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Maturational Changes in Diastolic Longitudinal Myocardial Velocity in Preterm Infants
Michael V Di Maria1, Adel K Younoszai1, Marci K Sontag2
1Section of Cardiology, Pediatric Heart Lung Center, Department of Pediatrics, Children's Hospital Colorado, University of Colorado Denver, Anschutz School of Medicine, Aurora, Colorado.
Insights
Diastolic tissue velocities increase with gestational age in preterm infants. By near term, these velocities mature independently of birth timing, suggesting consistent cardiac development.
Area of Science:
- Cardiology
- Neonatology
- Pediatric Echocardiography
Background:
- Doppler tissue imaging (DTI) assesses myocardial velocity for diastolic function.
- Limited data exist on diastolic function maturation in preterm infants.
- Bronchopulmonary dysplasia and pulmonary hypertension can affect cardiac function.
Purpose of the Study:
- To prospectively evaluate maturational changes in diastolic tissue velocities in preterm infants.
- To assess diastolic tissue velocities at 7 days and 36 weeks postmenstrual age (PMA).
- To determine if DTI measures are altered in infants who develop bronchopulmonary dysplasia or pulmonary hypertension.
Main Methods:
- 277 preterm infants (<34 weeks' PMA, 500-1250g birth weight) were enrolled.
- Echocardiograms were performed at 7 days and 36 weeks PMA.
- Left and right ventricular free wall annular velocities (E', A') were measured using DTI.
Main Results:
- An increased E'/A' ratio correlated with gestational age at 7 days.
- At 36 weeks PMA, the E'/A' ratio increased but showed no gestational age association.
- DTI measures did not differ between infants with or without bronchopulmonary dysplasia or pulmonary hypertension.
Conclusions:
- Preterm infants show a gestational age-related increase in early diastolic tissue velocities.
- Diastolic tissue velocities mature independently of birth timing by 36 weeks PMA.
- Cardiac diastolic function maturation appears consistent despite variations in preterm birth timing.
Background:
Doppler tissue imaging (DTI) has been used to evaluate myocardial velocity during ventricular filling, a means of characterizing diastolic function. Previous studies in older children have shown age-related increases in early diastolic tissue velocities, but there are limited data in preterm infants. The aim of this study was to prospectively determine maturational changes in diastolic tissue velocities at two points in time: (1) 7 days of age and (2) 36 weeks' postmenstrual age (PMA). It was further determined whether DTI measures were altered in infants who developed bronchopulmonary dysplasia with or without pulmonary hypertension.
Methods:
A total of 277 preterm infants born at <34 weeks' PMA, with birth weights between 500 and 1,250 g, were prospectively enrolled. Echocardiograms were obtained at 7 days of age and repeated at 36 weeks' PMA. Measurements included DTI assessment of early (E') and late (A') annular velocities of the left ventricular free wall, septum and the right ventricular free wall. Statistical analysis included the Wilcoxon rank sum test, simple linear regression, and the χ(2) test.
Results:
At 7 days of age, there was a statistically significant increase in the E'/A' ratio as a function of gestational age at birth. At 36 weeks' PMA, E'/A' ratio was increased, but there was no association with gestational age. DTI measures were not different between infants who did or did not develop bronchopulmonary dysplasia or pulmonary hypertension at either time point.
Conclusions:
A gestational age-related increase was found in the early diastolic tissue velocities of preterm infants. At a gestational age equivalent to near term, no difference was observed in diastolic tissue velocities, regardless of gestational age at birth. These findings suggest that maturational changes in diastolic function occur relatively independently of the timing of birth.
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