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Predictive value of right ventricular functional indices for bronchopulmonary dysplasia in preterm infants: A
Enyu Wan1,2, Qian Liu1,2, Yuanxia He2
1Department of Pediatrics, Affiliated Hospital of North Sichuan Medical College, Nanchong, Sichuan, China.
Insights
Echocardiographic measures like TAPSE, MPI, FAC, PAAT, and PAAT/RVET can predict bronchopulmonary dysplasia (BPD) in preterm infants. These right-sided cardiac performance indicators aid in identifying neonates at risk for BPD.
Area of Science:
- Neonatal Cardiology
- Pediatric Pulmonology
- Echocardiography
Background:
- Bronchopulmonary dysplasia (BPD) is a significant complication in premature neonates.
- Early identification of neonates at risk for BPD is crucial for timely intervention.
- Echocardiographic assessment of right-sided cardiac function may offer predictive insights.
Purpose of the Study:
- To determine if echocardiographic measures of right-sided cardiac performance can identify premature neonates at risk of developing BPD.
- To systematically review and meta-analyze existing evidence on this topic.
Main Methods:
- Systematic literature search of four major databases (PubMed, Embase, Cochrane Library, Web of Science) through April 2025.
- Inclusion of twelve studies involving 1316 preterm infants.
- Meta-analysis of echocardiographic parameters including TAPSE, MPI, FAC, PAAT, and PAAT/RVET.
Main Results:
- Tricuspid annular plane systolic excursion (TAPSE), myocardial performance index (MPI), fractional area change (FAC), pulmonary artery acceleration time (PAAT), and PAAT/RVET were found to be predictive of BPD.
- Predictive performance varied by postmenstrual age (PMA) and birth weight.
- Sensitivity analyses confirmed the stability of the pooled estimates.
Conclusions:
- Echocardiographic markers of right-sided cardiac performance, including TAPSE, MPI, FAC, PAAT, and PAAT/RVET, possess predictive value for BPD in preterm infants.
- These echocardiographic findings can assist in risk stratification for BPD development.
- Further research may refine the use of these measures in clinical practice.
Background:
To comprehensively determine whether echocardiographic measures of right-sided cardiac performance can identify premature neonates at risk of developing bronchopulmonary dysplasia.
Methods:
We systematically queried 4 electronic databases - PubMed, Embase, the Cochrane Library, and Web of Science - from their respective launch dates through April 2025 to retrieve eligible studies examining whether echocardiographic markers of right-sided cardiac performance could anticipate bronchopulmonary dysplasia in premature neonates. Study rigor was evaluated with the Newcastle-Ottawa Scale, while the review was designed and reported in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidance and the Cochrane Handbook. Pooled effect estimates were calculated in RevMan 5.3, whereas sensitivity analyses and Egger regression test were performed with Stata/SE 15.1.
Results:
Twelve studies were incorporated, involving 1316 preterm infants, with 414 of them diagnosed with bronchopulmonary dysplasia (BPD). Meta-analysis indicated that tricuspid annular plane systolic excursion (TAPSE) (weighted mean difference [WMD] = -0.08, 95% confidence interval [CI] -0.12 to -0.04, P = .0002), myocardial performance index (MPI) (WMD = 0.05, 95% CI 0.02-0.08, P = .004), fractional area change (FAC) (WMD = -3.51, 95% CI -6.68 to -0.33, P = .03), pulmonary artery acceleration time (PAAT) (WMD = -6.54, 95% CI -10.71 to -2.37, P = .002), and PAAT to right ventricular ejection time ratio (PAAT/RVET) (WMD = -0.04, 95% CI -0.07 to -0.01, P = .005) can aid BPD prediction. Subgroup analyses showed that measurements obtained before 36 weeks' postmenstrual age (PMA) had better predictive performance for TAPSE, MPI, and FAC than measurements obtained at 36 weeks' PMA. PAAT/RVET remained predictive of BPD both before 36 weeks' PMA and at 36 weeks' PMA. Among infants with birth weight ≥1000 g, MPI demonstrated better predictive performance for BPD. Sensitivity analyses (leave-one-out) showed that exclusion of individual studies had no meaningful effect on the summary estimates, supporting the stability of the results.
Conclusion:
TAPSE, MPI, FAC, PAAT, and PAAT/RVET have predictive value for BPD in preterm infants.
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