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Ficial B, Dolce P, Petoello E, Flore AI, Nogara S, Ciarcià M, Brancolini G, Alfarano A, Marzollo R, Bosio I, Raimondi F, Risso FM, Beghini R, Dani C, Benfari G, Ribichini FL, Corsini I. Left atrial strain assessment unveils left ventricular diastolic dysfunction in neonates with transient tachypnea of the newborn: A prospective observational study. Pediatr Pulmonol 2024. [PMID: 38953730 DOI: 10.1002/ppul.27156] [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: 03/04/2024] [Revised: 06/02/2024] [Accepted: 06/20/2024] [Indexed: 07/04/2024]
Abstract
INTRODUCTION An inadequate clearance of lung fluid plays a key role in the pathogenesis of transient tachypnea of the newborn (TTN). OBJECTIVES To evaluate if left ventricular diastolic dysfunction contributes to reduced clearance of lung fluid in TTN. MATERIALS AND METHODS This was a prospective, observational study. Echocardiography and lung ultrasound were performed at 2, 24 and 48 h of life (HoL) to assess biventricular function and calculate lung ultrasound score (LUS). Left atrial strain reservoir (LASr) provided surrogate measurement of left ventricular diastolic function. RESULTS Twenty-seven neonates with TTN were compared with 27 controls with no difference in gestation (36.1 ± 2 vs. 36.9 ± 2 weeks) or birthweight (2508 ± 667 vs. 2718 ± 590 g). Biventricular systolic function was normal in both groups. LASr was significantly lower in cases at 2 (21.0 ± 2.7 vs. 38.1 ± 4.4; p < 0.01), 24 (25.2 ± 4.5 vs. 40.6 ± 4.0; p < 0.01) and 48 HoL (36.5 ± 5.8 and 41.6 ± 5.2; p < 0.01), resulting in a significant group by time interaction (p < 0.001), after adjusting for LUS and gestational diabetes. A logistic regression model including LUS, birth weight and gestational diabetes as covariates, showed that LASr at 2 HoL was a predictor of respiratory support at 24 HoL, with an adjusted odds ratio of 0.60 (CI 0.36-0.99). CONCLUSIONS LASr was reduced in neonates with TTN, suggesting diastolic dysfunction, that may contribute to the delay in lung fluid clearance.
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Affiliation(s)
- Benjamim Ficial
- Neonatal Intensive Care Unit, Azienda Ospedaliera Universitaria Integrata Verona, Verona, Italy
| | - Pasquale Dolce
- Department of Translational Medical Science, University of Naples Federico II, Naples, Italy
| | - Enrico Petoello
- Neonatal Intensive Care Unit, Azienda Ospedaliera Universitaria Integrata Verona, Verona, Italy
| | - Alice Iride Flore
- Neonatal Intensive Care Unit, Azienda Ospedaliera Universitaria Integrata Verona, Verona, Italy
| | - Silvia Nogara
- Neonatal Intensive Care Unit, Azienda Ospedaliera Universitaria Integrata Verona, Verona, Italy
| | - Martina Ciarcià
- Neonatal Intensive Care Unit, Azienda Ospedaliera Universitaria Integrata Verona, Verona, Italy
| | - Giovanna Brancolini
- Neonatal Intensive Care Unit, Azienda Ospedaliera Universitaria Integrata Verona, Verona, Italy
| | - Angela Alfarano
- Neonatal Intensive Care Unit, Children's Hospital, ASST Spedali Civili di Brescia, Brescia, Italy
| | - Roberto Marzollo
- Neonatal Intensive Care Unit, Children's Hospital, ASST Spedali Civili di Brescia, Brescia, Italy
| | - Ilaria Bosio
- Neonatal Intensive Care Unit, Children's Hospital, ASST Spedali Civili di Brescia, Brescia, Italy
| | - Francesco Raimondi
- Division of Neonatology and Department of Translational Medical Sciences, Università "Federico II" di Napoli, Naples, Italy
| | - Francesco Maria Risso
- Neonatal Intensive Care Unit, Children's Hospital, ASST Spedali Civili di Brescia, Brescia, Italy
| | - Renzo Beghini
- Neonatal Intensive Care Unit, Azienda Ospedaliera Universitaria Integrata Verona, Verona, Italy
| | - Carlo Dani
- Division of Neonatology, Careggi University Hospital of Florence, Florence, Italy
| | - Giovanni Benfari
- Section of Cardiology, Department of Medicine, University of Verona, Verona, Italy
| | | | - Iuri Corsini
- Division of Neonatology, Careggi University Hospital of Florence, Florence, Italy
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Peček JR, Koželj M, Fister P. Longitudinal Strain vs. Conventional Echocardiographic Parameters in the First Week of Life in Healthy Term Newborns. Pediatr Cardiol 2024; 45:32-39. [PMID: 38062260 PMCID: PMC10776688 DOI: 10.1007/s00246-023-03291-x] [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: 05/14/2023] [Accepted: 08/29/2023] [Indexed: 01/10/2024]
Abstract
The first week of life is characterized by substantial alterations in hemodynamic conditions. Changes in myocardial contractility will reflect these changes. We aimed to assess right and left ventricular function on the third and seventh days of life in 50 healthy term newborns. To assess myocardial function, we used speckle tracking echocardiography. Pulsed-wave tissue Doppler imaging, M-mode, Doppler and pulsed-wave Doppler were also used to assess ventricular function. We found a significant increase in both right and left longitudinal strain and an increase in systolic and diastolic tissue Doppler velocities, whereas most other parameters remained unchanged. At both time points, the measured parameters were significantly greater for the right ventricle, but the changes with time were similar for both ventricles. We also found an increase in right ventricular outflow tract acceleration time as an indirect sign of decreasing pulmonary vascular resistance and an increase in systolic blood pressure, pointing to increasing systemic vascular resistance. Together with a decreasing proportion of patients with patent ductus arteriosus, the estimated left ventricular cardiac output decreased and right ventricular cardiac output increased but not to a statistically significant degree. In conclusion, the results of our study show how different echocardiographic techniques capture hemodynamic changes and changes in myocardial contractility and compliance. Both longitudinal strain and tissue Doppler imaging parameters seem to offer greater sensitivity in comparison with conventional echocardiographic parameters.
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Affiliation(s)
- Jerneja Rešek Peček
- Department of Pediatric Critical Care, Children's Hospital, University Medical Centre Ljubljana, Bohoričeva 20, 1000, Ljubljana, Slovenia
- Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Mirta Koželj
- Unit of Cardiology, Children's Hospital, University Medical Centre Ljubljana, Ljubljana, Slovenia
- Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Petja Fister
- Department of Pediatric Critical Care, Children's Hospital, University Medical Centre Ljubljana, Bohoričeva 20, 1000, Ljubljana, Slovenia.
- Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia.
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Moore SS, De Carvalho Nunes G, Dancea A, Wutthigate P, Simoneau J, Beltempo M, Sant'Anna G, Altit G. Early cardiac function and death, severe bronchopulmonary dysplasia and pulmonary hypertension in extremely preterm infants. Pediatr Res 2024; 95:293-301. [PMID: 37726544 DOI: 10.1038/s41390-023-02817-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Revised: 07/15/2023] [Accepted: 08/28/2023] [Indexed: 09/21/2023]
Abstract
BACKGROUND Association between early cardiac function and neonatal outcomes are scarcely reported. The aim of the current study was to describe this association with death, severe bronchopulmonary dysplasia (BPD) and BPD-related pulmonary hypertension (PH). METHODS Retrospective cohort study of infants <29 weeks born between 2015 and 2019. Infants with clinically acquired echocardiography at ≤21 days after birth were included and data were extracted by an expert masked to outcomes. RESULTS A total of 176 infants were included. Echocardiogram was performed at a median of 9 days (IQR 5-13.5). Of these, 31 (18%) had death/severe BPD and 59 (33.5%) had death/BPD-related PH. Infants with death/severe BPD were of lower birth weight (745 [227] vs 852 [211] grams, p = 0.01) and more exposed to invasive ventilation, late-onset sepsis, inotropes and/or postnatal steroids. Early echocardiograms demonstrated decreased right ventricular [Tricuspid Annular Plane Systolic Excursion: 5.2 (1.4) vs 6.2 (1.5) cm, p = 0.03] and left ventricular function [Ejection fraction 53 (14) vs 58 (10) %, p = 0.03]. Infants with death/BPD-related PH had an increased Eccentricity index (1.35 [0.20] vs 1.26 [0.19], p = 0.02), and flat/bowing septum (19/54 [35%] vs 20/109 [18%], p = 0.021). CONCLUSIONS In extremely premature infants, altered ventricular function and increased pulmonary pressure indices within the first 21 days after birth, were associated with the combined outcome of death/severe BPD and death/BPD-related PH. IMPACT Decreased cardiac function on echocardiography performed during first three weeks of life is associated with severe bronchopulmonary dysplasia in extremely premature infants. In extreme preterm infants, echocardiographic signs of pulmonary hypertension in early life are associated with later BPD-related pulmonary hypertension close to 36 weeks post-menstrual age. Early cardiac markers should be further studied as potential intervention targets in this population. Our study is adding comprehensive analysis of echocardiographic data in infants born below 29 weeks gestational age.
