Myocardial Tissue Doppler Changes in Patients with Bronchopulmonary Dysplasia

Yates, Andrew R.; Welty, Stephen E.; Gest, Alfred; Clifford, L.

doi:10.1016/j.jpeds.2007.11.039

Cited by 53 publications

(88 citation statements)

References 36 publications

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“…8,24 Recent technological advances such as myocardial tissue Doppler might increase the sensitivity of this important tool. 25 The retrospective nature of our study imposed several limitations. As the use of echocardiography was selective, we were only able to determine a minimal estimate of PH in ELBW with BPD requiring prolonged PPV.…”

Section: Discussionmentioning

confidence: 99%

Echocardiographic detection of pulmonary hypertension in extremely low birth weight infants with bronchopulmonary dysplasia requiring prolonged positive pressure ventilation

et al. 2011

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Objective: The goal of this study was to delineate the epidemiology of echocardiographically diagnosed pulmonary hypertension (PH) in extremely low birth weight (ELBW) infants with bronchopulmonary dysplasia (BPD) requiring prolonged positive pressure ventilation (PPV), and to determine the independent relationship between PH and mortality in these patients. Result:We identified 216 patients (19%) with BPD requiring prolonged PPV among 1156 ELBW infants. Of these patients, 41% received echocardiography after 4 weeks of life, with 37% showing evidence of PH. Logistic regression analysis demonstrated that infants with BPD requiring prolonged PPV, with PH detectable by echocardiogram, were four times more likely to die (adjusted odds ratio): 4.6, 95% confidence interval: 1.3-16.5) when compared with infants with BPD requiring prolonged PPV without echocardiographic evidence of PH.Conclusion: Pulmonary hypertension appears to be an important, independent determinant of death in infants with BPD requiring prolonged PPV.

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Section: Discussionmentioning

confidence: 99%

Echocardiographic detection of pulmonary hypertension in extremely low birth weight infants with bronchopulmonary dysplasia requiring prolonged positive pressure ventilation

et al. 2011

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“…In a series of clinical studies, parameters of diastolic function such as the E-wave velocity and early-to-atrial filling ratios were significantly lower in preterm infants (Kozák-Bárány et al 2001, Schmitz et al 2004, Ciccone et al 2011. Myocardial performance index, a measure of systolic and diastolic function that is independent of heart rate and size, is higher in preterm infants and strongly correlates with severity of pulmonary dysfunction and poor outcomes (Yates et al 2008). Given the importance of GR signalling for the maturation of cardiac function in mice shortly before birth, it is plausible that insufficient or mistimed glucocorticoid signalling may contribute to these common cardiovascular complications.…”

Section: Insufficient Glucocorticoid Action: Prematuritymentioning

confidence: 99%

Glucocorticoids and foetal heart maturation; implications for prematurity and foetal programming

Rog-Zielinska¹,

Richardson²,

Denvir³

et al. 2013

Journal of Molecular Endocrinology

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Glucocorticoids are steroid hormones, essential in mammals to prepare for life after birth. Blood levels of glucocorticoids (cortisol in most mammals including humans; corticosterone in rats and mice) rise dramatically shortly before birth. This is mimicked clinically in the routine administration of synthetic glucocorticoids to pregnant women threatened by a preterm birth or to preterm infants to improve neonatal survival. Whilst effects on lung are well documented and essential for postnatal survival, those on heart are less well known. In this study, we review recent evidence for a crucial role of glucocorticoids in late gestational heart maturation. Either insufficient or excessive glucocorticoid exposure before birth may alter the normal glucocorticoid-regulated trajectory of heart maturation with potential life-long consequences.

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“…The myocardial performance index (or Tei index), a marker of ventricular dysfunction consisting of the sum of isovolumetric contraction and relaxation times divided by the ejection time, is elevated in primary PH, may be elevated in preterm infants with BPD, and may correlate with BPD severity. [79][80][81][82] More recently, tissue Doppler measurements have been found to correlate with elevated end diastolic pressure in adults. The ratio of the early Doppler inflow velocity to the early myocardial tissue Doppler velocity (E/E¢) has been shown to correlate with the severity of BPD, but requires further study to determine if it will be a useful marker of disease.…”

Section: Screening and Diagnosis Of Ph In Bpdmentioning

confidence: 99%

“…The ratio of the early Doppler inflow velocity to the early myocardial tissue Doppler velocity (E/E¢) has been shown to correlate with the severity of BPD, but requires further study to determine if it will be a useful marker of disease. 82 The tricuspid annular plane systolic excursion (TAPSE) is a marker of RV systolic function that correlates with gestational age, but has not been studied in relation to BPD severity. [83][84][85] Thus, in spite of its limitations, echocardiography will likely remain a key clinical tool for diagnosing and monitoring PH in these children.…”

Section: Screening and Diagnosis Of Ph In Bpdmentioning

confidence: 99%

Pulmonary Hypertension in Preterm Infants with Bronchopulmonary Dysplasia

Baker

Abman

Mourani

2014

Pediatric Allergy, Immunology, and Pulmonology

115

100

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Bronchopulmonary dysplasia (BPD), the chronic lung disease of prematurity, is a significant contributor to perinatal morbidity and mortality. Premature birth disrupts pulmonary vascular growth and initiates a cascade of events that result in impaired gas exchange, abnormal vasoreactivity, and pulmonary vascular remodeling that may ultimately lead to pulmonary hypertension (PH). Even infants who appear to have mild BPD suffer from varying degrees of pulmonary vascular disease (PVD). Although recent studies have enhanced our understanding of the pathobiology of PVD and PH in BPD, much remains unknown with respect to how PH should be properly defined, as well as the most accurate methods for the diagnosis and treatment of PH in infants with BPD. This article will provide neonatologists and primary care providers, as well as pediatric cardiologists and pulmonologists, with a review of the pathophysiology of PH in preterm infants with BPD and a summary of current clinical recommendations for managing PH in this population.

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Myocardial Tissue Doppler Changes in Patients with Bronchopulmonary Dysplasia

Cited by 53 publications

References 36 publications

Echocardiographic detection of pulmonary hypertension in extremely low birth weight infants with bronchopulmonary dysplasia requiring prolonged positive pressure ventilation

Echocardiographic detection of pulmonary hypertension in extremely low birth weight infants with bronchopulmonary dysplasia requiring prolonged positive pressure ventilation

Glucocorticoids and foetal heart maturation; implications for prematurity and foetal programming

Pulmonary Hypertension in Preterm Infants with Bronchopulmonary Dysplasia

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