Yates Andrew R, Welty Stephen E, Gest Alfred L, Cua Clifford L
Department of Pediatrics, Ohio State University, and Columbus Children's Hospital Heart Center, Columbus, Ohio 43205, USA.
J Pediatr. 2008 Jun;152(6):766-70, 770.e1. doi: 10.1016/j.jpeds.2007.11.039. Epub 2008 Feb 1.
To determine whether tissue Doppler measurements provide sensitive measures of right ventricular function that correlate with the severity of bronchopulmonary dysplasia (BPD).
21 subjects (6 control subjects with no/mild BPD, 7 patients with moderate BPD, and 8 patients with severe BPD) underwent limited echocardiograms with standard M-mode, mitral and tricuspid inflow velocities, and tissue Doppler features measured. BPD severity was scored by using the NICHD/NHLBI/ORD workshop rating scale by physicians blinded to the echocardiogram results. Groups were compared by using 1-way analysis of variance with post-hoc testing and linear regression.
Patients with moderate BPD had a higher early Doppler inflow velocity to the early tissue Doppler velocity ratio (E/E' ratio; P = .03), corresponding to increased end diastolic pressure, compared with patients with no/mild BPD. Patients with severe BPD had a higher E/E' ratio (P = .004) than patients with no/mild BPD. Linear regression demonstrated a correlation between BPD category and right ventricle E/E' (P = .007, R(2) = 0.33) and left ventricular myocardial performance index (P = .02, R(2) = 0.28).
Increasing right ventricle E/E' ratio correlates with clinical severity of BPD. Abnormal left ventricular myocardial performance index was noted to correlate with the grade of BPD. Further longitudinal studies of tissue Doppler echocardiographic assessment of cardiac function in premature infants with BPD are needed.
确定组织多普勒测量是否能提供与支气管肺发育不良(BPD)严重程度相关的右心室功能敏感指标。
21名受试者(6名无/轻度BPD的对照受试者、7名中度BPD患者和8名重度BPD患者)接受了有限的超声心动图检查,测量标准M型、二尖瓣和三尖瓣流入速度以及组织多普勒特征。由对超声心动图结果不知情的医生使用NICHD/NHLBI/ORD研讨会评分量表对BPD严重程度进行评分。通过单向方差分析及事后检验和线性回归对各组进行比较。
与无/轻度BPD的患者相比,中度BPD患者的早期多普勒流入速度与早期组织多普勒速度之比(E/E'比值;P = .03)更高,这与舒张末期压力升高相对应。重度BPD患者的E/E'比值高于无/轻度BPD的患者(P = .004)。线性回归显示BPD类别与右心室E/E'(P = .007,R(2)=0.33)和左心室心肌性能指数(P = .02,R(2)=0.28)之间存在相关性。
右心室E/E'比值升高与BPD的临床严重程度相关。注意到左心室心肌性能指数异常与BPD分级相关。需要对患有BPD的早产儿进行组织多普勒超声心动图评估心脏功能的进一步纵向研究。