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Affiliation(s)
- Shiran S Moore
- Neonatology-McGill University Health Centre-Montreal Children's Hospital; Department of Pediatrics-McGill University, Montreal, QC, Canada
- Neonatology-Dana Dwek Children's Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Gabriela De Carvalho Nunes
- Neonatology-McGill University Health Centre-Montreal Children's Hospital; Department of Pediatrics-McGill University, Montreal, QC, Canada
| | - Adrian Dancea
- Pediatric Cardiology-McGill University Health Centre-Montreal Children's Hospital; Department of Pediatrics-McGill University, Montreal, QC, Canada
| | | | - Jessica Simoneau
- Pediatric Cardiology-McGill University Health Centre-Montreal Children's Hospital; Department of Pediatrics-McGill University, Montreal, QC, Canada
| | - Marc Beltempo
- Neonatology-McGill University Health Centre-Montreal Children's Hospital; Department of Pediatrics-McGill University, Montreal, QC, Canada
| | - Guilherme Sant'Anna
- Neonatology-McGill University Health Centre-Montreal Children's Hospital; Department of Pediatrics-McGill University, Montreal, QC, Canada
| | - Gabriel Altit
- Neonatology-McGill University Health Centre-Montreal Children's Hospital; Department of Pediatrics-McGill University, Montreal, QC, Canada.
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Martini S, Corsini I, Corvaglia L, Suryawanshi P, Chan B, Singh Y. A scoping review of echocardiographic and lung ultrasound biomarkers of bronchopulmonary dysplasia in preterm infants. Front Pediatr 2023; 11:1067323. [PMID: 36846161 PMCID: PMC9950276 DOI: 10.3389/fped.2023.1067323] [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: 10/11/2022] [Accepted: 01/18/2023] [Indexed: 02/12/2023] Open
Abstract
Despite recent improvements in neonatal care, moderate to severe bronchopulmonary dysplasia (BPD) is still associated with high mortality and with an increased risk of developing pulmonary hypertension (PH). This scoping review provides an updated overview of echocardiographic and lung ultrasound biomarkers associated with BPD and PH, and the parameters that may prognosticate their development and severity, which could be clinically helpful to undertake preventive strategies. A literature search for published clinical studies was conducted in PubMed using MeSH terms, free-text words, and their combinations obtained through appropriate Boolean operators. It was found that the echocardiography biomarkers for BPD, and especially those assessing right ventricular function, are reflective of the high pulmonary vascular resistance and PH, indicating a strong interplay between heart and lung pathophysiology; however, early assessment (e.g., during the first 1-2 weeks of life) may not successfully predict later BPD development. Lung ultrasound indicating poor lung aeration at day 7 after birth has been reported to be highly predictive of later development of BPD at 36 weeks' postmenstrual age. Evidence of PH in BPD infants increases risk of mortality and long-term PH; hence, routine PH surveillance in all at risk preterm infants at 36 weeks, including an echocardiographic assessment, may provide useful information. Progress has been made in identifying the echocardiographic parameters on day 7 and 14 to predict later development of pulmonary hypertension. More studies on sonographic markers, and especially on echocardiographic parameters, are needed for the validation of the currently proposed parameters and the timing of assessment before recommendations can be made for the routine clinical practice.
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Affiliation(s)
- Silvia Martini
- Neonatal Intensive Care Unit, IRCCS AOUBO, Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Iuri Corsini
- Division of Neonatology, Careggi University Hospital of Florence, Florence, Italy
| | - Luigi Corvaglia
- Neonatal Intensive Care Unit, IRCCS AOUBO, Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Pradeep Suryawanshi
- Department of Neonatology, Bharati Vidyapeeth University Medical College, Pune, India
| | - Belinda Chan
- Division of Neonatology, University of Utah, Salt Lake City, UT, United States
| | - Yogen Singh
- Department of Pediatrics - Division of Neonatology, Loma Linda University School of Medicine, Loma linda, CA, United States.,Neonatology/Pediatric Cardiology, Cambridge University Hospitals, Cambridge, United Kingdom
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Chang HY, Chang JH, Peng CC, Hsu CH, Ko MHJ, Hung CL, Chen MR. Subclinical Changes in Left Heart Structure and Function at Preschool Age in Very Low Birth Weight Preterm Infants. Front Cardiovasc Med 2022; 9:879952. [PMID: 35600491 PMCID: PMC9120602 DOI: 10.3389/fcvm.2022.879952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2022] [Accepted: 04/19/2022] [Indexed: 11/13/2022] Open
Abstract
Background Survivors of preterm birth are at risk of long-term cardiovascular consequences. The objective of this prospective observational study was to assess left heart function at preschool age in preterm children with very low birth weight (VLBW). Methods We recruited children aged 5–6 years from preterm infants and full-term children. All subjects underwent conventional echocardiography and speckle-tracking echocardiography. The results were compared between the preterm and term groups. Results Eighty-seven VLBW preterm children and 29 term controls were included in the study. After adjusting for body surface area, the preterm group compared to the full-term group had significantly smaller left ventricular (LV) end-diastolic and end-systolic internal dimensions (31.2 vs. 33.5 mm, p = 0.048; and 20.0 vs. 21.6 mm, respectively; p = 0.024), lower LV end-diastolic and end-systolic volumes (38.8 vs. 46.3 mL, p = 0.024; and 12.8 vs. 15.6 mL, respectively; p = 0.008). Left atrial (LA) maximal and minimal volume were also significantly smaller in the preterm group (15.4 vs. 18.9 mL, p = 0.017; and 6.2 vs 7.5 mL, respectively; p = 0.018). LV global longitudinal strain (−21.4 vs. −23.2%, p < 0.0001) and systolic strain rate (−1.30 vs. −1.37 /s, p = 0.001) were significantly lower in the preterm group than in the term control group. LA longitudinal strain was decreased (43.9 vs. 52.8%, p < 0.0001) and left atrial stiffness index (0.17 vs. 0.14, p < 0.0001) was increased in preterm infants. However, all the measurements in both groups were within normal range. Conclusions Subclinical changes of left heart structure and function were found in VLBW infants at preschool age. Additional long-term follow-ups of the cardiovascular outcomes are needed in this vulnerable population.
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Affiliation(s)
- Hung-Yang Chang
- Department of Pediatrics, MacKay Children's Hospital, Taipei, Taiwan
- Department of Medicine, MacKay Medical College, New Taipei City, Taiwan
| | - Jui-Hsing Chang
- Department of Pediatrics, MacKay Children's Hospital, Taipei, Taiwan
- Department of Medicine, MacKay Medical College, New Taipei City, Taiwan
| | - Chun-Chih Peng
- Department of Pediatrics, MacKay Children's Hospital, Taipei, Taiwan
- Department of Medicine, MacKay Medical College, New Taipei City, Taiwan
| | - Chyong-Hsin Hsu
- Department of Pediatrics, MacKay Children's Hospital, Taipei, Taiwan
| | - Mary Hsin-Ju Ko
- Department of Pediatrics, MacKay Children's Hospital, Taipei, Taiwan
- Department of Pediatrics, Hsinchu MacKay Hospital, Hsinchu, Taiwan
| | - Chung-Lieh Hung
- Department of Medicine, MacKay Medical College, New Taipei City, Taiwan
- Division of Cardiology, Department of Internal Medicine, Mackay Memorial Hospital, Taipei, Taiwan
- Institute of Biomedical Sciences, MacKay Medical College, New Taipei City, Taiwan
- *Correspondence: Ming-Ren Chen
| | - Ming-Ren Chen
- Department of Pediatrics, MacKay Children's Hospital, Taipei, Taiwan
- Department of Medicine, MacKay Medical College, New Taipei City, Taiwan
- Chung-Lieh Hung
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Hocq C, Vanhoutte L, Guilloteau A, Massolo AC, Van Grambezen B, Carkeek K, Piersigilli F, Danhaive O. Early diagnosis and targeted approaches to pulmonary vascular disease in bronchopulmonary dysplasia. Pediatr Res 2022; 91:804-815. [PMID: 33674739 DOI: 10.1038/s41390-021-01413-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Accepted: 01/25/2021] [Indexed: 01/31/2023]
Abstract
Pulmonary hypertension has emerged as a life-threatening disease in preterm infants suffering from bronchopulmonary dysplasia (BPD). Its development is closely linked to respiratory disease, as vasculogenesis and alveologenesis are closely interconnected. Once clinically significant, BPD-associated pulmonary hypertension (BPD-PH) can be challenging to manage, due to poor reversibility and multiple comorbidities frequently associated. The pulmonary vascular disease process underlying BPD-PH is the result of multiple innate and acquired factors, and emerging evidence suggests that it progressively develops since birth and, in certain instances, may begin as early as fetal life. Therefore, early recognition and intervention are of great importance in order to improve long-term outcomes. Based on the most recent knowledge of BPD-PH pathophysiology, we review state-of-the-art screening and diagnostic imaging techniques currently available, their utility for clinicians, and their applicability and limitations in this specific population. We also discuss some biochemical markers studied in humans as a possible complement to imaging for the detection of pulmonary vascular disease at its early stages and the monitoring of its progression. In the second part, we review pharmacological agents currently available for BPD-PH treatment or under preclinical investigation, and discuss their applicability, as well as possible approaches for early-stage interventions in fetuses and neonates. IMPACT: BPD-associated PH is a complex disease involving genetic and epigenetic factors, as well as environmental exposures starting from fetal life. The value of combining multiple imaging and biochemical biomarkers is emerging, but requires larger, multicenter studies for validation and diffusion. Since "single-bullet" approaches have proven elusive so far, combined pharmacological regimen and cell-based therapies may represent important avenues for research leading to future cure and prevention.
