Myocardial strain on admission predicts disease severity in infants hospitalized for bronchiolitis
Anna Claudia Massolo1, Giulia Vanina Cantone2, Anna Maria Caterina Musolino3
1Department of Medical and Surgical Neonatology, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy.
Insights
Infants with bronchiolitis often experience impaired cardiac function, specifically in the left and right ventricles. This myocardial impairment is linked to more severe disease and longer hospital stays.
Area of Science:
- Pediatric Cardiology
- Infectious Diseases
- Neonatal Medicine
Background:
- Bronchiolitis is a common viral respiratory infection in infants.
- Cardiac involvement in bronchiolitis is not well understood.
- Assessing cardiac function may predict disease severity.
Purpose of the Study:
- To evaluate cardiac function in infants diagnosed with bronchiolitis.
- To determine the association between cardiac function and disease severity.
- To explore the relationship between cardiac function and clinical outcomes.
Main Methods:
- Prospective cohort study of infants with suspected bronchiolitis.
- Echocardiography assessed left and right ventricular systolic and diastolic function using longitudinal strain.
- Viral detection, pulmonary artery pressure estimation, and outcome data (respiratory support, length of stay) were collected.
Main Results:
- Infants with bronchiolitis exhibited significantly reduced left and right ventricular longitudinal strain compared to healthy controls.
- 32% of infants showed biventricular impairment, and 32% had isolated left ventricular impairment.
- Biventricular impairment correlated with increased length of stay and need for higher levels of respiratory support.
Conclusions:
- Bronchiolitis is associated with myocardial impairment in infants.
- Impaired cardiac function in bronchiolitis is linked to increased disease severity and poorer outcomes.
Objective:
To assess cardiac function in infants with bronchiolitis and the association with disease severity and outcomes.
Working Hypothesis:
Cardiac function may be impaired in bronchiolitis and represent an early predictor of disease severity.
Study Design:
A prospective cohort study.
Patient Selection:
Infants with suspected bronchiolitis were included.
Methodology:
All cases received antigen detection and viral genome detection from nasal lavage or swabs and echocardiography within 24 hours from admission. Systolic and diastolic function in left ventricle (LV) and right ventricle (RV) were assessed using longitudinal strain (LS), a measure of myocardial deformation. Pulmonary artery pressures were estimated using tricuspid regurgitation jet (TR), when present, and end-systolic eccentricity index (EI ES). Main outcomes (duration of respiratory support, length of stay [LOS], and type of respiratory support) were collected. Data were compared to normative existing data, and a group of healthy infants, matched in age.
Results:
Twenty-eight infants with bronchiolitis and 10 healthy comparators were included. Cases with bronchiolitis showed significantly lower values of RV LS and LV LS compared to healthy comparators (LV: p0.04 and RV: P < .001). Ten infants (36%) had a normal biventricular function, nine (32%) had LV impairment, and nine (32%) had a biventricular impairment. No significant differences were found in TR and EI ES. Infants with biventricular impairment demonstrated a significant increase in LOS (p0.04) and higher levels of respiratory support compared to the healthy comparators (P = .03).
Conclusions:
Bronchiolitis is associated with myocardial impairment. Cardiac function is related to disease severity and outcome.
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