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Published on: January 27, 2023
Clinical utility of right ventricular fractional area change in preterm infants
Adam T James1, John David Corcoran2, Orla Franklin3
1Department of Neonatology, The Rotunda Hospital, Dublin, Ireland.
Insights
Right ventricular fractional area change (RV FAC) is a valuable tool for assessing preterm infants. Lower RV FAC on day one may predict intraventricular hemorrhage, and PDA influences RV FAC in the first week.
Area of Science:
- Neonatal Cardiology
- Pediatric Echocardiography
- Neonatal Physiology
Background:
- Right ventricular fractional area change (RV FAC) is a novel quantitative measure of right ventricular (RV) function.
- Reference values for RV FAC and RV end-systolic and -diastolic areas (RVEDA, RVESA) are established in preterm infants.
- The utility of RV FAC in assessing management strategies in the first week of life is largely unknown.
Purpose of the Study:
- Assess the relationship between RV FAC and gestational age/birthweight in preterm infants.
- Evaluate RV FAC on day one to predict peri/intraventricular hemorrhage (P/IVH) evolution.
- Determine the influence of persistent patent ductus arteriosus (PDA) on RV FAC within the first week.
Main Methods:
- Echocardiography assessments of preterm infants (<29 weeks gestation) on days 1, 2, and 5-7.
- Calculation of RV FAC using [(RVEDA-RVESA)÷(RVEDA)] × 100.
- Cranial ultrasound on days 5-7 to define P/IVH (grades II-IV); PDA treatment was withheld.
Main Results:
- 101 infants (mean gestation 26.5 weeks) were studied; no correlation between RV FAC and birthweight (p=0.86).
- RV FAC correlated negatively with systemic vascular resistance (SVR) (r=-0.57, p<0.001).
- On Day 1, lower RV FAC was associated with P/IVH development (24% vs. 31%, p=0.04). On Days 5-7, PDA infants had lower RV FAC (42% vs. 49%, p<0.001).
Conclusions:
- RV FAC demonstrates a negative correlation with SVR.
- Early RV FAC may predict P/IVH, and PDA impacts RV FAC in preterm neonates.
- RV FAC can be a valuable addition to hemodynamic assessment in preterm infants.
Introduction:
Right ventricular fractional area change (RV FAC) is a novel non-invasive quantitative measure of RV function. Reference values of RV FAC and RV end systolic and diastolic areas (RVEDA, RVESA) have recently been established in preterm infants, but their role as marker to assess the efficacy of patient management strategies in the first week of life is largely unknown. The aims of this study were to assess the relationship between RV FAC and gestational age/birthweight, assess the RV FAC on day one of age to predict the later evolution of peri/intraventricular haemorrhage (P/IVH), and assess the influence of a persistent patent ductus arteriosus (PDA) on RV FAC during the first week of age.
Methods:
Preterm infants <29 weeks gestation underwent echocardiography assessments on days 1, 2 and 5-7. RVEDA and RVESA were traced in the RV-focused apical four-chamber view, and RV FAC was calculated using the formula [(RVEDA-RVESA)÷(RVEDA)] × 100. PDA treatment was not carried out during the study period. A cranial ultrasound was carried out on all infants on Days 5-7 of age. P/IVH was defined as IVH grades II to IV.
Results:
One hundred and one infants with a mean gestation of 26.5 (1.4) weeks and a birthweight of 983 (240) grams were enrolled in the study. There was no relationship between RV FAC and birthweight (r=-0.02, p=0.86) but there was a negative correlation between RV FAC and echo-measured SVR (r=-0.57, p<0.001). On Day 1, RV FAC was lower in infants who developed P/IVH (24% [18-34] vs. 31% [25-40], p=0.04). On Days 5-7 infants with a PDA had a lower RV FAC compared with those without [42 (7) vs. 49 (9) %, p<0.001].
Conclusion:
RV FAC may be a useful addition to the haemodynamic assessment of preterm infants during the first week of age.