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Affiliation(s)
- Catheline Hocq
- Division of Neonatology, St-Luc University Hospital, Catholic University of Louvain, Brussels, Belgium
| | - Laetitia Vanhoutte
- Division of Pediatric Cardiology, St-Luc University Hospital, Catholic University of Louvain, Brussels, Belgium
| | - Axelle Guilloteau
- Division of Clinical Pharmacy, St-Luc University Hospital, Catholic University of Louvain, Brussels, Belgium
| | - Anna Claudia Massolo
- Department of Surgical and Medical Neonatology, Bambino Gesù Children's Hospital, Rome, Italy
| | - Bénédicte Van Grambezen
- Division of Neonatology, St-Luc University Hospital, Catholic University of Louvain, Brussels, Belgium
| | - Kate Carkeek
- Division of Neonatology, St-Luc University Hospital, Catholic University of Louvain, Brussels, Belgium
| | - Fiammetta Piersigilli
- Division of Neonatology, St-Luc University Hospital, Catholic University of Louvain, Brussels, Belgium
| | - Olivier Danhaive
- Division of Neonatology, St-Luc University Hospital, Catholic University of Louvain, Brussels, Belgium. .,Department of Pediatrics, Benioff Children's Hospital, University of California San Francisco, San Francisco, CA, USA.
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Feasibility, Reproducibility and Reference Ranges of Left Atrial Strain in Preterm and Term Neonates in the First 48 h of Life. Diagnostics (Basel) 2022; 12:diagnostics12020350. [PMID: 35204441 PMCID: PMC8871374 DOI: 10.3390/diagnostics12020350] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Revised: 01/22/2022] [Accepted: 01/27/2022] [Indexed: 11/17/2022] Open
Abstract
Left atrial strain (LAS) is the most promising technique for assessment of diastolic dysfunction but few data are available in neonates. Our aim was to assess feasibility and reproducibility, and to provide reference ranges of LAS in healthy neonates in the first 48 h of life. We performed one echocardiography in 30 neonates to assess feasibility and develop a standard protocol for image acquisition and analysis. LAS reservoir (LASr), conduit (LAScd) and contraction (LASct) were measured. We performed echocardiography at 24 and 48 h of life in an unrelated cohort of 90 neonates. Median (range) gestational age and weight of the first cohort were 34.4 (26.4–40.2) weeks and 2075 (660–3680) g. LAS feasibility was 96.7%. Mean (SD) gestational age and weight of the second cohort were 34.2 (3.8) weeks and 2162 (833) g. Mean (SD) LASr significantly increased from 24 to 48 h: 32.9 (3.2) to 36.8 (4.6). Mean (SD) LAScd and LASct were stable: −20.6 (8.0) and −20.8 (9.9), −11.6 (4.9) and −13.5 (6.4). Intra and interobserver intraclass correlation coefficient for LASr, LAScd and LASct were 0.992, 0.993, 0.986 and 0.936, 0.938 and 0.871, respectively. We showed high feasibility and reproducibility of LAS in neonates and provided reference ranges.
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8
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Änghagen O, Engvall J, Gottvall T, Nelson N, Nylander E, Bang P. Developmental Differences in Left Ventricular Strain in IUGR vs. Control Children the First Three Months of Life. Pediatr Cardiol 2022; 43:1286-1297. [PMID: 35333947 PMCID: PMC9293814 DOI: 10.1007/s00246-022-02850-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Accepted: 02/10/2022] [Indexed: 12/11/2022]
Abstract
BACKGROUND Intrauterine growth restriction (IUGR) may directly affect cardiovascular function in early life. Longitudinal data on left ventricular longitudinal strain (LVLS), a key measure of cardiac function independent of body size, is not available. We hypothesize impaired cardiac function among IUGR newborns and persistence of the impairment until age 3 months. METHOD This is a prospective cohort study of consecutive pregnancies where IUGR was identified at 18-38 weeks gestational age (GA) with healthy controls randomly selected at 18-20 weeks GA. Echocardiograms were performed at birth and at age 3-4 months, and then compared. RESULTS At birth, mean (SD) LVLS did not differ between the IUGR group [N = 19; - 15.76 (3.12) %] and controls [N = 35; - 15.53 (3.56) %]. The IUGR group demonstrated no significant change in LVLS at age 3-4 months [- 17.80 (3.82) %], while the control group [- 20.91 (3.31) %] showed a significant increase (P < 0.001). Thus, LVLS was lower in the IUGR group at age 3-4 months (P = 0.003). CONCLUSION The lack of increase in LVLS may suggest that IUGR has a direct impact on cardiac function as early as during the first months of life. Trial registration Clinical trials.gov Identifier: NCT02583763, registration October 22, 2015. Retrospectively registered September 2014-October 2015, thereafter, registered prospectively.
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Affiliation(s)
- Olov Änghagen
- Crown Princess Victoria's Child and Youth Hospital, and Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden. .,Division of Children's and Women's Health, Department of Biomedical and Clinical Sciences, Faculty of Health Sciences, Linköping University, Linköping, Sweden.
| | - Jan Engvall
- grid.5640.70000 0001 2162 9922Department of Clinical Physiology in Linköping, and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden ,grid.5640.70000 0001 2162 9922Center for Medical Image Science and Visualization (CMIV), Linköping University, Linköping, Sweden
| | - Tomas Gottvall
- grid.5640.70000 0001 2162 9922Department of Obstetrics and Gynaecology in Linköping, and Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Nina Nelson
- grid.5640.70000 0001 2162 9922Crown Princess Victoria’s Child and Youth Hospital, and Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden ,grid.24381.3c0000 0000 9241 5705National Highly Specialized Care, Karolinska University Hospital Stockholm, Stockholm, Sweden ,grid.5640.70000 0001 2162 9922Division of Children’s and Women’s Health, Department of Biomedical and Clinical Sciences, Faculty of Health Sciences, Linköping University, Linköping, Sweden
| | - Eva Nylander
- grid.5640.70000 0001 2162 9922Department of Clinical Physiology in Linköping, and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Peter Bang
- grid.5640.70000 0001 2162 9922Crown Princess Victoria’s Child and Youth Hospital, and Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden ,grid.5640.70000 0001 2162 9922Division of Children’s and Women’s Health, Department of Biomedical and Clinical Sciences, Faculty of Health Sciences, Linköping University, Linköping, Sweden
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Koestenberger M, Belyavskiy E. Myocardial strain analysis in infants with pectus excavatum: A subtle method to detect myocardial impairment? JOURNAL OF CLINICAL ULTRASOUND : JCU 2021; 49:929-931. [PMID: 34695241 DOI: 10.1002/jcu.23085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/02/2021] [Accepted: 10/05/2021] [Indexed: 06/13/2023]
Affiliation(s)
- Martin Koestenberger
- Division of Pediatric Cardiology, Department of Pediatrics, Medical University Graz, Graz, Austria
- European Pediatric Pulmonary Vascular Disease Network, Berlin, Germany
| | - Evgeny Belyavskiy
- Department of Internal Medicine and Cardiology, Charité - Universitätsmedizin Berlin, Campus Virchow Klinikum, Berlin, Germany
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10
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Sonaglioni A, Nicolosi GL, Braga M, Villa MC, Migliori C, Lombardo M. Does chest wall conformation influence myocardial strain parameters in infants with pectus excavatum? JOURNAL OF CLINICAL ULTRASOUND : JCU 2021; 49:918-928. [PMID: 34523718 DOI: 10.1002/jcu.23064] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/14/2021] [Revised: 08/31/2021] [Accepted: 09/03/2021] [Indexed: 06/13/2023]
Abstract
PURPOSE To investigate the possible influence of chest wall conformation on myocardial strain parameters in a consecutive population of infants with pectus excavatum (PE), noninvasively assessed by modified Haller index (MHI). METHODS Sixteen consecutive PE infants (MHI >2.5) and 44 infants with normal chest shape (MHI ≤2.5) entered in this prospective case-control study. All infants underwent evaluation by neonatologist, transthoracic echocardiography implemented with two-dimensional speckle tracking echocardiography (2D-STE) analysis of both ventricles and MHI assessment (ratio of chest transverse diameter over the distance between sternum and spine), at two time points: within 3 days and at about 40 days of life. RESULTS At 2.1 ± 1 days of life, compared to controls (MHI = 2.01 ± 0.2), PE infants (MHI = 2.76 ± 0.2) were diagnosed with significantly smaller cardiac chambers dimensions. Biventricular contractile function and hemodynamics were similar in both groups of infants. Left ventricular (LV) global longitudinal strain (GLS) (-16.0 ± 2.8 vs. -21.7 ± 2.2%), LV-global circumferential strain (GCS) (-16.3 ± 2.7 vs. -24.0 ± 5.2%), LV-global radial strain (GRS) (24.2 ± 3.0 vs. 31.5 ± 6.3%), and right ventricular free wall longitudinal strain (RVFWLS) (-16.0 ± 3.2 vs. -22.3 ± 4.4%) were significantly reduced in PE infants versus controls (all p < 0.001). A strong inverse correlation between MHI and the following parameters: LV-GLS (r = -0.92), LV-GCS (r = -0.88), LV-GRS (r = -0.87), and RVFWLS (r = -0.88), was demonstrated in PE infants, but not in controls, in perinatal period (all p < 0.001). Analogous results were obtained at 36.8 ± 5.2 days after birth. CONCLUSIONS Abnormal chest anatomy progressively impairs myocardial strain parameters in PE infants. This impairment might reflect intraventricular dyssynchrony due to compressive phenomena rather than intrinsic myocardial dysfunction.
