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Updated: Aug 13, 2026
Murine Fetal Echocardiography
Published on: February 15, 2013
Serial measures of cardiac performance using tissue Doppler imaging velocity in preterm infants <29weeks gestations
Colm R Breatnach1, Afif El-Khuffash2, Adam James1
1Department of Neonatology, The Rotunda Hospital, Dublin, Ireland.
Insights
Tissue Doppler imaging (TDI) shows increasing myocardial performance in preterm infants over time. Inotropes are linked to lower diastolic velocities, while a significant patent ductus arteriosus (hsPDA) elevates diastolic TDI velocities in these infants.
Area of Science:
- Neonatal cardiology
- Pediatric echocardiography
- Cardiovascular physiology in preterm infants
Background:
- Tissue Doppler imaging (TDI) is a valuable tool for assessing myocardial function.
- Understanding myocardial performance in extremely preterm infants is crucial for clinical management.
- Serial assessment of TDI velocities can reveal developmental trends and the impact of interventions.
Purpose of the Study:
- To track serial changes in TDI velocities in preterm infants born before 29 weeks gestation.
- To evaluate the influence of inotropic support on myocardial performance.
- To assess the effect of a hemodynamically significant patent ductus arteriosus (hsPDA) on TDI parameters.
Main Methods:
- Prospective observational study of preterm infants (<29 weeks gestation).
- Echocardiography performed at multiple time points (days 1, 2, 5-7, and 36 weeks corrected age or discharge).
- Systolic (s`) and diastolic (e`, a`) velocities measured at mitral and tricuspid annuli and basal septum, excluding infants with hsPDA or inotropes in the reference cohort.
Main Results:
- Reference cohort showed increasing LV s`, Septal s`, and RV s` from day 1 to 36 weeks (p<0.05).
- Infants receiving inotropes had lower LV e`, Septal e`, and RV a` on day 1 (p<0.05).
- Infants with hsPDA exhibited higher LV and Septal e` and higher LV E/e` (p<0.05).
Conclusions:
- Extremely preterm infants demonstrate progressive improvement in TDI velocities from birth to 36 weeks corrected age.
- A hsPDA is associated with elevated diastolic TDI velocities.
- Early inotropic support correlates with reduced diastolic myocardial velocities in preterm neonates.
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.
