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Published on: February 3, 2014
Echocardiography parameters used in identifying right ventricle dysfunction in preterm infants with early
Wisam Muhsen1,2, Eirik Nestaas1,3,4, Joanne Hosking5
1Faculty of Health, University of Plymouth, Plymouth, United Kingdom.
Insights
Bronchopulmonary Dysplasia (BPD) can impair right ventricular (RV) function in preterm infants within two weeks of birth. Echocardiography parameters, particularly RV Myocardial Performance Index (MPI), show promise in early detection, though optimal methods require further research.
Area of Science:
- Neonatal Cardiology
- Pediatric Pulmonology
- Echocardiography
Background:
- Bronchopulmonary Dysplasia (BPD) is a chronic lung disease in preterm infants.
- BPD can lead to significant hemodynamic alterations and right ventricular (RV) dysfunction.
- Early identification of RV dysfunction is crucial for managing BPD complications.
Purpose of the Study:
- To synthesize and map evidence on echocardiographic (echo) parameters for identifying RV dysfunction in preterm infants with early BPD.
- To determine the utility of various echo parameters within the first two weeks-after-birth (WAB) for assessing RV function in this population.
Main Methods:
- A comprehensive scoping review was conducted across multiple databases (Medline, CINAHL, PubMed, EMBASE, Scopus, etc.) and gray literature.
- Search strategy employed Boolean operators and Medical Subject Headings (MeSH).
- Included studies utilized echo parameters to examine RV function in preterm infants with early BPD within the first two WAB.
Main Results:
- Eight studies were included, revealing variations in echo scan timing, frequency, and parameters used.
- Significant differences in echo parameters between BPD and control infants were observed only in scans at the end of the first WAB.
- RV Myocardial Performance Index (MPI) measured by Pulsed-Wave Doppler showed promise, while Tissue-Doppler-Imaging yielded varied results; speckle tracking also showed inconsistent findings.
- Two studies incorporated blood tests, demonstrating significant differences between BPD-affected and control infants.
Conclusions:
- BPD adversely affects RV myocardial function, detectable within the first two WAB.
- Knowledge gaps persist regarding the optimal number, timing, and specific echo parameters for assessing RV function in early BPD.
- Further research is needed to establish standardized echocardiographic protocols for early BPD management.
Background:
Bronchopulmonary Dysplasia (BPD) is a chronic condition that affects preterm infants and is associated with long-term complications. Haemodynamic effects of BPD can lead to right ventricular (RV) dysfunction.
Objective:
To synthesise and map the evidence of echo parameters used in identifying RV dysfunction in the first two weeks-after-birth (WAB) of preterm infants with early BPD.
Information Sources:
This scoping review included the databases: Medline, CINAHL, PubMed, EMBASE, Scopus, ProQuest, Web of Science, Cochrane Library, JBI Evidence-Based Practise and Gray Literature.
Search Strategy:
The search utilised Boolean operators and descriptors registered in Medical Subject Headings.
Inclusion And Exclusion Criteria:
Included were studies utilising echo parameters to examine RV function in preterm infants with early BPD in the first two WAB.
Synthesis Of Results:
The results are presented as a map of the extracted findings in a tabular format with a narrative summary.
Results:
Eight studies were included. Differences were observed in the number and timing of echo scans performed in the first two WAB and the variations in the echo parameters used to compare preterm infants with and without early BPD. Only echo scans performed at the end of the first WAB, demonstrated significant differences in the echo parameters measurements between preterm infants with and without BPD. Studies using RV Myocardial Performance Index (MPI) to identify RV-dysfunction associated with early BPD demonstrated similar findings. The Pulsed-Wave Doppler technique identified differences in RV-MPI between preterm infants with and without BPD, while Tissue-Doppler-Imaging did not demonstrate similar results. Speckle tracking can measure strain (S) and strain rate (SR) and diagnose RV-dysfunction. However, the findings of studies that utilised speckle tracking varied. Finally, two of the included studies added blood tests to their diagnostic model of early BPD, which was able to demonstrate significant differences in blood test results between BPD-affected and control preterm infants.
Conclusion:
BPD could adversely affect the myocardium function of the RV; these negative influences can be captured in the first two WAB. However, there are still knowledge gaps regarding the appropriate number, timing and the most suitable echo parameters to assess RV function.
