Left ventricular diastolic function influences right ventricular — Pulmonary vascular coupling in premature infants. (January 2019)

• Record Type: Journal Article
• Authors: Bussmann, Neidin; EL-Khuffash, Afif; Breatnach, Colm R.; McCallion, Naomi; Franklin, Orla; Singh, Gautam K.; Levy, Philip T.
• Is Part Of: Early human development. Volume 128(2019)
• Page Start: 35
• Page End: 40
• Publication Date: 2019-01
• Subjects: 2DSTE two-dimensional speckle tracking echocardiography -- CLD chronic lung disease -- DVTR Doppler velocity of tricuspid regurgitation -- IQR interquartile range -- IVH intraventricular hemorrhage -- LV left ventricle -- MRI magnetic resonance imaging -- NEC necrotizing enterocolitis -- PAAT pulmonary artery acceleration time -- PAATi pulmonary artery acceleration time corrected for heart rate -- PDA patent ductus arteriosus -- PET preeclampsia -- PMA postmenstrual age -- PV pulmonary vasculature -- PVL periventricular leukomalacia -- RHC right heart catheterization -- RV Right ventricle -- RVET right ventricle ejection time -- TAPSE tricuspid annular plane systolic exclusion -- TDI tissue Doppler imaging; Fetus -- Periodicals; Neonatology -- Periodicals; Prenatal influences -- Periodicals; 612.65
• DOI: 10.1016/j.earlhumdev.2018.11.006
• Languages: English
• ISSNs: 0378-3782

Abstract

Abstract: Introduction: Reduced left ventricular (LV) diastolic function can exert significant load to the right ventricle (RV) that can affect RV–pulmonary vasculature (PV) coupling. RV–PV can be assessed with the RV length–force relationship (tricuspid annular plane systolic excursion [TAPSE] to pulmonary artery acceleration time [PAAT] ratio). We aimed to determine the association between LV diastolic function measured using tissue Doppler imaging (TDI) and TAPSE/PAAT. Methods: A study of premature infants <29 weeks gestation. TAPSE/PAAT, LV e′ and a′ waves were measured on Day 1 following birth. Correlation between diastolic indices and TAPSE/PAAT was performed. The independent effect of LV diastolic function and TAPSE/PAAT was assessed using linear regression. Results: One hundred and sixty-two infants with a mean ± SD gestation & birthweight of 26.6 ± 1.5 weeks & 938 ± 241 g. There was a significant positive correlation between LV e′ ( r = 0.44, p < 0.01)/LV a′ (r = 0.44, p < 0.01) and TAPSE/PAAT. This relationship remained significant when adjusting for important confounders (all p < 0.01). Infants with LV a′ values in the lowest quartile had lower TAPSE values (4.2 ± 1.2 vs. 5.1 ± 1.1 mm, p < 0.01) without a difference in PAAT (41 ± 8 vs. 41 ± 10 ms, p = 0.97). Conclusions: We observed a direct correlation between LV diastolic function and RV–PV coupling in the first day of age, highlighting the importance ventricular interdependence in premature infants. TAPSE/PAAT, as the index of the RV–PV interaction may be further explored for its potential to assess RV reserve under stress with preterm infants in health and disease. Highlights: The work of the right ventricle (RV) relies on proper hemodynamic coupling with a compliant pulmonary vasculature (PV). Reduced left ventricular (LV) diastolic function can exert significant load to the RV that can alter RV–PC coupling. RV-PV axis is assessed using the tricuspid annular plane systolic excursion to pulmonary artery acceleration time ratio. A direct correlation between LV diastolic function and RV-PV coupling highlights ventricular interdependence.