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Affiliation(s)
| | | | - Marta Braga
- Department of Neonatology, IRCCS MultiMedica, Milan, Italy
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11
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Aldana-Aguirre JC, Eckersley L, Hyderi A, Hirose A, Boom JVD, Kumaran K, Hornberger LK. Influence of extreme prematurity and bronchopulmonary dysplasia on cardiac function. Echocardiography 2021; 38:1596-1603. [PMID: 34505310 DOI: 10.1111/echo.15178] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Revised: 06/30/2021] [Accepted: 08/06/2021] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE Prematurity and bronchopulmonary dysplasia (BPD) are associated with poorly understood abnormalities of ventricular function. We therefore comprehensively compared biventricular function in infants with and without BPD. METHODS Prospective observational study in extremely preterm infants with (n = 20) and without (n = 38) BPD using conventional and advanced echocardiography at 28 days (T1) and near-term (T2). RESULTS Infants with BPD had lower birth gestational age (26.7±1.9 vs 27.4±1.1 weeks, p = 0.047) and weight (884±207 vs 1108±190 g, p = 0.0001). BPD was associated with larger right ventricles (RV) and reduced RV systolic strain rate at T1 and pulmonary hypertensive indicators at T2 (pulmonary artery acceleration time BPD 51±17 vs no BPD 63±12 ms, p = 0.017). At T1/T2, infants with BPD had lower RV tissue Doppler velocities (e', a' and s) and higher E/e' ratios (T1: BPD 10.4±2.4 vs no BPD 6.2±3.1 cm/sec, p = 0.001; T2: BPD 8.0±3.1 vs no BPD 5.6±2.6 cm/sec, p = 0.02), altered LV diastolic function (apical circumferential T1 early diastolic strain rate BPD 2.8±0.8 vs no BPD 3.6±1.0 /sec, p = 0.04; T2 late diastolic strain rate, BPD 2.29 ± 0.99 vs no BPD 1.67±0.84 /sec, p = 0.03) and LV rotational mechanics (T1: twist rate BPD 90±16 vs no BPD 130±48 deg/sec, p = 0.008; untwist rate (UTR) BPD -69±90 vs no BPD -147±68 deg/sec, p = 0.008; torsion BPD 2.78±0.56 vs no BPD 4.48±1.74 deg/cm, p = 0.009; and T2: UTR BPD -132±69 vs no BPD -179±57 deg/sec, p = 0.013). CONCLUSION BPD is associated with altered RV diastolic function that persists near term, with elevated pulmonary vascular resistance, and with persistent alterations in LV apical strain rate and rotational mechanics.
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Affiliation(s)
- Jose Carlos Aldana-Aguirre
- Division of Neonatology, Stollery Children's Hospital, Edmonton, Alberta, Canada.,SickKids Hospital, Toronto, Ontario, Canada
| | - Luke Eckersley
- Fetal & Neonatal Cardiology Program, Division of Cardiology, Department of Pediatrics, Stollery Children's Hospital, Edmonton, Alberta, Canada.,Women's & Children's Health Research Institute, University of Alberta, Edmonton, Alberta, Canada
| | - Abbas Hyderi
- Division of Neonatology, Stollery Children's Hospital, Edmonton, Alberta, Canada
| | - Akiko Hirose
- Division of Neonatology, Stollery Children's Hospital, Edmonton, Alberta, Canada
| | - Jutta van den Boom
- Division of Neonatology, Stollery Children's Hospital, Edmonton, Alberta, Canada
| | - Kumar Kumaran
- Division of Neonatology, Stollery Children's Hospital, Edmonton, Alberta, Canada
| | - Lisa K Hornberger
- Fetal & Neonatal Cardiology Program, Division of Cardiology, Department of Pediatrics, Stollery Children's Hospital, Edmonton, Alberta, Canada.,Women's & Children's Health Research Institute, University of Alberta, Edmonton, Alberta, Canada
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12
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Echocardiographic Assessment of Right Ventricular Afterload in Preterm Infants: Maturational Patterns of Pulmonary Artery Acceleration Time Over the First Year of Age and Implications for Pulmonary Hypertension. J Am Soc Echocardiogr 2020; 32:884-894.e4. [PMID: 31272593 DOI: 10.1016/j.echo.2019.03.015] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2019] [Revised: 03/20/2019] [Accepted: 03/20/2019] [Indexed: 12/11/2022]
Abstract
BACKGROUND Assessment of pulmonary hemodynamics is critical in the diagnosis and management of cardiopulmonary disease of premature infants, but reliable noninvasive indices of pulmonary hemodynamics in preterm infants are lacking. Because pulmonary artery acceleration time (PAAT) is a validated noninvasive method to assess right ventricular (RV) afterload in infants and children, the aim of this study was to investigate the maturational changes of PAAT measures in preterm infants over the first year of age and to discern the impact of typical cardiopulmonary abnormalities on these measures. METHODS In a prospective multicenter study of 239 preterm infants (<29 weeks at birth), PAAT was assessed at days 1, 2, and 5 to 7, at 32 and 36 weeks' postmenstrual age, and at 1-year corrected age. To account for heart rate variability, PAAT was adjusted for RV ejection time. Premature infants who developed bronchopulmonary dysplasia or had echocardiographic findings of pulmonary hypertension were analyzed separately. Intra- and interobserver reproducibility analysis was performed. RESULTS PAAT was feasible in 95% of the image acquisitions, and there was high intra- and interobserver agreement (intraclass correlation coefficients > 0.9 and coefficients of variation < 6%). In uncomplicated preterm infants (n = 103 [48%]) PAAT and PAAT adjusted for RV ejection time increased longitudinally from birth to 1-year corrected age (P < .001) and were linearly associated with gestational age at birth (r = 0.81 and r = 0.82, P < .001) and increasing postnatal weight and postnatal age (r > 0.81, P < .001). PAAT measures were significantly reduced (P < .001) in infants with bronchopulmonary dysplasia and/or pulmonary hypertension (n = 119 [51%]) beyond 1 week of age. CONCLUSIONS PAAT measures increase in preterm infants from birth to 1-year corrected age, reflective of the physiologic postnatal drop in RV afterload. Bronchopulmonary dysplasia and pulmonary hypertension have a negative impact on PAAT measures. By demonstrating excellent reliability and establishing reference patterns of PAAT in preterm infants, this study suggests that PAAT and PAAT adjusted for RV ejection time can be used as complementary parameters to assess physiologic and pathologic changes in pulmonary hemodynamics in neonates.
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13
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Maturational patterns of left ventricular rotational mechanics in pre-term infants through 1 year of age. Cardiol Young 2020; 30:1238-1246. [PMID: 32665043 DOI: 10.1017/s1047951120001912] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Pre-mature birth impacts left ventricular development, predisposing this population to long-term cardiovascular risk. The aims of this study were to investigate maturational changes in rotational properties from the neonatal period through 1 year of age and to discern the impact of cardiopulmonary complications of pre-maturity on these measures. METHODS Pre-term infants (<29 weeks at birth, n = 117) were prospectively enrolled and followed to 1-year corrected age. Left ventricular basal and apical rotation, twist, and torsion were measured by two-dimensional speckle-tracking echocardiography and analysed at 32 and 36 weeks post-menstrual age and 1-year corrected age. A mixed random effects model with repeated measures analysis was used to compare rotational mechanics over time. Torsion was compared in infants with and without complications of cardiopulmonary diseases of pre-maturity, specifically bronchopulmonary dysplasia, pulmonary hypertension, and patent ductus arteriosus. RESULTS Torsion decreased from 32 weeks post-menstrual age to 1-year corrected age in all pre-term infants (p < 0.001). The decline from 32 to 36 weeks post-menstrual age was more pronounced in infants with cardiopulmonary complications, but was similar to healthy pre-term infants from 36 weeks post-menstrual age to 1-year corrected age. The decline was due to directional and magnitude changes in apical rotation over time (p < 0.05). CONCLUSION This study tracks maturational patterns of rotational mechanics in pre-term infants and reveals torsion declines from the neonatal period through 1 year. Cardiopulmonary diseases of pre-maturity may negatively impact rotational mechanics during the neonatal period, but the myocardium recovers by 1-year corrected age.
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14
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Barrington K, El-Khuffash A, Dempsey E. Intervention and Outcome for Neonatal Hypotension. Clin Perinatol 2020; 47:563-574. [PMID: 32713451 DOI: 10.1016/j.clp.2020.05.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Many observational studies have shown that infants with blood pressures (BPs) that are in the lower range for their gestational age tend to have increased complications such as an increased rate of significant intraventricular hemorrhage and adverse long-term outcome. This relationship does not prove causation nor should it create an indication for treatment. However, many continue to intervene with medication for low BP on the assumption that an increase in BP will result in improved outcome. Only adequately powered prospective randomized controlled trials can answer the question of whether individual treatments of low BP are beneficial.
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Affiliation(s)
| | - Afif El-Khuffash
- The Rotunda Hospital, Dublin and Royal College of Surgeons, Dublin, Ireland
| | - Eugene Dempsey
- Department of Paediatrics and Child Health, INFANT Centre, University College Cork, Ireland.
