Mid-term differences in right ventricular function in patients with congenital diaphragmatic hernia compared with controls

Egan, Matthew; Husain, Nazia; Stines, Jack R.; Moiduddin, Nasser; Stein, M.; Nelin, Leif D.; Clifford, L.

doi:10.1007/s12519-012-0380-2

Cited by 17 publications

(10 citation statements)

References 26 publications

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“…However, RV strain was worse in patients with pulmonary hypertension than in those without pulmonary hypertension. The prognostic implications of this difference warrant further evaluation, but this is consistent with prior reports of decreased RV strain several years after CDH repair (32). These findings support the need for continued surveillance of ventricular function in these patients.…”

Section: Original Researchsupporting

confidence: 87%

Right Ventricular Strain, Brain Natriuretic Peptide, and Mortality in Congenital Diaphragmatic Hernia

Avitabile¹,

Wang²,

Zhang³

et al. 2020

Annals ATS

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Rationale: Brain-type natriuretic peptide (BNP) correlates with pulmonary hypertension as demonstrated by echocardiogram in congenital diaphragmatic hernia (CDH); however, its association with right ventricular (RV) function and mortality is unknown.Objectives: To characterize the relationships between echocardiogram-derived RV strain, BNP, and mortality in diaphragmatic hernia. Methods:We performed a single-center retrospective cohort study of infants with CDH and at least one BNP-echocardiogram pair within a 24-hour period. RV global longitudinal strain (GLS) and free-wall strain (FWS) were measured on existing echocardiograms. Associations among strain, BNP, and mortality were tested using mixed-effect linear and logistic regression models. Survival analysis was stratified by BNP and strain abnormalities.Results: There were 220 infants with 460 BNP-echocardiogram pairs obtained preoperatively (n = 237), <1 week postoperatively (n = 35), and .1 week postoperatively ("recovery"; n = 188). Strain improved after repair (P , 0.0001 for all periods). Higher BNP level was associated with worse strain in recovery but not before or immediately after operation (estimate [95% confidence interval] for recovery: GLS, 1.03 [0.50-1.57]; P = 0.0003; FWS, 0.62 [0.01-1.22]; P = 0.047). BNP and strain abnormalities were associated with an extracorporeal-membrane oxygenation requirement. Higher BNP level in recovery was associated with greater mortality (odds ratio, 11.2 [1.2-571.3]; P = 0.02). Abnormal strain in recovery had high sensitivity for detection of mortality (100% for GLS; 100% for FWS) but had low specificity for detection of mortality (28% for GLS; 48% for FWS).Conclusions: Persistent RV dysfunction after CDH repair may be detected by a high BNP level and abnormal RV strain.

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Section: Original Researchsupporting

confidence: 87%

Right Ventricular Strain, Brain Natriuretic Peptide, and Mortality in Congenital Diaphragmatic Hernia

Avitabile¹,

Wang²,

Zhang³

et al. 2020

Annals ATS

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“…Patients with CDH might present with anatomic and echocardiographic alterations of the left cardiac chambers (LV) ( 7 , 8 ), making the systemic circulation more dependent on the RV and exacerbating LV dysfunction ( 7 ). Additionally, the follow-up of children with CDH has demonstrated that altered RV function exists years after surgical correction ( 9 ). Given the importance of secondary cardiac function and pulmonary alterations in CDH, we performed an echocardiographic evaluation of the heart in a rabbit model of CDH ( 1 ) to verify whether myocardiac function exhibits primary or secondary alterations after birth and to correlate the data with histological findings.…”

Section: Introductionmentioning

confidence: 99%

Early neonatal echocardiographic findings in an experimental rabbit model of congenital diaphragmatic hernia

Manso

Figueira

Prado

et al. 2015

Braz J Med Biol Res

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This study aimed to demonstrate that congenital diaphragmatic hernia (CDH) results in vascular abnormalities that are directly associated with the severity of pulmonary hypoplasia and hypertension. These events increase right ventricle (RV) afterload and may adversely affect disease management and patient survival. Our objective was to investigate cardiac function, specifically right ventricular changes, immediately after birth and relate them to myocardial histological findings in a CDH model. Pregnant New Zealand rabbits underwent the surgical procedure at 25 days of gestation (n=14). CDH was created in one fetus per horn (n=16), and the other fetuses were used as controls (n=20). At term (30 days), fetuses were removed, immediately dried and weighed before undergoing four-parameter echocardiography. The lungs and the heart were removed, weighed, and histologically analyzed. CDH animals had smaller total lung weight (P<0.005), left lung weight (P<0.005), and lung-to-body ratio (P<0.005). Echocardiography revealed a smaller left-to-right ventricle ratio (LV/RV, P<0.005) and larger diastolic right ventricle size (DRVS, P<0.007). Histologic analysis revealed a larger number of myocytes undergoing mitotic division (186 vs 132, P<0.05) in CDH hearts. Immediate RV dilation of CDH hearts is related to myocyte mitosis increase. This information may aid the design of future strategies to address pulmonary hypertension in CDH.

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“…Exclusion criteria for HLHS patients included hospitalization, interventional cardiac catheterization, or cardiac surgery 2 months prior to the echocardiogram, or a history of a right ventriculotomy. Control patients were excluded if they had any cardiac abnormality except for a patent foramen ovale or if they had any other underlying medical issues such as reactive airway disease and diabetes . Control and HLHS patients were also excluded if they had poor echocardiographic image quality such that tissue Doppler imaging (TDI) and strain rate (SR) analysis could not be performed or if atrial or ventricular arrhythmias were present.…”

Section: Methodsmentioning

confidence: 99%

Diastolic Dyssynchrony Differences in Patients with Single Right Ventricles vs. Control Patients

et al. 2014

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Mid-term differences in right ventricular function in patients with congenital diaphragmatic hernia compared with controls

Abstract: Patients who underwent CDH repair continue to have differences in RV function years after repair. Follow-up is needed to determine how these differences impact cardiac function in adult survivors of CDH.

Cited by 17 publications

References 26 publications

Right Ventricular Strain, Brain Natriuretic Peptide, and Mortality in Congenital Diaphragmatic Hernia

Right Ventricular Strain, Brain Natriuretic Peptide, and Mortality in Congenital Diaphragmatic Hernia

Early neonatal echocardiographic findings in an experimental rabbit model of congenital diaphragmatic hernia

Diastolic Dyssynchrony Differences in Patients with Single Right Ventricles vs. Control Patients

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