Aggarwal Sanjeev, Agarwal Prashant, Natarajan Girija
Department of Pediatrics, Wayne State University, Children's Hospital of Michigan, Detroit, MI, USA.
J Perinatol. 2019 Dec;39(12):1656-1662. doi: 10.1038/s41372-019-0442-6. Epub 2019 Aug 30.
Among neonates undergoing whole body cooling for hypoxic-ischemic encephalopathy (HIE), to compare ventricular function in the presence and absence of pulmonary hypertension (PPHN) needing inhaled nitric oxide (iNO)/ECMO.
This retrospective study included infants with HIE who underwent cooling. ECHO (<24 h age) measures, RV fractional area change (FAC), RV Tricuspid annular plane systolic excursion (TAPSE), myocardial performance indices (MPI), and the RV systolic to diastolic duration (S/D) ratio were evaluated.
The iNO/ECMO group (n = 26) had lower TAPSE and RV FAC and higher RV MPI and S/D, compared with controls (n = 39). Area under the curve was highest for RV S/D, with fair sensitivity (95% CI) [76.9 (56.3-91%)] and negative predictive value [78.6 (63.3-88.6%)] for subsequent iNO/ECMO at cutoff >1.45.
Infants with HIE undergoing cooling who progressed to iNO/ECMO for PPHN had RV dysfunction on early ECHO; S/D had the best predictive performance. RV S/D may be a useful early marker of PPHN in HIE.
在因缺氧缺血性脑病（HIE）接受全身降温治疗的新生儿中，比较存在和不存在需要吸入一氧化氮（iNO）/体外膜肺氧合（ECMO）的肺动脉高压（PPHN）时的心室功能。
这项回顾性研究纳入了接受降温治疗的HIE婴儿。评估了超声心动图（<24小时龄）测量值、右心室面积变化分数（FAC）、右心室三尖瓣环平面收缩期位移（TAPSE）、心肌性能指数（MPI）以及右心室收缩期与舒张期持续时间（S/D）比值。
与对照组（n = 39）相比，iNO/ECMO组（n = 26）的TAPSE和右心室FAC较低，右心室MPI和S/D较高。右心室S/D的曲线下面积最高，在临界值>1.45时，对随后需要iNO/ECMO具有良好的敏感性（95%CI）[76.9（56.3 - 91%）]和阴性预测值[78.6（63.3 - 88.6%）]。
因HIE接受降温治疗且因PPHN进展为iNO/ECMO的婴儿在早期超声心动图检查时存在右心室功能障碍；S/D具有最佳预测性能。右心室S/D可能是HIE中PPHN的一个有用的早期标志物。
