James Adam T, Corcoran J D, Breatnach Colm R, Franklin Orla, Mertens Luc, El-Khuffash Afif
Department of Neonatology, The Rotunda Hospital, Dublin, Ireland.
Neonatology. 2016;109(1):69-75. doi: 10.1159/000440940. Epub 2015 Nov 20.
There is a paucity of longitudinal data on left ventricular (LV) and right ventricular (RV) function in preterm infants of less than 29 weeks' gestation.
The aim of this study was to describe changes in tissue Doppler-derived basal longitudinal strain (BLS) and systolic (SRs), early (SRe) and late (SRa) diastolic strain rates in extremely premature infants from birth to 36 weeks postmenstrual age (PMA).
Echocardiographic assessments were carried out on days 1, 2, 5-7 and at 36 weeks PMA. We assessed the following associations: correlation with systemic vascular resistance (SVR) on day 1, influence of a patent ductus arteriosus (PDA) during days 5-7, and the effect of chronic lung disease (CLD).
In total, 105 infants with a median gestation of 27.1 weeks (IQR 26.0-28.1) and a birthweight of 965 g (IQR 785-1,153) were included. There was an increase in most of the measurements across the four time points. On day 1, there was a weak negative correlation between SVR and LV BLS (r = -0.3, p = 0.01), SVR and septal BLS (r = -0.4, p < 0.001) and SVR and LV SRe (r = -0.4, p = 0.005). On days 5-7, infants with a PDA >1.5 mm had higher LV BLS [-13.0 (2.4) vs. -11.9 (1.9)%, p = 0.03]. At 36 weeks, infants with CLD (n = 28/47) had lower RV BLS [-26.4 (5.0) vs. -30.7 (5.5)%, p = 0.01] and lower RV SRa [4.2 (1.3) vs. 5.3 (1.9) s-1, p = 0.04].
Myocardial function undergoes important longitudinal changes in preterm infants. Left heart strain measurements appear to be weakly influenced by changes in preload and afterload. CLD appears to leave a negative impact on RV function.
关于孕龄小于29周的早产儿左心室（LV）和右心室（RV）功能的纵向数据较少。
本研究旨在描述极早产儿从出生到月经后年龄（PMA）36周期间组织多普勒衍生的基底纵向应变（BLS）以及收缩期（SRs）、早期（SRe）和晚期（SRa）舒张期应变率的变化。
在出生第1天、第2天、第5 - 7天以及PMA 36周时进行超声心动图评估。我们评估了以下关联：出生第1天与体循环血管阻力（SVR）的相关性、第5 - 7天动脉导管未闭（PDA）的影响以及慢性肺病（CLD）的影响。
总共纳入了105例婴儿，中位孕龄为27.1周（四分位间距26.0 - 28.1），出生体重为965 g（四分位间距785 - 1153）。在四个时间点的大多数测量值都有所增加。出生第1天，SVR与LV BLS（r = -0.3，p = 0.01）、SVR与室间隔BLS（r = -0.4，p < 0.001）以及SVR与LV SRe（r = -0.4，p = 0.005）之间存在弱负相关。在第5 - 7天，PDA >1.5 mm的婴儿LV BLS更高[-13.0（2.4）%对 -11.9（1.9）%，p = 0.03]。在36周时，患有CLD的婴儿（n = 28/47）RV BLS更低[-26.4（5.0）%对 -30.7（5.5）%，p = 0.01]，RV SRa更低[4.2（1.3）s⁻¹对5.3（1.9）s⁻¹，p = 0.04]。
早产儿的心肌功能经历重要的纵向变化。左心应变测量似乎受前负荷和后负荷变化的影响较弱。CLD似乎对RV功能有负面影响。