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15
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Emara M, Hafez MA, El-Bendary A, Razaky OE. Speckle tracking echocardiography for the evaluation of left ventricular function in children with systemic lupus erythematosus. Lupus 2020; 29:1449-1455. [PMID: 32723060 DOI: 10.1177/0961203320942296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Many studies in adult patients with systemic lupus erythematosus (SLE) have demonstrated that myocardial dysfunction was significantly associated with enhanced disease activity. However, similar studies in paediatric patients with SLE are limited. The aim of this study was to evaluate the role of speckle tracking echocardiography (STE) to detect left ventricular dysfunction in children with active and inactive SLE. METHODS This prospective case-control study was carried out on 50 children with SLE. Thirty healthy age- and sex-matched children comprised the control group. The patients were further subdivided into two subgroups: active SLE and inactive SLE. Laboratory investigations undertaken included complete blood count, renal function, C3, C4, ANA, anti-dsDNA and serum N-terminal pro-B type natriuretic peptide. Echocardiographic examinations were performed on all children and included conventional echocardiography, tissue Doppler imaging (TDI) and two- and three-dimensional STE. RESULTS There was no statistically significant difference in N-terminal pro B natriuretic peptide between the studied groups. The myocardial performance index by TDI was statistically significantly higher in SLE patients compared to controls. STE parameters were statistically significantly lower in SLE patients compared to controls. There was no correlation between STE parameters and disease activity. CONCLUSIONS STE could be a promising technique in the early detection of subclinical left ventricular dysfunction in children with SLE.
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Affiliation(s)
- Mai Emara
- Paediatric Department, Faculty of Medicine, Tanta University, Tanta, Egypt
| | - Maher Abdel Hafez
- Paediatric Department, Faculty of Medicine, Tanta University, Tanta, Egypt
| | - Aml El-Bendary
- Clinical Pathology Department, Faculty of Medicine, Tanta University, Tanta, Egypt
| | - Osama El Razaky
- Paediatric Department, Faculty of Medicine, Tanta University, Tanta, Egypt
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16
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Poon CY, Wilson DG, Joshi S, Fraser AG, Kotecha S. Longitudinal evaluation of myocardial function in preterm infants with respiratory distress syndrome. Echocardiography 2019; 36:1713-1726. [DOI: 10.1111/echo.14462] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2019] [Revised: 07/12/2019] [Accepted: 08/02/2019] [Indexed: 12/20/2022] Open
Affiliation(s)
- Chuen Y. Poon
- Department of Child Health School of Medicine Cardiff University Cardiff UK
| | - Dirk G. Wilson
- Children's Heart Unit University Hospital of Wales Cardiff UK
| | - Suchita Joshi
- Department of Child Health School of Medicine Cardiff University Cardiff UK
| | - Alan G. Fraser
- Wales Heart Research Institute School of Medicine Cardiff University Cardiff UK
| | - Sailesh Kotecha
- Department of Child Health School of Medicine Cardiff University Cardiff UK
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17
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Bussmann N, El-Khuffash A. Future perspectives on the use of deformation analysis to identify the underlying pathophysiological basis for cardiovascular compromise in neonates. Pediatr Res 2019; 85:591-595. [PMID: 30666047 DOI: 10.1038/s41390-019-0293-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2018] [Revised: 12/28/2018] [Accepted: 01/02/2019] [Indexed: 12/28/2022]
Abstract
The assessment of the wellbeing of the cardiovascular status in premature infants has come to the forefront in recent years. There is an increasing realisation that myocardial performance, systemic blood flow and end-organ perfusion (particularly during the transitional period) play an important role in determining short and long-term outcomes in this population. The recent open access series on Neonatologist Performed Echocardiography (NPE) published in this journal outline the necessary techniques for image acquisition and analysis and provide a framework for the potential clinical applications of NPE in neonatal, and specifically preterm care. In this "Future Perspectives" review, we describe the important determinants of adequate cellular metabolism and myocardial performance (e.g. loading conditions, intrinsic contractility and morphological change), we discuss the maladaptive state of the preterm cardiovascular system, and highlight the emerging role that non-invasive echocardiography techniques, such as deformation analysis, serve in identifying the underlying physiological basis for cardiovascular instability.
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Affiliation(s)
- Neidin Bussmann
- Department of Neonatology, The Rotunda Hospital, Dublin, Ireland
| | - Afif El-Khuffash
- School of Medicine, Department of Pediatrics, Royal College of Surgeons in Ireland, Dublin, Ireland.
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18
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Reference values for two-dimensional myocardial strain echocardiography of the left ventricle in healthy children. Cardiol Young 2019; 29:325-337. [PMID: 30777588 DOI: 10.1017/s1047951118002378] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Myocardial deformation by speckle tracking echocardiography provides additional information on left ventricular function. Values of myocardial deformation (strain and strain rate) depend on the type of ultrasound machine and software that is used. Normative values for QLAB (Philips) are scarce, especially for children. It is important to evaluate the influence of age and body size on myocardial deformation parameters, since anthropometrics strongly influence many standard echocardiographic parameters. The aim of this study was to provide comprehensive normal values for myocardial deformation of the left ventricle using a Philips platform and to evaluate the association with anthropometric and standard echocardiographic parameters. METHODS Healthy children between 1 and 18 years of age were prospectively examined using a standard echocardiographic protocol. Short-axis and apical four-chamber, two-chamber, and three-chamber views were used to measure peak systolic circumferential and longitudinal strain and systolic and early diastolic strain rate of the left ventricle using dedicated software. RESULTS A total of 103 children were included with a mean age of 10.8 and inter-quartile range 7.3-14.3 years. Global circumferential strain values (±SD) were -24.2±3.5% at basal, -25.8±3.5% at papillary muscle, and -31.9±6.2% at apex levels. Global left ventricular longitudinal strain values were -20.6±2.6% in apical four-chamber view, -20.9±2.7% in apical two-chamber, and -21.0 ±2.7% in apical three-chamber. Age was associated with longitudinal strain, longitudinal systolic and early diastolic strain rate, but not with circumferential strain. CONCLUSIONS Normal values for left ventricular deformation parameters in children are obtained using a Philips platform. Age partly explains normal variation of strain and strain rate.
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19
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Gill AW. Postnatal cardiovascular adaptation. Arch Dis Child Fetal Neonatal Ed 2019; 104:F220-F224. [PMID: 30049726 DOI: 10.1136/archdischild-2017-314453] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Revised: 07/12/2018] [Accepted: 07/13/2018] [Indexed: 12/12/2022]
Abstract
The heart undergoes rapid transformations in function during the transition to extrauterine life. Our understanding of the adaptive physiology underlying this process is able to inform the clinical management of infants who are struggling to complete this complex transition. Much of our knowledge of the cardiac transition is derived from the preterm infant in whom the preparative adaptations are incomplete and clinical sequelae all too common. This review will re-examine the cardiac transition highlighting the physiology that drives it and suggest appropriate clinical intervention to support the process.
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Affiliation(s)
- Andrew William Gill
- Centre for Neonatal Research and Education, University of Western Australia, Perth, Western Australia, Australia
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20
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Chu M, Qian L, Zhu M, Yao J, Xu D, Chen M. Circumferential strain rate to detect lipopolysaccharide-induced cardiac dysfunction: a speckle tracking echocardiography study. Quant Imaging Med Surg 2019; 9:151-159. [PMID: 30976539 DOI: 10.21037/qims.2018.11.03] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Background Lipopolysaccharide (LPS)-induced myocardial dysfunction is a widely used indicator to study septic cardiomyopathy (SC). This study investigated the efficiency of strain rate imaging (SRI) in detecting LPS-induced myocardial dysfunction. Methods A total of 30 mice were randomly assigned to saline group (n=10), 10 mg/kg LPS group (n=10) and 20 mg/kg LPS group (n=10). Then at baseline, 6 and 20 h after LPS injection, 2-D and M-mode echocardiography were conducted with GE Vivid 7 ultrasound (il3L linear probe, 10.0-14.0 MHz) and Echopac PC software. Ejection fraction (EF) and fractional shortening (FS) were measured with M-mode tracings. Serum biochemical examination was then performed to evaluate sepsis-induced myocardial injury. Results In LPS 20 mg/kg group, at 6 h after LPS injection, SRI found significantly decreased early diastolic strain rate (SRe, 1.76±1.05 vs. 3.18±0.83 unit/s, P<0.05), but M-mode echo found no change in EF and FS. In 10 mg/kg LPS group, compared with those at 6 h after LPS injection, SRI found a decline in SRe (1.57±0.75 vs. 3.18±0.83 unit/s, P<0.05), and M-mode tracings found an elevation in EF (71.31%±11.68% vs. 55.36%±7.42%, P<0.05) and FS (35.67%±8.79% vs. 25.43%±4.32%, P<0.05) at 20 h. Furthermore, LPS elevated the levels of serum creatine kinase-MB (CK-MB) and cardiac troponin-T (cTnT) at 20 h. Conclusions SRI is useful to early assess LPS-induced cardiac deformation in mice. circumferential strain rate (SRcirc) is a sensitive indicator for LPS-induced myocardial injury in severe sepsis.
