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Post-transitional adaptation of the left heart in uncomplicated, very preterm infants

Published online by Cambridge University Press:  24 January 2017

Koert De Waal ,
Nilkant Phad ,
Anil Lakkundi  and
Peter Tan
Koert De Waal*
Affiliation:
Neonatal Intensive Care Unit, John Hunter Children’s Hospital, Newcastle, Australia University of Newcastle, Newcastle, New South Wales, Australia
Nilkant Phad
Affiliation:
Neonatal Intensive Care Unit, John Hunter Children’s Hospital, Newcastle, Australia University of Newcastle, Newcastle, New South Wales, Australia
Anil Lakkundi
Affiliation:
Neonatal Intensive Care Unit, John Hunter Children’s Hospital, Newcastle, Australia University of Newcastle, Newcastle, New South Wales, Australia
Peter Tan
Affiliation:
University of Newcastle, Newcastle, New South Wales, Australia
*
Correspondence to: Dr K. de Waal, Neonatal Intensive Care Unit, John Hunter Children’s Hospital, Lookout road, New Lambton, NSW 3205, Australia. Tel: +61 2 49214362; Fax: +61 2 49214408; E-mail: [email protected]
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Abstract

Background

The postnatal period in preterm infants involves multiple physiological changes occurring immediately after birth and continuing for days or weeks. To recognise and treat compromise, it is important to measure cardiovascular function. The aim of this study was to describe longitudinal left ventricular function using conventional and novel echocardiography techniques in preterm infants who did not experience significant antenatal or postnatal complications and treatments.

Methods

We prospectively obtained cardiac ultrasound images at days 3, 7, 14, 21, and 28 in 25 uncomplicated, preterm infants <30 weeks of gestation. Speckle tracking analysis of the four chambers and short-axis images provided parameters of left ventricular volume, deformation, and basal myocardial velocities. The patent ductus arteriosus, cardiac dimensions, and atrial volume were also measured.

Results

Stroke volume increased by 24% during the study period (1.05–1.30 ml/kg, p<0.05). Cardiac length, diameter, and systolic basal myocardial velocity increased with unchanged wall stress and deformation parameters. Diastolic function parameters resembled that of the fetus with predominance of atrial contraction compared with early diastolic velocities. Blood pressure and estimates of left ventricular filing pressure increased, suggesting that left ventricular compliance did not change in this period.

Conclusion

Stroke volume increased in the first 28 days after preterm birth. The preterm heart adapted by increasing its size, while maintaining systolic and atrial function, independent of early diastolic maturation. Longitudinal deformation of the left ventricle remained unchanged, suggesting relatively preserved function with maturation.

Keywords

Speckle tracking echocardiographypreterm infantreference valuesleft ventricular function
Type
Original Articles
Information
Cardiology in the Young , Volume 27 , Issue 6 , August 2017 , pp. 1167 - 1173
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Copyright
© Cambridge University Press 2017 

