Neonatal Intensive Care Unit, Fondazione MBBM-ASST-Monza, Monza, Italy.
Pediatric Department, School of Medicine, Hashemite University, Zarqa, Jordan.
Pediatr Res. 2023 Mar;93(4):1010-1016. doi: 10.1038/s41390-022-02216-3. Epub 2022 Jul 27.
The role of left ventricular (LV) diastolic pressure in the pathophysiology of bronchopulmonary dysplasia (BPD) is unclear. We evaluated the trajectory of echocardiographic parameters of LV diastolic function and the association with respiratory outcomes in preterm infants.
We retrospectively analysed measurements of LV diastolic function (E, e', A, Ee' and E/A ratios) in infants below 32 weeks' gestation (GA). We compared infants with and without BPD by two-way RM ANOVA. We considered Ee' ratio as a proxy of LV filling pressure and identified a cut-off value using ROC analysis. We divided infants using such threshold and compared respiratory outcomes between groups by Mann-Whitney or Chi-square tests.
We included 72 infants. Ee' ratio at 28 days was significantly associated with the duration of respiratory support (beta (std. error) = 5.32 (1.82), p = 0.005) and BPD (beta = 0.27 (0.10), p = 0.008). Infants with Ee' ratio > 12 at 28 days had longer respiratory support, oxygen requirement, and higher BPD rates than infants with Ee' ratio ≤ 12.
LV diastolic function associated with elevated LV filling pressure may contribute to the pathophysiology of BPD. Serial echocardiographic measurements could identify infants at risk of worse respiratory outcomes.
In very preterm infants, we assessed the trajectory of left ventricular diastolic function by serial echocardiographic evaluations and evaluated its association with respiratory outcomes. On average, infants who developed bronchopulmonary dysplasia had higher Ee' at 28 postnatal days and 36 weeks postmentrual age than infants who did not develop the disease. Infants with elevated Ee' at 28 postnatal days, suggestive of elevated left atrial pressure, required longer respiratory support.
左心室（LV）舒张压在支气管肺发育不良（BPD）的病理生理学中的作用尚不清楚。我们评估了早产儿 LV 舒张功能的超声心动图参数轨迹及其与呼吸结局的相关性。
我们回顾性分析了胎龄（GA）低于 32 周的婴儿的 LV 舒张功能（E、e'、A、Ee'和 E/A 比值）的测量值。我们通过双向重复测量方差分析比较了有和无 BPD 的婴儿。我们将 Ee'比值作为 LV 充盈压的替代指标，并使用 ROC 分析确定了截断值。我们根据该阈值将婴儿分组，并通过曼-惠特尼或卡方检验比较组间的呼吸结局。
我们纳入了 72 名婴儿。28 天时的 Ee'比值与呼吸支持的持续时间（β（标准误）=5.32（1.82），p=0.005）和 BPD（β=0.27（0.10），p=0.008）显著相关。28 天时 Ee'比值＞12 的婴儿的呼吸支持、氧需求和 BPD 发生率均高于 Ee'比值≤12 的婴儿。
与升高的 LV 充盈压相关的 LV 舒张功能可能有助于 BPD 的病理生理学。连续的超声心动图测量可以识别出呼吸结局较差的风险婴儿。
在极早产儿中，我们通过连续超声心动图评估评估了左心室舒张功能的轨迹，并评估了其与呼吸结局的关系。平均而言，患有支气管肺发育不良的婴儿在 28 天和 36 周校正胎龄时的 Ee'值高于未患该病的婴儿。28 天时 Ee'值升高的婴儿，提示左心房压升高，需要更长时间的呼吸支持。