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Affiliation(s)
- Ming Chu
- Department of Geriatrics, the First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China
| | - Lijun Qian
- Department of Geriatrics, the First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China
| | - Menglin Zhu
- Department of Geriatrics, the First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China
| | - Jing Yao
- Department of Cardiology, the First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China
| | - Di Xu
- Department of Geriatrics, the First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China
| | - Minglong Chen
- Department of Cardiology, the First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China
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Maturational patterns in right ventricular strain mechanics from the fetus to the young infant. Early Hum Dev 2019; 129:23-32. [PMID: 30616038 DOI: 10.1016/j.earlhumdev.2018.12.015] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Revised: 10/23/2018] [Accepted: 12/18/2018] [Indexed: 12/11/2022]
Abstract
AIM To test the hypothesis that right ventricular (RV) function has age-specific patterns of development, we tracked the evolution of RV strain mechanics by 2D-speckle tracking echocardiography (2DSTE) in healthy subjects from mid-gestation through one year of age. METHODS We conducted a prospective longitudinal echocardiography study in 50 healthy subjects at five time periods across gestation (16-20 weeks, 21-25 weeks, 26-30 weeks, 31-35 weeks, and 36-40 weeks) and four time periods following delivery (1 week, 1 month, 6 months, and 1 year of age). We characterized RV function by measuring RV global and free wall longitudinal strain and systolic strain rate, and segmental longitudinal strain at the apical-, mid-, and basal- ventricular levels of the free wall. Possible associations of gestational age, postnatal age, estimated fetal weight, body surface area, gender, and heart rate on strain were investigated. RESULTS The magnitudes of RV global and free wall longitudinal strain and global strain rate were decreased throughout gestation (p < 0.05 for all). Following birth, the magnitudes of all measures increased from one week through one year (p < 0.001 for all). RV segmental longitudinal strain maintained a base-to-apex gradient (highest-to-lowest) from mid-gestation through one year (p < 0.001). There was no significant difference in strain patterns based on gender or hear rate. CONCLUSION The maturational patterns of RV strain are gestational- and postnatal age- specific. With accepted physiological maturation patterns in healthy subjects, these myocardial deformation parameters can provide a valid basis that allows comparison between health and disease.
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22
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Left ventricular diastolic function influences right ventricular - Pulmonary vascular coupling in premature infants. Early Hum Dev 2019; 128:35-40. [PMID: 30465910 DOI: 10.1016/j.earlhumdev.2018.11.006] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Revised: 10/04/2018] [Accepted: 11/13/2018] [Indexed: 12/17/2022]
Abstract
INTRODUCTION Reduced left ventricular (LV) diastolic function can exert significant load to the right ventricle (RV) that can affect RV-pulmonary vasculature (PV) coupling. RV-PV can be assessed with the RV length-force relationship (tricuspid annular plane systolic excursion [TAPSE] to pulmonary artery acceleration time [PAAT] ratio). We aimed to determine the association between LV diastolic function measured using tissue Doppler imaging (TDI) and TAPSE/PAAT. METHODS A study of premature infants <29 weeks gestation. TAPSE/PAAT, LV e' and a' waves were measured on Day 1 following birth. Correlation between diastolic indices and TAPSE/PAAT was performed. The independent effect of LV diastolic function and TAPSE/PAAT was assessed using linear regression. RESULTS One hundred and sixty-two infants with a mean ± SD gestation & birthweight of 26.6 ± 1.5 weeks & 938 ± 241 g. There was a significant positive correlation between LV e' (r = 0.44, p < 0.01)/LV a' (r = 0.44, p < 0.01) and TAPSE/PAAT. This relationship remained significant when adjusting for important confounders (all p < 0.01). Infants with LV a' values in the lowest quartile had lower TAPSE values (4.2 ± 1.2 vs. 5.1 ± 1.1 mm, p < 0.01) without a difference in PAAT (41 ± 8 vs. 41 ± 10 ms, p = 0.97). CONCLUSIONS We observed a direct correlation between LV diastolic function and RV-PV coupling in the first day of age, highlighting the importance ventricular interdependence in premature infants. TAPSE/PAAT, as the index of the RV-PV interaction may be further explored for its potential to assess RV reserve under stress with preterm infants in health and disease.
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23
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Blanca AJ, Duijts L, van Mastrigt E, Pijnenburg MW, Ten Harkel DJD, Helbing WA, Bartelds B, Reis I, Koopman LP. Right ventricular function in infants with bronchopulmonary dysplasia and pulmonary hypertension: a pilot study. Pulm Circ 2018; 9:2045894018816063. [PMID: 30419798 PMCID: PMC6295707 DOI: 10.1177/2045894018816063] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Premature birth and bronchopulmonary dysplasia (BPD) are risk factors for the development of echocardiographic signs of pulmonary hypertension (PH) and are associated with changes in cardiac structure and function. It is unclear whether this association persists beyond early infancy. The aims of this study are to prospectively investigate the prevalence of PH in children with severe BPD and to investigate the effect of BPD and PH on myocardial structure and function at six months corrected age. Preterm infants (gestational age ≤ 32 weeks) with severe BPD were included. Echocardiography was used to define PH and to measure speckle tracking derived longitudinal and circumferential strain of the left ventricle (LV) and right ventricle (RV). Sixty-nine infants with a median (interquartile range [IQR]) gestational age of 25.6 (24.9–26.4) weeks and a median birthweight of 770 (645–945) gram were included. Eight (12%) infants had signs of PH at six months corrected age. RV fractional area change was lower in infants with severe BPD and PH at six months compared to infants without PH (35% ± 9% vs. 43% ± 9%, P = 0.03). RV mean longitudinal systolic strain was lower in infants with severe BPD and PH compared to infants without PH (17.6% [−19.5%/−16.1%] vs. −20.9% [−25.9%/−17.9%], P = 0.04). RV size and LV longitudinal and circumferential strain in children with BPD with or without PH were similar. Signs of PH were found in 12% of infants with severe BPD at six months corrected age and the presence of PH is associated with reduced RV systolic function.
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Affiliation(s)
- Arabella J Blanca
- 1 Division of Pediatric Cardiology, Department of Pediatrics, Erasmus Medical Centre, Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Liesbeth Duijts
- 2 Division of Pediatric Pulmonology, Department of Pediatrics, Erasmus Medical Centre, Sophia Children's Hospital, Rotterdam, The Netherlands.,3 Division of Neonatology, Erasmus Medical Centre, Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Esther van Mastrigt
- 2 Division of Pediatric Pulmonology, Department of Pediatrics, Erasmus Medical Centre, Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Marielle W Pijnenburg
- 2 Division of Pediatric Pulmonology, Department of Pediatrics, Erasmus Medical Centre, Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Derk-Jan D Ten Harkel
- 4 Department of Pediatric Cardiology, Leiden University Medical Centre, Leiden, The Netherlands
| | - Willem A Helbing
- 1 Division of Pediatric Cardiology, Department of Pediatrics, Erasmus Medical Centre, Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Beatrijs Bartelds
- 1 Division of Pediatric Cardiology, Department of Pediatrics, Erasmus Medical Centre, Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Irwin Reis
- 3 Division of Neonatology, Erasmus Medical Centre, Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Laurens P Koopman
- 1 Division of Pediatric Cardiology, Department of Pediatrics, Erasmus Medical Centre, Sophia Children's Hospital, Rotterdam, The Netherlands
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Early diastolic dysfunction and respiratory morbidity in premature infants: an observational study. J Perinatol 2018; 38:1205-1211. [PMID: 29887608 DOI: 10.1038/s41372-018-0147-2] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2018] [Revised: 04/01/2018] [Accepted: 04/18/2018] [Indexed: 11/08/2022]
Abstract
OBJECTIVE To test if diastolic dysfunction measured on day one of age is associated with the need for invasive ventilation in preterm infants. STUDY DESIGN We conducted a retrospective observational tissue Doppler echocardiographic study over the first 12 h of age for infants born <32 weeks who were invasively ventilated, and infants on continuous positive pressure ventilation (CPAP). RESULTS One hundred and eighty-three infants were included (27 ± 2 weeks and 999 ± 296 g). Invasively ventilated infants [(n = 96 (53%)] had lower left ventricular (LV) e' (3.4 ± 1.0 vs. 4.1 ± 1.5 cm/s, p < 0.01) and lower LV ea' ratio (0.8 ± 0.2 vs. 1.0 ± 0.4, p < 0.01), even after adjusting for common neonatal confounders (LV e' adjusted OR 0.62, 95% CI 0.45 - 0.87, p < 0.01; LV ea' adjusted OR 0.14, 95% CI 0.03-0.68, p = 0.01). CONCLUSION LV diastolic dysfunction is independently associated with a higher risk for invasive ventilation on day one of age.
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Smith A, Breatnach CR, James AT, Franklin O, El-Khuffash A. Incidental Findings on Routine Targeted Neonatal Echocardiography Performed in Preterm Neonates Younger Than 29 Weeks' Gestation. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2018; 37:843-849. [PMID: 28945279 DOI: 10.1002/jum.14422] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/02/2017] [Revised: 06/20/2017] [Accepted: 06/28/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVES The aim of this study was to quantify the rate of incidental findings identified on elective research echocardiography performed on neonates younger than 29 weeks' gestation. METHODS We conducted a retrospective study of echocardiographic examinations performed within the first 24 hours of age on neonates younger than 29 weeks' gestation over a 3-year period for research purposes. Incidental echocardiographic findings and pertinent clinical data were recorded. RESULTS Echocardiographic examinations performed on 145 neonates were retrospectively reviewed. Forty-three neonates (30%) had a total of 54 unexpected findings (37%). Most comprised malpositioned umbilical venous catheters, where the tip was located in the left atrium. The remainder of the conditions identified included unsuspected congenital heart disease, liver hematomas, and unexpected pulmonary hypertension. CONCLUSIONS There is a high rate of incidental findings identified on screening echocardiograms. Routine targeted neonatal echocardiographic screening of preterm neonates may be warranted to identify the considerable likelihood of asymptomatic findings.
