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The impact of a hyperdynamic left ventricle on right ventricular function measurements in preterm infants with a

Colm R Breatnach1, Orla Franklin2, Adam T James1

  • 1Department of Neonatology, The Rotunda Hospital, Dublin, Ireland.

Archives of Disease in Childhood. Fetal and Neonatal Edition
|February 25, 2017
PubMed

Insights

A hyperdynamic left ventricle (LV) in premature infants with a patent ductus arteriosus (PDA) affects right ventricular (RV) function measurements. This study found that while RV displacement and velocity measures were unchanged, RV strain and area change were reduced in infants with PDA.

Area of Science:

  • Neonatal cardiology
  • Pediatric echocardiography
  • Cardiovascular physiology

Background:

  • Right ventricular (RV) function is crucial in premature infants, assessed via basal longitudinal strain (RV BLS), systolic tissue Doppler velocity (RV s'), tricuspid annular plane systolic excursion (TAPSE), and fractional area change (FAC).
  • A hyperdynamic left ventricle (LV) may confound RV displacement (TAPSE) and velocity (RV s') measurements, but not relative strain (RV BLS) or area (FAC) changes.
  • Investigating this hypothesis in preterm infants with a patent ductus arteriosus (PDA) is essential for accurate functional assessment.

Purpose of the Study:

  • To explore the influence of a hyperdynamic left ventricle (LV) on various right ventricular (RV) functional parameters in preterm infants with a patent ductus arteriosus (PDA).
  • To determine if specific RV measures are more susceptible to LV effects in this vulnerable population.

Main Methods:

  • Echocardiographic measurements of LV and RV function (LV EF, RV BLS, RV s', TAPSE, FAC) were performed on preterm infants (<29 weeks) on days 1, 2, and 5-7.
  • Infants were grouped based on the presence or absence of a PDA by days 5-7.
  • Two-way repeated measures ANOVA was used to compare LV and RV function between groups.

Main Results:

  • Of 121 infants enrolled, 83 (69%) had a persistent PDA by days 5-7, exhibiting hyperdynamic LV function.
  • No significant differences in RV s' or TAPSE were observed between infants with and without PDA.
  • Infants with PDA showed significantly lower RV FAC and RV BLS compared to those without PDA.

Conclusions:

  • The hyperdynamic left ventricle associated with PDA in preterm infants impacts RV fractional area change and basal longitudinal strain.
  • These findings highlight the need to consider LV influence when interpreting RV functional parameters, particularly FAC and BLS, in preterm neonates with PDA.
  • Accurate RV assessment in neonates requires accounting for the complex interplay between LV and RV function.
Abstract

Keywords:
LV functionPatent Ductus ArteriosusPreterm InfantsRV function

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