increased right ventricular volume or pressure load.
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Affiliation(s)
- Martin Koestenberger
- Division of Pediatric Cardiology, Department of Pediatrics, Medical University Graz, Austria
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Effect of angiotensin II on the left ventricular function in a near-term fetal sheep with metabolic acidemia. J Pregnancy 2011; 2011:634240. [PMID: 22132338 PMCID: PMC3206332 DOI: 10.1155/2011/634240] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2011] [Revised: 08/17/2011] [Accepted: 08/17/2011] [Indexed: 11/18/2022] Open
Abstract
We tested the hypothesis that, in acute metabolic acidemia, the fetal left ventricle (LV) has the capacity to increase its contractility in response to angiotensin II infusion. Eleven ewes and their fetuses were instrumented at 127–138/145 days of gestation. The effect of angiotensin II on fetal LV function was assessed using intraventricular pressure catheter and tissue Doppler imaging (TDI). Angiotensin II increased fetal arterial blood pressure, whereas pH and pO2 decreased. The heart rate and systemic venous pressure were not affected significantly. The LV end-diastolic and end-systolic pressures, as well as dP/dtmax, increased. The TDI-derived LV longitudinal myocardial isovolumic contraction velocity and its acceleration and velocity during early filling were higher than those at baseline. The incidence of absent isovolumic relaxation velocity was greater during angiotensin II infusion. In summary, during acute metabolic acidemia, the fetal left ventricle could increase its contractility in response to inotropic stimulus even in the presence of increased afterload. The diastolic LV function parameters were altered by angiotensin II.
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Birth asphyxia as the major complication in newborns: moving towards improved individual outcomes by prediction, targeted prevention and tailored medical care. EPMA J 2011. [PMID: 23199149 PMCID: PMC3405378 DOI: 10.1007/s13167-011-0087-9] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Perinatal Asphyxia—oxygen deficit at delivery—can lead to severe hypoxic ischaemic organ damage in newborns followed by a fatal outcome or severe life-long pathologies. The severe insults often cause neurodegenerative diseases, mental retardation and epilepsies. The mild insults lead to so-called “minimal brain-damage disorders” such as attention deficits and hyperactivity, but can also be associated with the development of schizophrenia and life-long functional psychotic syndromes. Asphyxia followed by re-oxygenation can potentially lead to development of several neurodegenerative pathologies, diabetes type 2 and cancer. The task of individual prediction, targeted prevention and personalised treatments before a manifestation of the life-long chronic pathologies usually developed by newborns with asphyxic deficits, should be given the extraordinary priority in neonatology and paediatrics. Socio-economical impacts of educational measures and advanced strategies in development of robust diagnostic approaches targeted at effected molecular pathways, biomarker-candidates and potential drug-targets for tailored treatments are reviewed in the paper.
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