Tydén Katarina Övermo, Mesas Burgos Carmen, Jonsson Baldvin, Nordenstam Felicia
Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden.
Pediatric Cardiology Unit, Karolinska University Hospital, Stockholm, Sweden.
Front Pediatr. 2024 Jun 4;12:1404350. doi: 10.3389/fped.2024.1404350. eCollection 2024.
The role of cardiac left ventricle (LV) dysfunction in children with congenital diaphragmatic hernia (CDH) has gained increasing attention. The hernia allows abdominal mass to enter thorax and subsequently both dislocating and compressing the heart. The pressure on vessels and myocardium alters blood flow and may interfere with normal development of the LV. A dysfunctional LV is concerning and impacts the complex pathophysiology of CDH. Hence, assessing both the systolic and diastolic LV function in the newborn with CDH is important, and it may add value for medical treatment and prognostic factors as length of stay (LOS) in pediatric intensive care unit (PICU). LV strain is considered an early marker of systolic dysfunction used in the pediatric population. Left atrial (LA) strain is an echocardiographic marker of LV diastolic dysfunction used in the adult population. When filling pressure of the LV increases, the strain of the atrial wall is decreased. We hypothesized that reduced LA strain and LV strain are correlated with the LOS in the PICU of newborns with CDH.
This retrospective observational cohort study included data of 55 children born with CDH between 2018 and 2020 and treated at Karolinska University Hospital, Sweden. Overall, 46 parents provided consent. Echocardiograms were performed in 35 children <72 h after birth. The LA reservoir strain (LASr), LV global longitudinal strain, LV dimensions, and direction of blood flow through the patent foramen ovale (PFO) were retrospectively assessed using the echocardiograms.
Children with LASr <33% ( = 27) had longer stays in the PICU than children with LA strain ≥33% ( = 8) (mean: 20.8 vs. 8.6 days; < 0.002). The LASr was correlated with the LOS in the PICU (correlation coefficient: -0.378; = 0.025). The LV dimension was correlated with the LOS (correlation coefficient: -0.546; = 0.01). However, LV strain was not correlated to LOS.
Newborns with CDH and a lower LASr (<33%) had longer stays in the PICU than children with LASr ≥33%. LASr is a feasible echocardiographic marker of diastolic LV dysfunction in newborns with CDH and may indicate the severity of the condition.
先天性膈疝（CDH）患儿中心脏左心室（LV）功能障碍的作用日益受到关注。膈疝使腹部脏器进入胸腔，进而使心脏移位并受到压迫。血管和心肌上的压力改变了血流，可能会干扰左心室的正常发育。功能失调的左心室令人担忧，并影响CDH复杂的病理生理过程。因此，评估CDH新生儿的左心室收缩和舒张功能很重要，这可能会为治疗及诸如小儿重症监护病房（PICU）住院时间（LOS）等预后因素增加价值。左心室应变被认为是儿科人群中收缩功能障碍的早期标志物。左心房（LA）应变是成人群体中用于评估左心室舒张功能障碍的超声心动图标志物。当左心室充盈压升高时，心房壁的应变会降低。我们假设，CDH新生儿中降低的左心房应变和左心室应变与PICU住院时间相关。
这项回顾性观察性队列研究纳入了2018年至2020年间在瑞典卡罗林斯卡大学医院出生并接受治疗的55例CDH患儿的数据。总体而言，46位家长提供了同意书。35例出生后<72小时的患儿接受了超声心动图检查。使用超声心动图回顾性评估左心房储备应变（LASr）、左心室整体纵向应变、左心室尺寸以及通过卵圆孔未闭（PFO）的血流方向。
LASr<33%的患儿（n = 27）在PICU的住院时间比LASr≥33%的患儿（n = 8）更长（平均：20.8天对8.6天；P<0.002）。LASr与PICU住院时间相关（相关系数：-0.378；P = 0.025）。左心室尺寸与住院时间相关（相关系数：-0.546；P = 图1）。然而，左心室应变与住院时间无关。
CDH新生儿且LASr较低（<33%）的患儿在PICU的住院时间比LASr≥33%的患儿更长。LASr是CDH新生儿左心室舒张功能障碍的一种可行的超声心动图标志物，可能表明病情的严重程度。
