Akiko Hirose1, Nee S Khoo1, Khalid Aziz2, Najlaa Al-Rajaa1, Jutta van den Boom1, Winnie Savard1, Paul Brooks1, Lisa K Hornberger3. 1. Fetal & Neonatal Cardiology Program, Department of Pediatrics, Division of Cardiology, University of Alberta, Edmonton, Alberta, Canada. 2. Department of Pediatrics, Division of Neonatology, University of Alberta, Edmonton, Alberta, Canada. 3. Fetal & Neonatal Cardiology Program, Department of Pediatrics, Division of Cardiology, University of Alberta, Edmonton, Alberta, Canada; Department of Obstetrics and Gynecology, Women's & Children's Health Research Institute, Mazankowski Alberta Heart Institute, Cardiovascular Research Centre, University of Alberta, Edmonton, Alberta, Canada. Electronic address: lisa.hornberger@albertahealthservices.ca.
Abstract
BACKGROUND: The aim of this study was to evaluate left ventricular function in preterm infants from 28 days to near term using echocardiography. METHODS: Thirty clinically stable preterm infants delivered at <30 weeks' gestational age were prospectively enrolled. At 28 days, conventional, tissue Doppler, and speckle-tracking echocardiography evaluations of left ventricular function were performed, with comparison made to findings in 30 healthy term infants of similar postnatal age. Sixteen preterm infants underwent repeat examinations near term. RESULTS: Compared with controls, preterm infants at 28 days had decreased peak mitral valve (MV) E-wave velocities (P < .01), E/A ratios (P < .0001), annular e' velocities (P < .0001), and e'/a' ratios (P < .0001); increased MV E/e' ratios (P < .01); and lower basal circumferential early diastolic and higher late diastolic strain rates. No significant differences were found in fractional shortening, ejection fraction, and longitudinal or circumferential strain and strain rate between preterm infants and controls. Although preterm infants at 28 days had higher heart rates compared with controls (161 ± 15 vs 142 ± 16 beats/min), no significant correlations existed between heart rate and MV E, E/A ratio, e', e'/a' ratio, and E/e' ratio. Near term, the differences in diastolic function persisted, including decreased MV e'/a' ratio (P < .05), increased E/e' ratio (P < .01), and increased late diastolic strain rate. CONCLUSIONS: Clinically stable preterm infants have normal left ventricular systolic function but altered diastolic function, with greater dependence on atrial contraction, the latter of which persists despite nearing term. These findings may be relevant to the management of preterm infants and may relate to the longer term myocardial dysfunction observed in affected adults.
BACKGROUND: The aim of this study was to evaluate left ventricular function in preterm infants from 28 days to near term using echocardiography. METHODS: Thirty clinically stable preterm infants delivered at <30 weeks' gestational age were prospectively enrolled. At 28 days, conventional, tissue Doppler, and speckle-tracking echocardiography evaluations of left ventricular function were performed, with comparison made to findings in 30 healthy term infants of similar postnatal age. Sixteen preterm infants underwent repeat examinations near term. RESULTS: Compared with controls, preterm infants at 28 days had decreased peak mitral valve (MV) E-wave velocities (P < .01), E/A ratios (P < .0001), annular e' velocities (P < .0001), and e'/a' ratios (P < .0001); increased MV E/e' ratios (P < .01); and lower basal circumferential early diastolic and higher late diastolic strain rates. No significant differences were found in fractional shortening, ejection fraction, and longitudinal or circumferential strain and strain rate between preterm infants and controls. Although preterm infants at 28 days had higher heart rates compared with controls (161 ± 15 vs 142 ± 16 beats/min), no significant correlations existed between heart rate and MV E, E/A ratio, e', e'/a' ratio, and E/e' ratio. Near term, the differences in diastolic function persisted, including decreased MV e'/a' ratio (P < .05), increased E/e' ratio (P < .01), and increased late diastolic strain rate. CONCLUSIONS: Clinically stable preterm infants have normal left ventricular systolic function but altered diastolic function, with greater dependence on atrial contraction, the latter of which persists despite nearing term. These findings may be relevant to the management of preterm infants and may relate to the longer term myocardial dysfunction observed in affected adults.
Authors: G Escourrou; L Renesme; E Zana; A Rideau; M O Marcoux; E Lopez; G Gascoin; P Kuhn; P Tourneux; I Guellec; C Flamant Journal: J Perinatol Date: 2017-05-04 Impact factor: 2.521
Authors: Philip T Levy; Afif El-Khuffash; Meghna D Patel; Colm R Breatnach; Adam T James; Aura A Sanchez; Cristina Abuchabe; Sarah R Rogal; Mark R Holland; Patrick J McNamara; Amish Jain; Orla Franklin; Luc Mertens; Aaron Hamvas; Gautam K Singh Journal: J Am Soc Echocardiogr Date: 2017-04-19 Impact factor: 5.251
Authors: Christina Y L Aye; Adam J Lewandowski; Pablo Lamata; Ross Upton; Esther Davis; Eric O Ohuma; Yvonne Kenworthy; Henry Boardman; Samuel Wopperer; Alice Packham; Satish Adwani; Kenny McCormick; Aris T Papageorghiou; Paul Leeson Journal: Pediatr Res Date: 2017-05-24 Impact factor: 3.756