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References

1. Evans, N. Assessment and support of the preterm circulation. Early Hum Dev 2006; 82: 803–810.Google Scholar
2. Murase, M, Ishida, A, Momota, T. Serial pulsed Doppler assessment of early left ventricular output in critically ill very low-birth-weight infants. Pediatr Cardiol 2002; 23: 442–448.CrossRefGoogle ScholarPubMed
3. Kluckow, M. Low systemic blood flow and pathophysiology of the preterm transitional circulation. Early Hum Dev 2005; 81: 429–437.Google Scholar
4. Sloot, SC, de Waal, KA, van der Lee, JH, et al. Central blood flow measurements in stable preterm infants after the transitional period. Arch Dis Child Fetal Neonatal Ed 2010; 95: F369–F372.CrossRefGoogle ScholarPubMed
5. Murase, M, Ishida, A, Morisawa, T. Left and right ventricular myocardial performance index (Tei index) in very-low-birth-weight infants. Pediatr Cardiol 2009; 30: 928–935.Google Scholar
6. Murase, M, Morisawa, T, Ishida, A. Serial assessment of left-ventricular function using tissue Doppler imaging in premature infants within 7 days of life. Pediatr Cardiol 2013; 34: 1491–1498.Google Scholar
7. Helfer, S, Schmitz, L, Buhrer, C, et al. Tissue Doppler-derived strain and strain rate during the first 28 days of life in very low birth weight infants. Echocardiography 2014; 31: 765–772.Google Scholar
8. Czernik, C, Rhode, S, Helfer, S, Schmalisch, G, Bührer, C, Schmitz, L. Development of left ventricular longitudinal speckle tracking echocardiography in very low birth weight infants with and without bronchopulmonary dysplasia during the neonatal period. PLoS One 2014; 9: e106504. doi: 10.1371/journal.pone.0106504.Google Scholar
9. Saleemi, MS, El-Khuffash, A, Franklin, O, et al. Serial changes in myocardial function in preterm infants over a four week period: the effect of gestational age at birth. Early Hum Dev 2014; 90: 349–352.Google Scholar
10. Schubert, U, Müller, M, Abdul-Khaliq, H, et al. Preterm birth is associated with altered myocardial function in infancy. J Am Soc Echocardiogr 2016; 29: 670–678.Google Scholar
11. James, AT, Corcoran, JD, Breatnach, CR, et al. Longitudinal assessment of left and right myocardial function in preterm infants using strain and strain rate imaging. Neonatology 2016; 109: 69–75.CrossRefGoogle ScholarPubMed
12. Hirose, A, Khoo, NS, Aziz, K, et al. Evolution of left ventricular function in the preterm infant. J Am Soc Echocardiogr 2015; 28: 302–308.Google Scholar
13. Lopez, L, Colan, SD, Frommelt, PC, et al. Recommendations for quantification methods during the performance of a pediatric echocardiogram: a report from the Pediatric Measurements Writing Group of the American Society of Echocardiography Pediatric and Congenital Heart Disease Council. J Am Soc Echocardiogr 2010; 23: 465–495.Google Scholar
14. Courand, JA, Marshall, J, Chang, Y, et al. Clinical applications of wall-stress analysis in the pediatric intensive care unit. Crit Care Med 2001; 29: 526–533.Google Scholar
15. Evans, N, Iyer, P. Longitudinal changes in the diameter of the ductus arteriosus in ventilated preterm infants: correlation with respiratory outcomes. Arch Dis Child Fetal Neonatal Ed 1995; 72: F156–F161.Google Scholar
16. Nishikage, T, Nakai, H, Mor-Avi, V, et al. Quantitative assessment of left ventricular volume and ejection fraction using two-imensional speckle tracking echocardiography. Eur J Echocardiogr 2009; 10: 82–88.Google Scholar
17. Zeidan, Z, Erbel, R, Barkhausen, J, et al. Analysis of global systolic and diastolic left ventricular performance using volume-time curves by real-time three-dimensional echocardiography. J Am Soc Echocardiogr 2003; 16: 29–37.Google Scholar
18. de Waal, K, Phad, N, Lakkundi, A, et al. Cardiac function after the immediate transitional period in very preterm infants using speckle tracking analysis. Pediatr Cardiol 2016; 37: 295–303.Google Scholar
19. van Dalen, BM, Bosch, JG, Kauer, F, et al. Assessment of mitral annular velocities by speckle tracking echocardiography versus tissue Doppler imaging: validation, feasibility, and reproducibility. J Am Soc Echocardiogr 2009; 22: 1302–1308.Google Scholar
20. Park, JH, Marwick, TH. Use and limitations of E/e’ to assess left ventricular filling pressure by echocardiography. J Cardiovasc Ultrasound 2011; 19: 169–173.CrossRefGoogle ScholarPubMed
21. Bijnens, BH, Cikes, M, Claus, P, et al. Velocity and deformation imaging for the assessment of myocardial dysfunction. Eur J Echocardiogr 2009; 10: 216–226.Google Scholar
22. Marciniak, A, Claus, P, Sutherland, GR, et al. Changes in systolic left ventricular function in isolated mitral regurgitation. A strain rate imaging study. Eur Heart J 2007; 28: 2627–2636.Google Scholar
23. Tobita, K, Garrison, JB, Liu, LJ, Tinney, JP, Keller, BB. Three-dimensional myofiber architecture of the embryonic left ventricle during normal development and altered mechanical loads. Anat Rec A Discov Mol Cell Evol Biol 2005; 283: 193–201.Google Scholar
24. Nii, M, Roman, KS, Kingdom, J, et al. Assessment of the evolution of normal fetal diastolic function during mid and late gestation by spectral Doppler tissue echocardiography. J Am Soc Echocardiogr 2006; 19: 1431–1437.Google Scholar
25. Levy, PT, Machefsky, A, Sanchez, AA, et al. Reference ranges of left ventricular strain measures by two-dimensional speckle-tracking echocardiography in children: a systematic review and meta-analysis. J Am Soc Echocardiogr 2016; 29: 209–225.Google Scholar
26. Breatnach, CR, Levy, PT, James, AT, et al. Novel echocardiography methods in the functional assessment of the newborn heart. Neonatology 2016; 110: 248–260.Google Scholar
27. Sanchez, AA, Levy, PT, Sekarski, TJ, et al. Effects of frame rate on two-dimensional speckle tracking-derived measurements of myocardial deformation in premature infants. Echocardiography 2015; 32: 839–847.Google Scholar
28. Pinsky, MR. Cardiovascular issues in respiratory care. Chest 2005; 128 (Suppl 2): 592S–597S.Google Scholar
29. Sehgal, A, Doctor, T, Menahem, S. Cyclooxygenase inhibitors in preterm infants with patent ductus arteriosus: effects on cardiac and vascular indices. Pediatr Cardiol 2014; 35: 1429–1436.Google Scholar
30. El-Khuffash, AF, Jain, A, Dragulescu, A, et al. Acute changes in myocardial systolic function in preterm infants undergoing patent ductus arteriosus ligation: a tissue Doppler and myocardial deformation study. J Am Soc Echocardiogr 2012; 25: 1058–1067.Google Scholar