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Published on: January 27, 2023
Longitudinal echocardiographic parameters for evaluation of pulmonary hypertension in preterm infants with very low
Kwannapas Saengsin1, Varangthip Khuwuthayakorn2, Yupada Prongprot1
1Division of Cardiology, Department of Pediatrics, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand.
Insights
Left ventricular eccentric index and right ventricular isovolumic systolic velocity are feasible echocardiographic parameters for screening and monitoring pulmonary hypertension in preterm infants. Serial measurements may predict late-onset pulmonary hypertension and detect right ventricular dysfunction early.
Area of Science:
- Neonatal Medicine
- Pediatric Cardiology
- Medical Imaging
Background:
- Echocardiography is crucial for evaluating pulmonary hypertension (PH) in preterm infants.
- Identifying reliable quantitative parameters for PH screening and monitoring is essential.
Purpose of the Study:
- To determine feasible quantitative echocardiographic parameters for screening and monitoring PH in preterm infants.
- To assess the predictive value of these parameters for late-onset PH and right ventricular dysfunction.
Main Methods:
- Secondary analysis of a prospective cohort study (August 2019-September 2020).
- Serial echocardiography at 7, 28 days, and 36 weeks postmenstrual age.
- Comparison of infants with and without PH at 36 weeks; trend analysis using multi-level Gaussian regression.
Main Results:
- Left ventricular eccentric index (LVEI) was obtainable in all infants; tricuspid jet velocity in 44.1%.
- LVEI correlated well with tricuspid regurgitation jet velocity (r=0.77, P<0.001).
- Serial LVEI showed a significantly different trend in the PH group (P for interaction=0.007); RV systolic function and isovolumic velocity also differed.
Conclusions:
- Left ventricular eccentric index and right ventricular isovolumic systolic velocity are feasible for PH assessment in preterm infants.
- Serial measurements may aid in predicting late PH and early detection of right ventricular dysfunction.
Background:
Echocardiography is essential for the evaluation of pulmonary hypertension. We determined the feasible quantitative parameter for screening and monitoring pulmonary hypertension in preterm infants.
Methods:
This secondary analysis of a prospective cohort single-centre study was conducted between August 2019 and September 2020. Serial echocardiography was performed 7 and 28 days after birth and at 36 weeks postmenstrual age. The data of infants who developed pulmonary hypertension at 36 weeks postmenstrual age were compared with those without pulmonary hypertension. We also modelled the parameters' trend and performed an interaction test using multi-level Gaussian regression.
Results:
Out of 30 infants enrolled in the study, 79 echocardiograms were analysed. Left ventricular eccentric index was obtainable in all infants, while tricuspid jet velocity was measurable in 44.1%. Left ventricular eccentric index correlated well with tricuspid regurgitation jet velocity (r = 0.77, P < 0.001). Six infants were diagnosed with newly developed or persistent pulmonary hypertension at 36 weeks postmenstrual age. Serial left ventricular eccentric index showed a significantly different increasing trend in the pulmonary hypertension group (change per day: +0.004; P = 0.090) from the decreasing trend among a non-pulmonary hypertension group (change per day: -0.001; P = 0.041) (P for interaction = 0.007). Right ventricular systolic function and right ventricular isovolumic systolic velocity revealed a reducing trend in the pulmonary hypertension group, which was different from the improving trend in non-pulmonary hypertension infants. Infants with low current weight, low postmenstrual age, and requiring high-flow oxygen therapy at day 28 of life trended to increase the risk of late pulmonary hypertension.
Conclusion:
Left ventricular eccentric index and right ventricular isovolumic systolic velocity were feasible for assessing pulmonary hypertension and should be incorporated into pulmonary hypertension evaluation. Serial left ventricular eccentric index and right ventricular isovolumic systolic velocity may help predict late pulmonary hypertension and early detection of right ventricular dysfunction.