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Affiliation(s)
- Aisling Smith
- Department of Neonatology, Rotunda Hospital, Dublin, Ireland
| | | | - Adam T James
- Department of Neonatology, Rotunda Hospital, Dublin, Ireland
| | - Orla Franklin
- Department of Cardiology, Our Lady's Children's Hospital, Crumlin, Dublin, Ireland
| | - Afif El-Khuffash
- Department of Neonatology, Rotunda Hospital, Dublin, Ireland
- Department of Pediatrics, School of Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland
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Kang SJ, Cho YS, Hwang SJ, Kim HJ. Outcomes of Left Ventricular Function According to Treatment Response for a Patent Ductus Arteriosus in Preterm Infants. J Cardiovasc Ultrasound 2018; 25:131-137. [PMID: 29333220 PMCID: PMC5762696 DOI: 10.4250/jcu.2017.25.4.131] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2017] [Revised: 12/16/2017] [Accepted: 12/16/2017] [Indexed: 11/22/2022] Open
Abstract
Background To evaluate the outcomes of left ventricular (LV) function according to treatment response for a hemodynamically significant patent ductus arteriosus (hsPDA) in preterm infants. Methods Echocardiograms of 21 preterm infants born at gestational age < 31 weeks obtained at term-equivalent age were retrospectively studied. Among preterm infants with a hsPDA, 9 underwent ligation after failure of pharmacological closure (ligation group) and 6 experienced successful pharmacological closure (medication group). Six preterm infants without hsPDA (no-hsPDA group) were studied as controls. LV peak longitudinal systolic strain (ε) of each infant was retrospectively obtained from echocardiograms using velocity vector imaging, along with neonatal outcomes. Results Pharmacological closures were attempted at postnatal day 2-3. In the ligation group, the median postnatal age at ligation was 20 days. In the ligation group, LV peak longitudinal systolic ε was significantly decreased at term-equivalent age compared to the other groups. Between the medication and no-hsPDA groups, LV peak longitudinal systolic ε did not differ significantly. Among the neonatal outcomes, infants who experienced necrotizing enterocolitis (NEC) showed significantly decreased LV peak longitudinal systolic ε compared to the infants who did not experience NEC . Conclusion We speculate that in preterm infants with an hsPDA, in cases of medical treatment failure, early PDA ligation at less than 20 days of postnatal age would be beneficial for preserving LV systolic function.
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Affiliation(s)
- Soo Jung Kang
- Department of Pediatrics, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Korea
| | - Young Sun Cho
- Department of Pediatrics, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Korea
| | - Seo Jung Hwang
- Department of Diagnostic Laboratory Medicine, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Korea
| | - Hyo Jin Kim
- Department of Diagnostic Laboratory Medicine, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Korea
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Abstract
In many preterm infants, the ductus arteriosus remains patent beyond the first few days of life. This prolonged patency is associated with numerous adverse outcomes, but the extent to which these adverse outcomes are attributable to the hemodynamic consequences of ductal patency, if at all, has not been established. Different treatment strategies have failed to improve short-term outcomes, with a paucity of data on the correct diagnostic and pathophysiological assessment of the patent ductus arteriosus (PDA) in association with long-term outcomes. Echocardiography is the selected method of choice for detecting a PDA, assessing the impact on the preterm circulation and monitoring treatment response. PDA in a preterm infant can result in pulmonary overcirculation and systemic hypoperfusion, Therefore, echocardiographic assessment should include evaluation of PDA characteristics, indices of pulmonary overcirculation with left heart loading conditions, and indices of systemic hypoperfusion. In this review, we provide an evidence-based overview of the current and emerging ultrasound measurements available to identify and monitor a PDA in the preterm infant. We offer indications and limitations for using Neonatologist Performed Echocardiography to optimize the management of a neonate with a PDA.
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El-Khuffash A, Schubert U, Levy PT, Nestaas E, de Boode WP. Deformation imaging and rotational mechanics in neonates: a guide to image acquisition, measurement, interpretation, and reference values. Pediatr Res 2018; 84:30-45. [PMID: 30072804 PMCID: PMC6257225 DOI: 10.1038/s41390-018-0080-2] [Citation(s) in RCA: 60] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Advances in neonatal cardiac imaging permit a more comprehensive assessment of myocardial performance in neonates that could not be previously obtained with conventional imaging. Myocardial deformation analysis is an emerging quantitative echocardiographic technique to characterize global and regional ventricular function in neonates. Cardiac strain is a measure of tissue deformation and strain rate is the rate at which deformation occurs. These measurements are obtained in neonates using tissue Doppler imaging (TDI) or two-dimensional speckle tracking echocardiography (STE). There is an expanding body of literature describing longitudinal reference ranges and maturational patterns of strain values in term and preterm infants. A thorough understanding of deformation principles, the technical aspects, and clinical applicability is a prerequisite for its routine clinical use in neonates. This review explains the fundamental concepts of deformation imaging in the term and preterm population, describes in a comparative manner the two major deformation imaging methods, provides a practical guide to the acquisition and interpretation of data, and discusses their recognized and developing clinical applications in neonates.
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Affiliation(s)
- 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
| | - Ulf Schubert
- 0000 0004 1937 0626grid.4714.6Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
| | - Philip T. Levy
- 0000 0001 2355 7002grid.4367.6Department of Pediatrics, Washington University School of Medicine, Saint Louis, MO USA ,grid.429583.1Department of Pediatrics, Goryeb Children’s Hospital, Morristown, NJ USA
| | - 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
| | - 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
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Strain Rate and Its Positive Force-Frequency Relationship: Further Evidence from a Premature Infant Cohort. J Am Soc Echocardiogr 2017; 30:1045-1046. [DOI: 10.1016/j.echo.2017.07.008] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2017] [Indexed: 11/22/2022]
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30
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Abstract
BACKGROUND The postnatal period in preterm infants involves multiple physiological changes occurring immediately after birth and continuing for days or weeks. To recognise and treat compromise, it is important to measure cardiovascular function. The aim of this study was to describe longitudinal left ventricular function using conventional and novel echocardiography techniques in preterm infants who did not experience significant antenatal or postnatal complications and treatments. METHODS We prospectively obtained cardiac ultrasound images at days 3, 7, 14, 21, and 28 in 25 uncomplicated, preterm infants <30 weeks of gestation. Speckle tracking analysis of the four chambers and short-axis images provided parameters of left ventricular volume, deformation, and basal myocardial velocities. The patent ductus arteriosus, cardiac dimensions, and atrial volume were also measured. RESULTS Stroke volume increased by 24% during the study period (1.05-1.30 ml/kg, p<0.05). Cardiac length, diameter, and systolic basal myocardial velocity increased with unchanged wall stress and deformation parameters. Diastolic function parameters resembled that of the fetus with predominance of atrial contraction compared with early diastolic velocities. Blood pressure and estimates of left ventricular filing pressure increased, suggesting that left ventricular compliance did not change in this period. CONCLUSION Stroke volume increased in the first 28 days after preterm birth. The preterm heart adapted by increasing its size, while maintaining systolic and atrial function, independent of early diastolic maturation. Longitudinal deformation of the left ventricle remained unchanged, suggesting relatively preserved function with maturation.
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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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Levy PT, El-Khuffash A, Patel MD, Breatnach CR, James AT, Sanchez AA, Abuchabe C, Rogal SR, Holland MR, McNamara PJ, Jain A, Franklin O, Mertens L, Hamvas A, Singh GK. Maturational Patterns of Systolic Ventricular Deformation Mechanics by Two-Dimensional Speckle-Tracking Echocardiography in Preterm Infants over the First Year of Age. J Am Soc Echocardiogr 2017; 30:685-698.e1. [PMID: 28433214 DOI: 10.1016/j.echo.2017.03.003] [Citation(s) in RCA: 62] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2016] [Indexed: 01/29/2023]
Abstract
BACKGROUND The aim of this study was to determine the maturational changes in systolic ventricular strain mechanics by two-dimensional speckle-tracking echocardiography in extremely preterm neonates from birth to 1 year of age and discern the impact of common cardiopulmonary abnormalities on the deformation measures. METHODS In a prospective multicenter study of 239 extremely preterm infants (<29 weeks gestation at birth), left ventricular (LV) global longitudinal strain (GLS) and global longitudinal systolic strain rate (GLSRs), interventricular septal wall (IVS) GLS and GLSRs, right ventricular (RV) free wall longitudinal strain and strain rate, and segmental longitudinal strain in the RV free wall, LV free wall, and IVS were serially measured on days 1, 2, and 5 to 7, at 32 and 36 weeks postmenstrual age, and at 1 year corrected age (CA). Premature infants who developed bronchopulmonary dysplasia or had echocardiographic findings of pulmonary hypertension were analyzed separately. RESULTS In uncomplicated preterm infants (n = 103 [48%]), LV GLS and GLSRs remained unchanged from days 5 to 7 to 1 year CA (P = .60 and P = .59). RV free wall longitudinal strain, RV free wall longitudinal strain rate, and IVS GLS and GLSRs significantly increased over the same time period (P < .01 for all measures). A significant base-to-apex (highest to lowest) segmental longitudinal strain gradient (P < .01) was seen in the RV free wall and a reverse apex-to-base gradient (P < .01) in the LV free wall. In infants with bronchopulmonary dysplasia and/or pulmonary hypertension (n = 119 [51%]), RV free wall longitudinal strain and IVS GLS were significantly lower (P < .01), LV GLS and GLSRs were similar (P = .56), and IVS segmental longitudinal strain persisted as an RV-dominant base-to-apex gradient from 32 weeks postmenstrual age to 1 year CA. CONCLUSIONS This study tracks the maturational patterns of global and regional deformation by two-dimensional speckle-tracking echocardiography in extremely preterm infants from birth to 1 year CA. The maturational patterns are ventricular specific. Bronchopulmonary dysplasia and pulmonary hypertension leave a negative impact on RV and IVS strain, while LV strain remains stable.
