Romero Orozco Rossana, Mohammed Tazuddin A, Carter Kerri, Brown Shaaron, Miller Stephen, Sabo Roy T, Joseph Meredith Campbell, Truong Uyen, Nair Megha, Anderson Victoria, Xu Jie, Voynow Judith A, Hendricks-Muñoz Karen D
Department of Pediatrics, Children's Hospital of Richmond at VCU, Virginia Commonwealth University, Richmond, VA 23298, USA.
Virginia Commonwealth University School of Medicine, Richmond, VA 23298, USA.
Children (Basel). 2024 Sep 13;11(9):1121. doi: 10.3390/children11091121.
(1) Background: Pulmonary hypertension (PH) increases pulmonary vascular resistance and right ventricular (RV) afterload. Assessment of RV systolic function in PH using RV fractional area change (RV FAC) as a marker directly correlates with mortality and the need for extracorporeal membrane oxygenation (ECMO). However, few studies have assessed neurodevelopmental outcomes. We hypothesize that cardiac RV systolic dysfunction with lower RV FAC is associated with worse neurodevelopmental impairment (NI). (2) Methods: Retrospective study of 42 subjects with PH to evaluate neurodevelopmental outcomes in the first two years of life based on (i) subjective assessment of RV systolic function and (ii) RV FAC, a specific echocardiographic marker for RV function. (3) Results: Subjects from the initial study cohort ( = 135) with PH who had long-term follow-up were divided into RV dysfunction (study, = 20) and non-RV dysfunction (control, = 22) groups. RV FAC in the study vs. control group (0.18 vs. 0.25) was lower ( = 0.00017). There was no statistically significant difference in NI either with RV dysfunction or lower RV FAC. Although not significant, RV dysfunction was associated with longer mean duration of mechanical ventilation, time on ECMO, and length of stay. In the initial cohort (135), mortality was 16.3% and the percentage of NI was 62%. (4) Conclusions: Neonatal pulmonary hypertension is associated with a high degree of neurodevelopment impairment. Early RV systolic dysfunction, as identified by RV FAC, was not an optimal predictive biomarker for infants with PH and neurodevelopmental impairment.
(1) 背景：肺动脉高压（PH）会增加肺血管阻力和右心室（RV）后负荷。使用右心室面积变化分数（RV FAC）作为标志物评估PH患者的右心室收缩功能，与死亡率及体外膜肺氧合（ECMO）需求直接相关。然而，很少有研究评估神经发育结局。我们假设右心室FAC降低的心脏右心室收缩功能障碍与更严重的神经发育损害（NI）相关。(2) 方法：对42例PH患者进行回顾性研究，基于（i）右心室收缩功能的主观评估和（ii）RV FAC（一种用于评估右心室功能的特定超声心动图标志物）来评估其生命最初两年的神经发育结局。(3) 结果：对最初研究队列（n = 135）中接受长期随访的PH患者，分为右心室功能障碍组（研究组，n = 20）和非右心室功能障碍组（对照组，n = 22）。研究组与对照组的RV FAC（分别为0.18和0.25）相比更低（P = 0.00017）。右心室功能障碍或RV FAC降低在NI方面均无统计学显著差异。虽然无统计学意义，但右心室功能障碍与机械通气平均持续时间延长、使用ECMO时间及住院时间延长相关。在最初队列（135例）中，死亡率为16.3%，NI发生率为62%。(4) 结论：新生儿肺动脉高压与高度神经发育损害相关。通过RV FAC确定的早期右心室收缩功能障碍，并非PH合并神经发育损害婴儿的最佳预测生物标志物。
