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Left ventricular diastolic function influences right ventricular - Pulmonary vascular coupling in premature infants

Neidin Bussmann1, Afif El-Khuffash2, Colm R Breatnach3

  • 1Department of Neonatology, The Rotunda Hospital, Dublin, Ireland; National Children's Research Centre, Our Lady's Children's Hospital Crumlin, Dublin, Ireland.

Early Human Development
|November 23, 2018
PubMed

Insights

Reduced left ventricular diastolic function is linked to right ventricle-pulmonary vasculature coupling in premature infants. This study highlights ventricular interdependence and the potential of TAPSE/PAAT to assess right ventricle function.

Area of Science:

  • Cardiology
  • Neonatology
  • Pediatric Cardiology

Background:

  • Reduced left ventricular (LV) diastolic dysfunction can increase load on the right ventricle (RV), impacting RV-pulmonary vasculature (PV) coupling.
  • The RV-PV relationship is assessed using the tricuspid annular plane systolic excursion (TAPSE) to pulmonary artery acceleration time (PAAT) ratio.

Purpose of the Study:

  • To determine the association between LV diastolic function, measured by tissue Doppler imaging (TDI), and the TAPSE/PAAT ratio in premature infants.
  • To investigate ventricular interdependence in preterm neonates.

Main Methods:

  • A cohort of 162 premature infants (<29 weeks gestation) was studied.
  • TAPSE/PAAT, LV e', and a' waves were measured on day 1 post-birth.
  • Correlation and linear regression analyses were used to assess the relationship between LV diastolic indices and TAPSE/PAAT.

Main Results:

  • A significant positive correlation was found between LV e' and a' waves and TAPSE/PAAT (r=0.44, p<0.01).
  • This association remained significant after adjusting for confounders.
  • Infants in the lowest quartile of LV a' values exhibited lower TAPSE (4.2±1.2 mm vs. 5.1±1.1 mm, p<0.01) without significant difference in PAAT (41±8 ms vs. 41±10 ms, p=0.97).

Conclusions:

  • A direct correlation exists between LV diastolic function and RV-PV coupling in the early postnatal period of premature infants.
  • Ventricular interdependence is crucial in this population.
  • TAPSE/PAAT may serve as a valuable index for assessing RV reserve in preterm infants under stress.
Abstract

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