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Affiliation(s)
- Philip T Levy
- Department of Pediatrics, Washington University School of Medicine, St. Louis, Missouri; Department of Pediatrics, Goryeb Children's Hospital, Morristown, New Jersey.
| | - 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
| | - Meghna D Patel
- Department of Pediatrics, Washington University School of Medicine, St. Louis, Missouri
| | - Colm R Breatnach
- Department of Neonatology, The Rotunda Hospital, Dublin, Ireland
| | - Adam T James
- Department of Neonatology, The Rotunda Hospital, Dublin, Ireland
| | - Aura A Sanchez
- Department of Pediatrics, University of Minnesota, Minneapolis, Minnesota
| | - Cristina Abuchabe
- Department of Pediatrics, Washington University School of Medicine, St. Louis, Missouri
| | - Sarah R Rogal
- Department of Pediatrics, Goryeb Children's Hospital, Morristown, New Jersey
| | - Mark R Holland
- Department of Radiology and Imaging Sciences, Indiana University Purdue University, Indianapolis, Indiana
| | - Patrick J McNamara
- Division of Neonatology and Department of Physiology, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Amish Jain
- Department of Paediatrics, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Orla Franklin
- Department of Cardiology, Our Lady's Children's Hospital Crumlin, Dublin, Ireland
| | - Luc Mertens
- Division of Cardiology, The Labatt Family Heart Centre, The Hospital for Children, Toronto, Ontario, Canada
| | - Aaron Hamvas
- Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Gautam K Singh
- Department of Pediatrics, Washington University School of Medicine, St. Louis, Missouri
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Weisz DE, McNamara PJ, El-Khuffash A. Cardiac biomarkers and haemodynamically significant patent ductus arteriosus in preterm infants. Early Hum Dev 2017; 105:41-47. [PMID: 27998626 DOI: 10.1016/j.earlhumdev.2016.12.007] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Accurately defining haemodynamically significant patent ductus arteriosus (PDA) in preterm infants who are at risk of PDA related morbidities are active areas of neonatal research. Natriuretic peptides are cardiac hormones that respond to volume and pressure loading, with elevated plasma levels found in infants with PDA. In the preterm neonatal setting, studies to date have predominantly investigated the ability of these biomarkers to discriminate between infants with and without a PDA at various postnatal ages. Their clinical utility has therefore been exclusively evaluated as a method of triaging cases of suspected hsPDA to decrease the need for echocardiograms, and to monitor treatment response. Biomarkers are yet to be robustly investigated for their ability to predict important PDA associated morbidities. In this review, we examine the most recent literature to date on the use of biomarkers in the management of PDA.
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Affiliation(s)
- Dany E Weisz
- Department of Newborn and Developmental Paediatrics, Sunnybrook Health Sciences Centre, Toronto, Canada; Department of Paediatrics, University of Toronto, Toronto, Canada
| | - Patrick J McNamara
- Department of Paediatrics, University of Toronto, Toronto, Canada; Department of Physiology, University of Toronto, Toronto, Ontario, Canada; Physiology and Experimental Medicine Program, SickKids Research Institute, Toronto, Canada
| | - 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.
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Haque U, Stiver C, Rivera BK, Richards B, Ma N, Cua CL, Smith CV, Backes CH. Right ventricular performance using myocardial deformation imaging in infants with bronchopulmonary dysplasia. J Perinatol 2017; 37:81-87. [PMID: 27711043 DOI: 10.1038/jp.2016.173] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2016] [Revised: 08/24/2016] [Accepted: 08/30/2016] [Indexed: 12/19/2022]
Abstract
OBJECTIVE Right ventricular (RV) performance among infants with bronchopulmonary dysplasia (BPD) remains poorly understood. We tested the hypothesis that myocardial deformation imaging (MDI) strain and strain rate would allow for differentiation between infants with severe and milder forms of BPD, independent of tissue Doppler imaging (TDI) and superior to conventional echocardiographic measurements. STUDY DESIGN Infants with various severities of BPD (11 with none or mild, 13 with moderate and 10 with severe) underwent conventional echocardiography, TDI and MDI assessments at >36 weeks of corrected gestational age. BPD severity grading was determined according to the National Institutes of Child Health and Disease workshop rating scale by physicians blinded to the echocardiogram results. Group data were compared with one-way analysis of variance or Kruskal-Wallis tests, with post hoc multiple comparisons. RESULTS No differences in traditional echocardiographic parameters or TDI among the three BPD severity groups were observed; none of the infants had evidence of pulmonary hypertension. Using MDI, infants with severe BPD had lower peak global systolic strain than did infants with moderate BPD (P<0.01) or mild/none BPD (P<0.01). Early and late diastolic strain rate measurements were similar across the three groups. CONCLUSIONS Among infants with severe forms of BPD, evidence of abnormal RV systolic function was detected with MDI, but not traditional echocardiographic or TDI measurements. Infants with severe forms of BPD may represent a particularly high-risk subgroup for decreased RV performance warranting cardiac surveillance. MDI should be considered as a method to quantitate RV function in this population.
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Affiliation(s)
- U Haque
- Nationwide Children's Hospital Center for Perinatal Research, Columbus, OH, USA.,Ohio University Heritage College of Osteopathic Medicine, Athens, OH, USA
| | - C Stiver
- Nationwide Children's Hospital Heart Center, Columbus, OH, USA.,The Ohio State University Wexner College of Medicine, Columbus, OH, USA
| | - B K Rivera
- Nationwide Children's Hospital Center for Perinatal Research, Columbus, OH, USA
| | - B Richards
- Nationwide Children's Hospital Heart Center, Columbus, OH, USA
| | - N Ma
- The Ohio State University Wexner College of Medicine, Columbus, OH, USA
| | - C L Cua
- Nationwide Children's Hospital Heart Center, Columbus, OH, USA.,The Ohio State University Wexner College of Medicine, Columbus, OH, USA
| | - C V Smith
- Seattle Children's Research Institute, Center for Developmental Therapeutics, Seattle, WA, USA
| | - C H Backes
- Nationwide Children's Hospital Center for Perinatal Research, Columbus, OH, USA.,Nationwide Children's Hospital Heart Center, Columbus, OH, USA.,The Ohio State University Wexner College of Medicine, Columbus, OH, USA
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Breatnach CR, Forman E, Foran A, Monteith C, McSweeney L, Malone F, McCallion N, Franklin O, El-Khuffash A. Left ventricular rotational mechanics in infants with hypoxic ischemic encephalopathy and preterm infants at 36 weeks postmenstrual age: A comparison with healthy term controls. Echocardiography 2016; 34:232-239. [PMID: 27933664 DOI: 10.1111/echo.13421] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2016] [Revised: 10/15/2016] [Accepted: 11/14/2016] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND AND AIMS There is a paucity of data on left ventricle (LV) rotational physiology in neonates. We aimed to assess rotational mechanics in infants with hypoxic ischemic encephalopathy (HIE) and premature infants (<32 weeks) at 36 weeks postmenstrual age (PMA) (preterm group) and compare them with healthy term controls (term controls). We also compared the parameters in preterm infants with and without chronic lung disease (CLD). METHODS Echocardiography was performed within 48 hours of birth or at 36 weeks PMA. LV basal and apical rotation, twist (and torsion=twist/LV length), twist rate (LVTR), and untwist rate (LVUTR) were measured. One-way ANOVA was used to compare values. RESULTS There was no difference in gestation (40.0 [39.1-40.3] vs 39.9 [39.0-40.9], P>.05) or birthweight (3.7 [3.4-4.1] vs 3.5 [3.2-3.9], P>.05) between the HIE group (n=16) and term controls (n=30). The preterm group (n=35) had a gestation and weight of 36.0 [34.6-36.3] weeks and 2.3 [2.0-2.4] kg. The HIE group had lower twist, torsion, LVTR, and LVUTR than the other two groups. The preterm group had a more negative (clockwise) basal rotation while the term group had a more positive (counterclockwise) apical rotation. Preterm infants with CLD had higher apical rotation, twist, and torsion when compared to infants without CLD. CONCLUSION Infants with HIE have reduced rotational mechanics. Preterm infants at 36 weeks PMA have comparable measurements of twist to term infants. This is achieved by predominant basal rather than apical rotation. Infants with CLD have increased apical rotation.
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Affiliation(s)
- Colm R Breatnach
- Department of Neonatology, The Rotunda Hospital, Dublin, Ireland
| | - Eva Forman
- Department of Neonatology, The Rotunda Hospital, Dublin, Ireland
| | - Adrienne Foran
- Department of Neonatology, The Rotunda Hospital, Dublin, Ireland.,Department of Paediatrics, School of Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Cathy Monteith
- Department of Obstetrics and Gynaecology, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Lisa McSweeney
- Department of Obstetrics and Gynaecology, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Fergal Malone
- Department of Obstetrics and Gynaecology, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Naomi McCallion
- Department of Neonatology, The Rotunda Hospital, Dublin, Ireland.,Department of Paediatrics, School of Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Orla Franklin
- Department of Cardiology, Our Lady's Children's Hospital Crumlin, Dublin, Ireland
| | - Afif El-Khuffash
- Department of Neonatology, The Rotunda Hospital, Dublin, Ireland.,Department of Paediatrics, School of Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland
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Challenges in Interpreting Deformation Values by Two-Dimensional Speckle-Tracking Echocardiography in Preterm and Term Infants. J Am Soc Echocardiogr 2016; 30:97-98. [PMID: 27638237 DOI: 10.1016/j.echo.2016.08.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2016] [Indexed: 01/15/2023]
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37
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Levy PT, Singh GK. Author’s Reply. J Am Soc Echocardiogr 2016; 29:568-9. [DOI: 10.1016/j.echo.2016.03.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2016] [Indexed: 10/21/2022]
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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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