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Echocardiography algorithms to assess high left atrial pressure and grade diastolic function in preterm infants
Koert de Waal1, Nilkant Phad1, Edward Crendal1,2
1Department of Neonatology, John Hunter Children's Hospital Department of Neonatology and University of Newcastle, Newcastle NSW, Australia.
Insights
Assessing diastolic function in preterm infants is crucial. Adding left atrial strain to echocardiography significantly improves the detection of high left atrial pressure (LAP).
Area of Science:
- Neonatal cardiology
- Pediatric echocardiography
- Cardiovascular physiology
Background:
- Left ventricular (LV) diastolic function is determined by relaxation, restoring forces, myocardial stiffness, and atrial function.
- Assessing diastolic function in preterm infants is essential for understanding their cardiovascular health.
- Conventional echocardiography and speckle tracking imaging offer advanced methods for this assessment.
Purpose of the Study:
- To comprehensively assess diastolic function in preterm infants.
- To evaluate the diagnostic accuracy of various algorithms in detecting high left atrial pressure (LAP).
- To determine the role of left atrial strain in improving diagnostic sensitivity.
Main Methods:
- Echocardiograms were performed on preterm infants one week after birth.
- Diastolic reference values were established from stable preterm infants.
- Algorithms incorporating EA ratio and left atrial strain were used to grade diastolic function and detect high LAP.
Main Results:
- Diastolic dysfunction was observed in preterm infants, with impaired relaxation, LV stiffness, and high LAP found in 8%, 7%, and 14% respectively.
- Patent ductus arteriosus was identified as a contributing factor to high LAP and LV stiffness.
- Incorporating left atrial strain into the 2016 American Society of Echocardiography algorithm improved diagnostic accuracy from 90% to 96% and sensitivity from 40% to 90% for detecting high LAP.
Conclusions:
- A multi-parameter approach using echocardiography can effectively identify various grades of diastolic dysfunction in preterm infants.
- Left atrial strain significantly enhances the sensitivity of detecting high LAP in this population.
- These findings support the use of advanced echocardiographic techniques for improved neonatal cardiac assessment.
Background:
Relaxation, restoring forces, myocardial stiffness and atrial function determine left ventricular (LV) diastolic function. This study aims to provide a comprehensive assessment of diastolic function in preterm infants using conventional echocardiography and speckle tracking imaging and determine the diagnostic accuracy of various algorithms to detect high left atrial pressure (LAP).
Methods:
Preterm infants received an echocardiogram 1 week after birth and diastolic reference values were derived from the outer percentiles of stable preterm infants. Impaired relaxation, LV stiffness and high LAP were defined by using algorithms where at least half of the parameters were outside the normal range. Diastolic function was graded using the 2016 American Society of Echocardiography algorithm and expanded with the EA ratio and left atrial strain. The diagnostic accuracy of various algorithms to detect high LAP was determined with sensitivity analysis.
Results:
We studied 146 infants (59 stable) with a mean of 27(1) weeks gestation. Impaired relaxation, LV stiffness and high LAP were found in 8%, 7%, and 14% of infants. The patent ductus arteriosus was a contributing factor to high LAP and LV stiffness, not impaired relaxation. Diagnostic accuracy improved from 90% to 96% and sensitivity from 40% to 90% by adding left atrial strain to the 2016 algorithm.
Conclusion:
Various grades of diastolic dysfunction could be appreciated in preterm infants using a multi-parameter approach. Adding left atrial strain improved sensitivity to detect infants with high LAP.
