Sonaglioni Andrea, Nicolosi Gian Luigi, Braga Marta, Villa Maria Cristina, Migliori Claudio, Lombardo Michele
Division of Cardiology, MultiMedica IRCCS, Milan, Italy.
Division of Cardiology, Policlinico San Giorgio, Pordenone, Italy.
J Cardiovasc Echogr. 2022 Jul-Sep;32(3):137-144. doi: 10.4103/jcecho.jcecho_2_22. Epub 2022 Nov 16.
The present study was designed to investigate the possible influence of chest shape, noninvasively assessed by modified Haller index (MHI), on ventricular-arterial coupling (VAC) parameters in a population of term infants with pectus excavatum (PE).
Sixteen consecutive PE infants (MHI >2.5) and 44 infants with normal chest shape (MHI ≤2.5) were prospectively analyzed. All infants underwent evaluation by a neonatologist, transthoracic echocardiography, and MHI assessment (ratio of chest transverse diameter over the distance between sternum and spine) within 3 days of life. Arterial elastance index (EaI) was determined as end-systolic pressure (ESP)/stroke volume index, whereas end-systolic elastance index (EesI) was measured as ESP/left ventricular end-systolic volume index. Finally, VAC was derived by the Ea/Ees ratio.
At 2.1 ± 1 days after birth, compared to controls (MHI = 2.01 ± 0.2), PE infants (MHI = 2.76 ± 0.2) were diagnosed with significantly smaller size of all cardiac chambers. Biventricular systolic function, left ventricular filling pressures, and pulmonary hemodynamics were similar in both the groups of infants. Both EaI (4.4 ± 1.0 mmHg/ml/m vs. 3.4 ± 0.6 mmHg/ml/m, < 0.001) and EesI (15.1 ± 3.0 mmHg/ml/m vs. 12.7 ± 2.5 mmHg/ml/m, = 0.003) were significantly increased in PE infants than controls. The resultant VAC (0.30 ± 0.10 vs. 0.30 ± 0.08, > 0.99) was similar in both the groups of infants. Both EaI ( = 0.93) and EesI ( = 0.87) were linearly correlated with MHI in PE infants, but not in controls. On the other hand, no correlation was found between MHI and VAC in both the groups of infants.
Chest deformity strongly influences both Ea and Ees in PE infants, due to extrinsic cardiac compression, in the absence of any intrinsic cardiovascular dysfunction.
本研究旨在调查通过改良哈勒指数（MHI）无创评估的胸廓形状对一组患有漏斗胸（PE）的足月儿心室 - 动脉耦合（VAC）参数的可能影响。
对16例连续的PE婴儿（MHI>2.5）和44例胸廓形状正常的婴儿（MHI≤2.5）进行前瞻性分析。所有婴儿在出生后3天内由新生儿科医生进行评估、经胸超声心动图检查以及MHI评估（胸廓横径与胸骨和脊柱之间距离的比值）。动脉弹性指数（EaI）定义为收缩末期压力（ESP）/每搏量指数，而收缩末期弹性指数（EesI）测量为ESP/左心室收缩末期容积指数。最后，通过Ea/Ees比值得出VAC。
出生后2.1±1天，与对照组（MHI = 2.01±0.2）相比，PE婴儿（MHI = 2.76±0.2）被诊断为所有心腔尺寸明显较小。两组婴儿的双心室收缩功能、左心室充盈压和肺血流动力学相似。PE婴儿的EaI（4.4±1.0 mmHg/ml/m对3.4±0.6 mmHg/ml/m，P<0.001）和EesI（15.1±3.0 mmHg/ml/m对12.7±2.5 mmHg/ml/m，P = 0.003）均显著高于对照组。两组婴儿的VAC结果相似（0.30±0.10对0.30±0.08，P>0.99）。在PE婴儿中，EaI（P = 0.93）和EesI（P = 0.87）均与MHI呈线性相关，但在对照组中无相关性。另一方面，两组婴儿的MHI与VAC之间均未发现相关性。
由于外在心脏压迫，胸廓畸形在无任何内在心血管功能障碍的情况下，对PE婴儿的Ea和Ees均有强烈影响。
