Sullivan Rachel T, Tandel Megha D, Bhombal Shazia, Adamson Gregory T, Boothroyd Derek B, Tracy Michael, Moy Amanda, Hopper Rachel K
Division of Pediatric Cardiology, Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, United States.
Quantitative Sciences Unit, Department of Medicine, School of Medicine, Stanford University, Palo Alto, CA, United States.
Front Pediatr. 2022 Sep 20;10:1012136. doi: 10.3389/fped.2022.1012136. eCollection 2022.
Left atrial hypertension (LAH) may contribute to pulmonary hypertension (PH) in premature infants with bronchopulmonary dysplasia (BPD). Primary causes of LAH in infants with BPD include left ventricular diastolic dysfunction or hemodynamically significant left to right shunt. The incidence of LAH, which is definitively diagnosed by cardiac catheterization, and its contribution to PH is unknown in patients with BPD-PH. We report the prevalence of LAH in an institutional cohort with BPD-PH with careful examination of hemodynamic contributors and impact on patient outcomes. This single-center, retrospective cohort study examined children <2 years of age with BPD-PH who underwent cardiac catheterization at Lucile Packard Children's Hospital Stanford. Patients with unrepaired simple shunt congenital heart disease (CHD) and pulmonary vein stenosis (only 1 or 2 vessel disease) were included. Patients with complex CHD were excluded. From April 2010 to December 2021, 34 patients with BPD-PH underwent cardiac catheterization. We define LAH as pulmonary capillary wedge pressure (PCWP) or left atrial pressure (LAP) of at least 10 mmHg. In this cohort, median PCWP was 8 mmHg, with LAH present in 32% ( = 11) of the total cohort. A majority (88%, = 30) of the cohort had severe BPD. Most patients had some form of underlying CHD and/or pulmonary vein stenosis: 62% ( = 21) with an atrial septal defect or patent foramen ovale, 62% ( = 21) with patent ductus arteriosus, 12% ( = 4) with ventricular septal defect, and 12% ( = 4) with pulmonary vein stenosis. Using an unadjusted logistic regression model, baseline requirement for positive pressure ventilation at time of cardiac catheterization was associated with increased risk for LAH (odds ratio 8.44, 95% CI 1.46-48.85, = 0.02). Small for gestational age birthweight, sildenafil use, and CHD were not associated with increased risk for LAH. LAH was associated with increased risk for the composite outcome of tracheostomy and/or death, with a hazard ratio of 6.32 (95% CI 1.72, 22.96; = 0.005). While the etiology of BPD-PH is multifactorial, LAH is associated with PH in some cases and may play a role in clinical management and patient outcomes.
左心房高压（LAH）可能导致患有支气管肺发育不良（BPD）的早产儿发生肺动脉高压（PH）。BPD患儿LAH的主要原因包括左心室舒张功能障碍或具有血流动力学意义的左向右分流。经心导管检查确诊的LAH发生率及其对PH的影响在BPD-PH患者中尚不清楚。我们报告了在一个机构队列中BPD-PH患者LAH的患病率，并仔细检查了血流动力学因素及其对患者预后的影响。这项单中心回顾性队列研究检查了在斯坦福大学露西尔·帕卡德儿童医院接受心导管检查的2岁以下BPD-PH儿童。纳入未修复的单纯分流型先天性心脏病（CHD）和肺静脉狭窄（仅1或2支血管病变）患者。排除复杂CHD患者。2010年4月至2021年12月，34例BPD-PH患者接受了心导管检查。我们将LAH定义为肺毛细血管楔压（PCWP）或左心房压力（LAP）至少10 mmHg。在该队列中，PCWP中位数为8 mmHg，整个队列中32%（n = 11）存在LAH。队列中的大多数（88%，n = 30）患有重度BPD。大多数患者有某种形式的潜在CHD和/或肺静脉狭窄：62%（n = 21）患有房间隔缺损或卵圆孔未闭，62%（n = 21）患有动脉导管未闭，12%（n = 4）患有室间隔缺损，12%（n = 4）患有肺静脉狭窄。使用未调整的逻辑回归模型，心导管检查时正压通气的基线需求与LAH风险增加相关（比值比8.44，95%可信区间1.46 - 48.85，P = 0.02）。小于胎龄出生体重、使用西地那非和CHD与LAH风险增加无关。LAH与气管造口术和/或死亡的复合结局风险增加相关，危险比为6.32（95%可信区间1.72，22.96；P = 0.005）。虽然BPD-PH的病因是多因素的，但LAH在某些情况下与PH相关，可能在临床管理和患者预后中起作用。
