Clinical Utility of Echocardiography for the Diagnosis and Prognosis in Children with Bronchopulmonary Dsyplasia

Abstract

BackgroundBronchopulmonary dysplasia (BPD) may result in chronic pulmonary artery hypertension and right ventricular (RV) dysfunction. Various echocardiographic assessments of RV dysfunction have been used to determine whether echocardiographic measurements of premature infants with BPD could provide sensitive measures of RV function that correlates with BPD severity.MethodsTwenty-eight control subjects without BPD (non BPD group), 28 patients with mild BPD, 11 patients with moderate BPD, and six patients with severe BPD underwent echocardiograms with standard measurement such as ejection fraction by M-mode, tricuspid regurgitation pressure gradient, myocardial performance index (MPI) derived from pulse Doppler, and tissue Doppler imaging (TDI) measurements. BPD severity was classified by the NICHD/NHLBI/ORD workshop rating scale. Twenty-eight control subjects without BPD (non BPD group), 28 patients with mild BPD, 11 patients with moderate BPD, and six patients with severe BPD underwent echocardiograms with standard measurement such as ejection fraction by M-mode, tricuspid regurgitation pressure gradient, myocardial performance index (MPI) derived from pulse Doppler, and TDI measurements. BPD severity was classified by the NICHD/NHLBI/ORD workshop rating scale.ResultsNone of the standard echocardiographic findings was significantly different between the control group and BPD groups. However, mean septal TDI-MPI of the severe BPD group (0.68 ± 0.06) was significantly (p < 0.01) higher than that of the non-BPD (0.58 ± 0.10) or the mild BPD group (0.59 ± 0.12). In addition, mean RV TDI-MPI of the severe BPD group (0.71 ± 0.13) was significantly (p < 0.05) higher than that of the non-BPD group (0.56 ± 0.08) or the mild BPD group (0.60 ± 0.125). Linear regression showed a good correlation between the severity of BPD and RV TDI-MPI (p = 0.01, R = 0.30) or septal TDI-MPI (p = 0.04, R = 0.24).ConclusionEchocardiographic evaluation of RV function based on an assessment of RV TDI-MPI can provide RV dysfunction parameter in premature infants with BPD.

Echocardiographic Measurements of Right Ventricular Mechanics in Infants with Bronchopulmonary Dysplasia at 36 Weeks Postmenstrual Age

“…Choi et al found that preterm BPD patients without evidence PVD/PH may nevertheless have RV dysfunction between 35 and 37 weeks PMA. 36 Haque et al found similar results using myocardial deformation imaging in a cohort of BPD patients without PH. 37 The current paradigm of BPD suggests that preterm infants with BPD may have impairments in the growth, structure and function of the pulmonary vasculature which may lead to PH and ultimately RV dysfunction.…”

Influence of extreme prematurity and bronchopulmonary dysplasia on cardiac function

“…1,[21][22][23] Previous echocardiography studies have found BPD to have a detrimental impact on cardiac function at or near term corrected gestational age, 4,6,7,12,24-26 early infancy 5,8,11,13,14 and school age. 27 Most studies have found alterations in RV function 4,6,7,[11][12][13][14]24 while few have performed prospective longitudinal echocardiography analysis 4,12,13,26 or have examined LV function. 5,8,26 Due to the presence of ventricular interactions it is relevant to include a biventricular analysis.…”

“…In BPD, right ventricular dysfunction is common and associated with adverse outcomes and the left ventricular (LV) function is characterized by abnormal diastolic but preserved systolic function by conventional analysis. [2][3][4][5][6][7][8] These early abnormalities may contribute to longer-term cardiovascular disease related morbidity and mortality. 9,10 Newer echocardiographic methods such as myocardial deformational imaging have been demonstrated to be more sensitive than conventional methods in detecting changes in cardiac function, 3,6,11,12 potentially allowing for improved detection and targeted intervention in at-risk infants.…”

Early Detection for Right Ventricular Dysfunction in Bronchopulmonary Dysplasia without Pulmonary Hypertension

“…There are several parameters to evaluate RV dysfunction, in this issue of the journal, Choi et al,2) tissue Doppler imaging (TDI)-myocardial performance index (MPI) is used to evaluate RV dysfunction in BPD. Previous studies showed difference in TDI across various BPD severities with pulmonary hypertension.…”

“…The current research by Choi et al2) represent that RV TDI-MPI may be useful method for early detection of RV dysfunction without pulmonary hypertension in BPD and it is necessary to study the incidence and severity of future pulmonary hypertension accordance with value of RV TDI-MPI.…”