对因新生儿脑病接受治疗性低温治疗的新生儿左右心室应变力学的回顾性研究。

Retrospective study of left and right ventricular strain mechanics among neonates undergoing therapeutic hypothermia for neonatal encephalopathy.

作者信息

Jin Justin B, Liu Wei, Karnati Sreenivas, Sammour Ibrahim, Komarlu Rukmini

机构信息

Department of Pediatric Cardiology, Ann & Robert Lurie Children's Hospital, Chicago, IL 60611, USA.

Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH, USA.

出版信息

Early Hum Dev. 2025 Jan;200:106163. doi: 10.1016/j.earlhumdev.2024.106163. Epub 2024 Nov 23.

DOI:10.1016/j.earlhumdev.2024.106163

PMID:39613504

Abstract

PURPOSE

Early diagnosis of impaired myocardial function and timely therapeutic hypothermia is vital among patients with Neonatal Encephalopathy (NE). Traditional markers of myocardial function (Left Ventricular Ejection Fraction (LV EF) & LV Fractional Shortening (LV FS) can be variably reduced. Speckle tracking echocardiography (STE) is a more sensitive marker for impairment but remains inadequately studied in this patient population.

METHODS

A retrospective study of neonates who underwent therapeutic hypothermia (TH) for NE from 2009 to2020 were matched 1:1 with normal neonates with normal echocardiograms performed for indications other than NE. Matching was based on gestational age, birth weight, days of age, and sex. Left ventricular 4 Chamber (4Ch) strain, right ventricular 4 Chamber (RV 4Ch), and RV free wall strain (RV FWS) were measured offline using vendor independent strain software (TomTec, GMBH, Munich, Germany).

RESULTS

Ninety pairs of NE patients and controls were studied. Compared to controls, RV 4Ch strain (-17.3 % vs. -19.6 %), RV FWS (-18.8 % vs. -21.9 %), and RV fractional area change (FAC) (35 % vs. 37 %) were lower in NE cases (all p < 0.001), while differences in LV 4Ch strain, LV EF, and LV FS did not reach statistical significance. Moderate/severe NE (72 %) was associated with lower LV 4Ch strain compared to mild NE (-22.2 %/-19.3 % vs. -25.4 %, p = 0.004). RV 4Ch strain (-14.9 % vs. -18.8 %, p = 0.020) and RV FAC (27 % vs. 36 %, p = 0.006) were lower in severe NE compared to mild NE. Lower LV 4Ch was associated with need for chest compressions (-18.5 % vs. -23.3 %), epinephrine at delivery (-19.3 % vs. -23.4 %), and decreased survival to discharge (-15.9 % vs. -22.7 %).

CONCLUSIONS

RV and LV strain mechanics are impaired in NE patients. Lower RV Strain and LV 4Ch strain were associated with need for increased medical support and decreased survival to discharge.

摘要

目的

对于新生儿脑病（NE）患者，早期诊断心肌功能受损并及时进行治疗性低温治疗至关重要。传统的心肌功能标志物（左心室射血分数（LV EF）和左心室短轴缩短率（LV FS））可能会有不同程度的降低。斑点追踪超声心动图（STE）是一种更敏感的心肌功能受损标志物，但在该患者群体中的研究仍不充分。

方法

对2009年至2020年因NE接受治疗性低温治疗（TH）的新生儿进行回顾性研究，将其与因非NE适应证进行正常超声心动图检查的正常新生儿按1:1配对。配对基于胎龄、出生体重、日龄和性别。使用独立于供应商的应变软件（TomTec，GMBH，慕尼黑，德国）离线测量左心室四腔心（4Ch）应变、右心室四腔心（RV 4Ch）和右心室游离壁应变（RV FWS）。

结果

研究了90对NE患者和对照组。与对照组相比，NE病例的RV 4Ch应变（-17.3%对-19.6%）、RV FWS（-18.8%对-21.9%）和右心室面积变化分数（FAC）（35%对37%）较低（所有p<0.001），而LV 4Ch应变、LV EF和LV FS的差异未达到统计学意义。与轻度NE相比，中度/重度NE（72%）与较低的LV 4Ch应变相关（-22.2%/-19.3%对-25.4%，p = 0.004）。与轻度NE相比，重度NE的RV 4Ch应变（-14.9%对-18.8%，p = 0.020）和RV FAC（27%对36%，p = 0.006）较低。较低的LV 4Ch应变与需要胸外按压（-18.5%对-23.3%）、分娩时使用肾上腺素（-19.3%对-23.4%）以及出院生存率降低（-15.9%对-22.7%）相关。