Assessment of ductal blood flow in newborns with obstructive left heart lesions by cardiovascular magnetic resonance

Fluid flow to mimic organ function in 3D in vitro models

Many different strategies can be found in the literature to model organ physiology, tissue functionality, and disease in vitro; however, most of these models lack the physiological fluid dynamics present in vivo. Here, we highlight the importance of fluid flow for tissue homeostasis, specifically in vessels, other lumen structures, and interstitium, to point out the need of perfusion in current 3D in vitro models. Importantly, the advantages and limitations of the different current experimental fluid-flow setups are discussed. Finally, we shed light on current challenges and future focus of fluid flow models applied to the newest bioengineering state-of-the-art platforms, such as organoids and organ-on-a-chip, as the most sophisticated and physiological preclinical platforms.

NT-Pro-BNP and echocardiography for the early assessment of cardiovascular dysfunction in neonates with sepsis

To investigate the predictive manner of N-terminal fragment of brain natriuretic peptide (NT-Pro-BNP) and echocardiography in the early assessment of cardiovascular dysfunction (CVD) in neonates with sepsis, we recruited 108 neonates with sepsis in intensive care units and divided them into a sepsis with CVD (sepsis + CVD) group (n = 48) and a sepsis only group (n = 60). Neonates with other infections (n = 65) constituted the control group. Clinical, laboratory, and bedside echocardiography findings were evaluated. Compared to both the sepsis only and control groups, the sepsis + CVD group showed an earlier onset of symptoms [52.94 (0-185.6) h], higher NT-Pro-BNP levels (P = .02), a higher Tei index (0.52 + 0.03; P = .03), and lower ejection fraction (62.61% ± 12.31%, P < .05). Compared to the control group, the sepsis + CVD group exhibited hematogenous etiology (P < .05), lower albumin (ALB) levels (P = .04), lower white blood cell counts (P = .03), a higher high-sensitivity C-reactive protein/ALB ratio, and a larger right-ventricle-inner diameter (10.74 + 2.42 mm; P = .01). CVD in the septic neonates could be predicted by either NT-Pro-BNP levels (cut-off: 12,291.5 pg/L; sensitivity, 80%; specificity, 79%; area under the curve-receiver operating characteristic, 0.81) or Tei index (cut-off: 0.45; sensitivity, 74%; specificity, 77%; area under the curve-receiver operating characteristic, 0.78). NT-Pro-BNP levels and echocardiography can be used to determine early onset of CVD in neonatal sepsis, which facilitates timely pharmacological interventions and treatment.

Low descending aorta flow is associated with adverse feeding outcomes in neonates with small left-sided structures

Feeding intolerance and necrotizing enterocolitis (NEC) cause significant morbidity in neonates with duct-dependent systemic circulations. Whether these complications are associated with low blood flow to the bowel is unproven. The aim of this study was to determine whether low descending aortic (DAO) flow is associated with adverse feeding outcomes in neonates with small left-sided structures, including borderline left ventricle and hypoplastic left heart syndrome (HLHS). The cardiac magnetic resonance (CMR) imaging studies and abdominal Doppler ultrasound profiles prior to any cardiac interventions in neonates with small left-sided structures were analyzed. Descending aortic flows, indexed to body surface area, were collected. Medical charts were reviewed for a composite outcome of feeding intolerance and/or NEC. Among the 51 enrolled study patients (mean age 4.6, SD 4.5 days), 13 experienced the composite outcome (feeding intolerance in 13, NEC in 2). The mean DAO flow in patients who experienced the composite outcome was 0.89 L/min/m² (SD 0.33 L/min/m²), compared to 1.23 L/min/m² (SD 0.41 L/min/m²) in those that did not (p = 0.007). A DAO flow of 0.91 L/min/m² identified patients who experienced feeding intolerance or NEC with a sensitivity of 61% and a specificity of 76%. Doppler ultrasound metrics of DAO flow did not correlate with DAO flow or predict adverse feeding outcomes. Low DAO flow is associated with adverse outcomes, including feeding intolerance and NEC, in neonates with small left-sided structures. Heightened clinical vigilance towards feeding complications in patients with low DAO flow is recommended.

Review of Journal of Cardiovascular Magnetic Resonance 2014

There were 102 articles published in the Journal of Cardiovascular Magnetic Resonance (JCMR) in 2014, which is a 6% decrease on the 109 articles published in 2013. The quality of the submissions continues to increase. The 2013 JCMR Impact Factor (which is published in June 2014) fell to 4.72 from 5.11 for 2012 (as published in June 2013). The 2013 impact factor means that the JCMR papers that were published in 2011 and 2012 were cited on average 4.72 times in 2013. The impact factor undergoes natural variation according to citation rates of papers in the 2 years following publication, and is significantly influenced by highly cited papers such as official reports. However, the progress of the journal's impact over the last 5 years has been impressive. Our acceptance rate is <25% and has been falling because the number of articles being submitted has been increasing. In accordance with Open-Access publishing, the JCMR articles go on-line as they are accepted with no collating of the articles into sections or special thematic issues. For this reason, the Editors have felt that it is useful once per calendar year to summarize the papers for the readership into broad areas of interest or theme, so that areas of interest can be reviewed in a single article in relation to each other and other recent JCMR articles. The papers are presented in broad themes and set in context with related literature and previously published JCMR papers to guide continuity of thought in the journal. We hope that you find the open-access system increases wider reading and citation of your papers, and that you will continue to send your quality papers to JCMR for publication.

