动脉导管未闭早产儿中高动力性左心室对右心室功能测量的影响。

The impact of a hyperdynamic left ventricle on right ventricular function measurements in preterm infants with a patent ductus arteriosus.

作者信息

Breatnach Colm R, Franklin Orla, James Adam T, McCallion Naomi, El-Khuffash Afif

机构信息

Department of Neonatology, The Rotunda Hospital, Dublin, Ireland.

Department of Cardiology, Our Lady's Children's Hospital, Crumlin, Dublin, Ireland.

出版信息

Arch Dis Child Fetal Neonatal Ed. 2017 Sep;102(5):F446-F450. doi: 10.1136/archdischild-2016-311189. Epub 2017 Feb 23.

DOI:10.1136/archdischild-2016-311189

PMID:28232519

Abstract

BACKGROUND AND AIMS

Right ventricular (RV) functional assessment in premature infants includes basal longitudinal strain (RV BLS), RV systolic tissue Doppler velocity (RV s'), tricuspid annular plane systolic excursion (TAPSE) and RV fractional area change (FAC). A hyperdynamic left ventricle (LV) may influence RV measures of displacement (TAPSE) and velocity (RV s') but not measures of relative change of length (RV BLS) or area (FAC). We aimed to explore this hypothesis in preterm infants with a patent ductus arteriosus (PDA).

METHODS

We measured LV function (ejection fraction (LV EF); left ventricular output) and RV function (RV BLS; RV s'; TAPSE; FAC) on days 1, 2 and 5-7 in infants <29 weeks. The cohort was divided based on PDA presence by days 5-7. LV and RV function measurements were compared between the groups using two-way analysis of variance with repeated measures.

RESULTS

121 infants with a mean (SD) gestation and birth weight of 26.8 (1.4) weeks and 968 (250) g were enrolled. By days 5-7, the PDA remained open in 83 (69%), with evidence of hyperdynamic LV function. There was no difference in RV s' (5.3 (0.9) vs 5.1 (1.0) cm/s, p=0.3) or TAPSE (6.2 (1.3) vs 6.1 (1.2) mm, p=0.7) between infants with and without a PDA, but infants in the PDA group had lower RV FAC (41 (8) vs 47 (10) %, p<0.01) and lower RV BLS (-24.2 (5.0) vs -26.2 (4.1) %, p=0.03).

CONCLUSIONS

LV influence on RV functional parameters must be taken into account when interpreting of RV function using those techniques.

摘要

背景与目的

早产儿右心室（RV）功能评估包括基底纵向应变（RV BLS）、右心室收缩期组织多普勒速度（RV s'）、三尖瓣环平面收缩期位移（TAPSE）和右心室面积变化分数（FAC）。高动力性左心室（LV）可能会影响右心室的位移测量值（TAPSE）和速度测量值（RV s'），但不会影响长度相对变化测量值（RV BLS）或面积测量值（FAC）。我们旨在对患有动脉导管未闭（PDA）的早产儿进行这一假设的探究。

方法

我们对孕周小于29周的婴儿在出生第1天、第2天以及第5 - 7天测量左心室功能（射血分数（LV EF）；左心室输出量）和右心室功能（RV BLS；RV s'；TAPSE；FAC）。根据出生第5 - 7天是否存在PDA对队列进行分组。使用重复测量的双向方差分析对两组间的左心室和右心室功能测量值进行比较。

结果

共纳入121例婴儿，平均（标准差）孕周和出生体重分别为26.8（1.4）周和968（250）g。到第5 - 7天，83例（69%）婴儿的PDA仍未闭合，存在高动力性左心室功能的证据。有PDA和无PDA的婴儿之间，RV s'（5.3（0.9）对5.1（1.0）cm/s，p = 0.3）或TAPSE（6.2（1.3）对6.1（1.2）mm，p = 0.7）没有差异，但PDA组婴儿的RV FAC较低（41（8）%对47（10）%，p < 0.01）且RV BLS较低（-24.2（5.0）%对-26.2（4.1）%，p = 0.03）。