Bussmann Neidin, Smith Aisling, Cappelleri Alessia, Levy Phillip T, McCallion Naomi, Franklin Orla, El-Khuffash Afif
Department of Neonatology, The Rotunda Hospital, Dublin, Ireland.
Division of Newborn Medicine, Boston Children's Hospital, Boston, MA, USA.
Echocardiography. 2019 Aug;36(8):1532-1539. doi: 10.1111/echo.14442. Epub 2019 Aug 5.
Speckle tracking echocardiography (STE) is a validated method to measure longitudinal deformation in premature infants, but there is a paucity of data on STE-derived circumferential and radial strain in this population. We assessed the feasibility and reproducibility of circumferential and radial deformation measurements in premature infants.
In a prospective study of 40 premature infants (<29 weeks of gestation at birth), STE-derived circumferential and radial strain, systolic strain rate (SRs), early diastolic strain rate (SRe), and late diastolic strain rate (SRa) were measured on day 2 and day 8. Intra- and inter-observer reproducibility analysis were performed using Bland-Altman analysis, coefficient of variation (COV), and intra-class correlation coefficient (ICC). The impact of a persistent patent ductus arteriosus (PDA) was analyzed.
Deformation analysis was feasible in 98% of the acquisitions. Circumferential parameters demonstrated excellent intra- and inter-observer reproducibility with an ICC between 0.89 and 0.99 (all P < 0.001) and a COV between 4% and 13%. Radial parameters demonstrated acceptable intra- and inter-observer reproducibility with an ICC between 0.73 and 0.96 (all P < 0.001) and a COV between 14% and 27%. Infants with a PDA on day 8 (n = 21, 53%) demonstrated higher radial strain, SRs and SRe. There were no differences in circumferential parameters with a PDA at either time point.
This study demonstrates clinical feasibility and reproducibility of circumferential and radial strain by STE in premature infants. A PDA elevates radial deformation measures, suggesting that the increased LV preload from a PDA may augment intrinsic contractility in the radial but not circumferential plane.
斑点追踪超声心动图（STE）是一种用于测量早产儿纵向变形的有效方法，但关于该人群中STE衍生的圆周应变和径向应变的数据较少。我们评估了早产儿圆周和径向变形测量的可行性和可重复性。
在一项对40例早产儿（出生时孕周<29周）的前瞻性研究中，在第2天和第8天测量STE衍生的圆周应变和径向应变、收缩期应变率（SRs）、舒张早期应变率（SRe）和舒张晚期应变率（SRa）。使用Bland-Altman分析、变异系数（COV）和组内相关系数（ICC）进行观察者内和观察者间的可重复性分析。分析持续性动脉导管未闭（PDA）的影响。
98%的采集可进行变形分析。圆周参数在观察者内和观察者间均显示出极好的可重复性，ICC在0.89至0.99之间（所有P<0.001），COV在4%至13%之间。径向参数在观察者内和观察者间显示出可接受的可重复性，ICC在0.73至0.96之间（所有P<0.001），COV在14%至27%之间。第8天患有PDA的婴儿（n=21，53%）表现出更高的径向应变、SRs和SRe。在两个时间点，患有PDA的婴儿在圆周参数上没有差异。
本研究证明了STE在早产儿中测量圆周应变和径向应变的临床可行性和可重复性。PDA会提高径向变形测量值，表明PDA增加的左心室前负荷可能增强径向而非圆周平面的固有收缩力。