Changes in pulmonary artery pressure during early transitional circulation in healthy full-term newborns

BACKGROUND

Although pulmonary artery systolic pressures (PASPs) are frequently measured in newborn infants using the tricuspid regurgitant jet velocity or ductal Doppler velocity, little is known about the reference range in the general population.

METHODS

This was a retrospective study of 296 neonates less than 14 days of age who were evaluated using echocardiography. Patients included in this study did not have clinical or acquired cardiac disease. PASP was estimated using the ductal Doppler velocity and/or the tricuspid regurgitant jet velocity and the Bernoulli equation.

RESULTS

The majority of the definite right-to-left through the ductus arteriosus was limited to the first 6 h after birth, and the majority of the left-to-right shunt was limited to 10 h after birth. After 10 h, 24 infants with Doppler color-flow imaging revealed a very small and transient jet. The percentage of measurable tricuspid regurgitation was 91% after 24 h. Multivariable regression analysis found that there was a significant correlation between neonatal age and PASP (determined from tricuspid regurgitant jet velocity and Bernoulli equation: r(2)=0.748, P<0.0001; and from ductal Doppler velocity: r(2)=0.179, P<0.001). The upper 95% limit for PASP measured in healthy neonates younger than 14 days was 39.1 mmHg.

CONCLUSIONS

The ductal Doppler velocity is measured more easily for monitoring PASP than tricuspid regurgitant jet velocity in newborns soon after birth; however, in neonates older than 24 h, the tricuspid regurgitant jet velocity is easier for measurement. Age is an independent impact factor of PASP in the neonates. And PASP values gradually decreased to less than 39.1 mmHg by 14 days after birth.

Review of Journal of Cardiovascular Magnetic Resonance 2013

There were 109 articles published in the Journal of Cardiovascular Magnetic Resonance (JCMR) in 2013, which is a 21% increase on the 90 articles published in 2012. The quality of the submissions continues to increase. The editors are delighted to report that the 2012 JCMR Impact Factor (which is published in June 2013) has risen to 5.11, up from 4.44 for 2011 (as published in June 2012), a 15% increase and taking us through the 5 threshold for the first time. The 2012 impact factor means that the JCMR papers that were published in 2010 and 2011 were cited on average 5.11 times in 2012. The impact factor undergoes natural variation according to citation rates of papers in the 2 years following publication, and is significantly influenced by highly cited papers such as official reports. However, the progress of the journal's impact over the last 5 years has been impressive. Our acceptance rate is <25% and has been falling because the number of articles being submitted has been increasing. In accordance with Open-Access publishing, the JCMR articles go on-line as they are accepted with no collating of the articles into sections or special thematic issues. For this reason, the Editors have felt that it is useful once per calendar year to summarize the papers for the readership into broad areas of interest or theme, so that areas of interest can be reviewed in a single article in relation to each other and other recent JCMR articles. The papers are presented in broad themes and set in context with related literature and previously published JCMR papers to guide continuity of thought in the journal. We hope that you find the open-access system increases wider reading and citation of your papers, and that you will continue to send your quality manuscripts to JCMR for publication.

Non-invasive measurements of ductus arteriosus flow directly after birth

OBJECTIVE

To assess ductus arteriosus (DA) blood flow directly after birth in healthy term infants after elective caesarean section.

DESIGN

In healthy term newborns, echocardiography was performed at 2, 5 and 10 min after birth to monitor cardiac output and DA blood flow. Heart rate (HR) was assessed using ECG.

SETTING

The delivery rooms of the Leiden University Medical Center.

PATIENTS

24 healthy term infants born after a caesarean section were included in this study.

RESULTS

Mean (SD) HR did not change (158 (18) beats per minute (bpm), 5 min (159 (23) bpm) and 10 min (156 (19) bpm). DA diameter decreased from 5.2 (1.3) mm at 2 min to 4.6 (1.3) mm at 5 min (p=0.01) to (3.9 (1.2) mm) (p=0.01) at 10 min. Right-to-left DA shunting was unaltered (median (IQR) 95 (64-154) mL/kg/min to 90 (56-168) mL/kg/min and 80 (64-120) mL/kg/min, respectively (ns)), whereas left-to-right shunting significantly increased between 2 and 5 min (41 (31-70) mL/kg/min vs 67 (37-102) mL/kg/min (p=0.01)) and increased significantly between 2 and 10 min (93 (67-125)) mL/kg/min (p<0.001). Right-to-left/left-to-right shunting ratio decreased significantly from 2.1 (1.4-3.1) at 2 min to 1.4 (1.0-1.8) at 5 min (p<0.0001) and to 0.9 (0.6-1.1) at 10 min (p<0.0001).

CONCLUSIONS

DA shunting changes swiftly from predominantly right-to-left shunting to predominantly left-to-right shunting at 10 min after birth, reflecting differential changes in pulmonary and systemic vascular resistance.