Left ventricular diastolic function influences right ventricular — Pulmonary vascular coupling in premature infants

Bussmann, Neidin; El-Khuffash, Afif; Breatnach, Colm R.; McCallion, Naomi; Franklin, Orla; Singh, Gautam K.; Levy, Philip

doi:10.1016/j.earlhumdev.2018.11.006

Cited by 26 publications

(18 citation statements)

References 21 publications

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“…Increased PCWP may also lead to pulmonary venous congestion and PHT in neonates. Etiologies include left atrial and ventricular dysfunction seen in prematurity (8) and infants with hypoxic ischemic encephalopathy(HIE) (9). Pulmonary vein stenosis may also result in PHT in premature infants and has been observed with growing frequency in infants with chronic lung disease (CLD) (10).…”

Section: Etio-pathogenesis Of Pulmonary Hypertensionmentioning

confidence: 99%

“…Tissue Doppler imaging measures the peak systolic (s'), early diastolic (e'), late diastolic (a'), and peak isovolumetric contraction velocities (52). Normative values exist in neonates and can provide longitudinal measurements of RV diastolic performance in preterm infants (8). Speckle-tracking echocardiography is used to assess global and free wall longitudinal strain and has been shown to be a predictive measure of PHT in neonates and children (53).…”

Section: Right Ventricular Performancementioning

confidence: 99%

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Comprehensive Evaluation of Right Heart Performance and Pulmonary Hemodynamics in Neonatal Pulmonary Hypertension

Bhattacharya

Sen

Levy

et al. 2019

Curr Treat Options Cardio Med

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Purpose of review: Pulmonary hypertension is characterized by an elevation of pulmonary artery pressures and prolonged exposure of the right ventricle to high afterload that collectively contribute to morbidity and mortality in both the term and preterm infants. This review summarizes the pathogenesis, etiologies, and hemodynamics profiles of the conditions that result in pulmonary hypertension in neonates. We explore the application of echocardiographic techniques for the assessment of right ventricular performance and pulmonary hemodynamics that enhance and guide the diagnosis and management strategies in neonates. Recent Findings: Clinical assessments based on the determinants of mean pulmonary artery pressures (pulmonary vascular resistance, pulmonary blood flow, and pulmonary capillary wedge pressure) provide a physiologic approach for determining the acute and chronic etiologies of pulmonary hypertension in neonates. In addition, advances in neonatal echocardiography now afford the capability to obtain quantitative information that often precedes the qualitative information acquired by conventional methods and also provide sensitive markers of right ventricle performance for prognostic information based on the determinants of mean pulmonary artery pressures. Summary: Neonatal pulmonary hypertension represents a physiologic spectrum that accounts for the variance in clinical presentation and response to therapies. Physiology based approaches to etiology identification, coupled with the emerging echocardiographic methods for the assessment of pulmonary hypertension in neonates will likely help to identify cardiovascular compromise

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Section: Etio-pathogenesis Of Pulmonary Hypertensionmentioning

confidence: 99%

Section: Right Ventricular Performancementioning

confidence: 99%

Comprehensive Evaluation of Right Heart Performance and Pulmonary Hemodynamics in Neonatal Pulmonary Hypertension

Bhattacharya

Sen

Levy

et al. 2019

Curr Treat Options Cardio Med

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“…The presence of TR and the increased number with flattened septum may suggest that there is a mild increase in PAP in bronchiolitis. Increased PAP in the bronchiolitis group may support the hypothesis that LV dysfunction contributes to increased PAP 17 . These findings may also reflect the difficulty of measuring PAP by echo 18,23 …”

Section: Discussionmentioning

confidence: 54%

“…First, LV dysfunction may be explained by reduced diastolic ventricular filling associated with tachycardia due to respiratory distress 15,16 . LV dysfunction might, in turn, lead to elevated pulmonary venous pressure and pulmonary vascular resistance (PVR) resulting in a secondary increase in RV afterload and deterioration in RV function 17,18 …”

Section: Discussionmentioning

confidence: 99%

Myocardial strain on admission predicts disease severity in infants hospitalized for bronchiolitis

Massolo

Cantone²,

Musolino

et al. 2020

Pediatric Pulmonology

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Objective To assess cardiac function in infants with bronchiolitis and the association with disease severity and outcomes. Working Hypothesis Cardiac function may be impaired in bronchiolitis and represent an early predictor of disease severity. Study Design A prospective cohort study. Patient Selection Infants with suspected bronchiolitis were included. Methodology All cases received antigen detection and viral genome detection from nasal lavage or swabs and echocardiography within 24 hours from admission. Systolic and diastolic function in left ventricle (LV) and right ventricle (RV) were assessed using longitudinal strain (LS), a measure of myocardial deformation. Pulmonary artery pressures were estimated using tricuspid regurgitation jet (TR), when present, and end‐systolic eccentricity index (EI ES). Main outcomes (duration of respiratory support, length of stay [LOS], and type of respiratory support) were collected. Data were compared to normative existing data, and a group of healthy infants, matched in age. Results Twenty‐eight infants with bronchiolitis and 10 healthy comparators were included. Cases with bronchiolitis showed significantly lower values of RV LS and LV LS compared to healthy comparators (LV: p0.04 and RV: P < .001). Ten infants (36%) had a normal biventricular function, nine (32%) had LV impairment, and nine (32%) had a biventricular impairment. No significant differences were found in TR and EI ES. Infants with biventricular impairment demonstrated a significant increase in LOS (p0.04) and higher levels of respiratory support compared to the healthy comparators (P = .03). Conclusions Bronchiolitis is associated with myocardial impairment. Cardiac function is related to disease severity and outcome.

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“…The presence of LV diastolic compromise results in a reduction of this decoupling threshold. Evolving pulmonary venous hypertension secondary to impaired LV diastolic function can therefore impair RV performance [33]. This can have significant clinical implications, such as an increase in the incidence of pulmonary haemorrhage and prolonging the need for ventilation [34].…”

Section: Echocardiographic Assessment Of Hsmentioning

confidence: 99%

Defining “Haemodynamic Significance” of the Patent Ductus Arteriosus: Do We Have All the Answers?

Smith

El-Khuffash

2020

Neonatology

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Optimum management of the patent ductus arteriosus (PDA) in preterm infants remains one of the most debated topics within the field of neonatology. Despite numerous observational studies and over 60 randomized control trials, consensus on PDA management remains elusive. In order to make meaningful progress on the controversial issue of PDA management, several key factors must be thoroughly addressed; namely (1) accurate identification of infants at greatest risk of long-term morbidities from PDA exposure, (2) acceptance that the PDA is not a dichotomous entity and an individualised approach to its management is required for each neonate, (3) international consensus on what constitutes a haemodynamically significant PDA and (4) the incorporation of multi-organ assessment when evaluating the impact a PDA may pose on overall neonatal physiology. This review assesses the evidence base available supporting various therapeutic strategies for PDA, the deficits in our current knowledge on the definition of haemodynamic significance and future directions to pursue in order to more successfully address this contentious subject.

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Left ventricular diastolic function influences right ventricular — Pulmonary vascular coupling in premature infants

Cited by 26 publications

References 21 publications

Comprehensive Evaluation of Right Heart Performance and Pulmonary Hemodynamics in Neonatal Pulmonary Hypertension

Comprehensive Evaluation of Right Heart Performance and Pulmonary Hemodynamics in Neonatal Pulmonary Hypertension

Myocardial strain on admission predicts disease severity in infants hospitalized for bronchiolitis

Defining “Haemodynamic Significance” of the Patent Ductus Arteriosus: Do We Have All the Answers?

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