The association between patterns of early respiratory disease and diastolic dysfunction in preterm infants

Abstract

Background This study aims to determine the association between clinical patterns of early respiratory disease and diastolic dysfunction in preterm infants. Methods Preterm infants <29 weeks’ gestation underwent cardiac ultrasounds around day 7 and 14–21. Respiratory dysfunction patterns were classified as stable (ST), respiratory deterioration (RD) or early persistent respiratory dysfunction (EPRD) according to oxygen need. Diastolic dysfunction was diagnosed using a multi-parameter approach including left atrial strain (LASR) to help differentiate between cardiac or pulmonary pathophysiology. Results 98 infants (mean 27 weeks) were included. The prevalence of ST, RD and EPRD was 53%, 21% and 26% respectively. Diastolic dysfunction was more prevalent in the RD and EPRD groups with patent ductus arteriosus and significant growth restriction as risk factors. Not all infants with a PDA developed diastolic dysfunction. LASR was lower in the EPDR group. Conclusion Respiratory dysfunction patterns are associated with diastolic dysfunction in preterm infants.

Echocardiography algorithms to assess high left atrial pressure and grade diastolic function in preterm infants

“…The data found with this study supports the hypothesis that this pathway might also exists in the preterm infant, whereby increasing and persistent high inflow and/or high LV stiffness led to cardiac adaptation, either by increasing ejection fraction or by increasing LAP to maintain stroke volume. Previously we described that the persistent high LAP is associated with clinical changes that are suggestive of diastolic heart failure, further supporting the hypothesis that the pathway from diastolic dysfunction to diastolic heart failure is comparable amongst all age groups 9 …”

“…2,7 Up to one in five very preterm infants develop diastolic dysfunction on cardiac ultrasound in the first weeks after birth, and over 20% of those infants are at risk of developing clinical signs and symptoms suggestive of heart failure. 8,9 The aim of this study is to provide a comprehensive assessment of diastolic function in preterm infants using conventional echocardiography and speckle tracking imaging, and determine the diagnostic accuracy of various multi-parameter algorithms to detect high LAP. A secondary aim is to detail various subgroups of diastolic dysfunction (impaired relaxation, increases LV stiffness) in preterm infants.…”

Patent ductus arteriosus, bronchopulmonary dysplasia and pulmonary hypertension—a complex conundrum with many phenotypes?

“…These changes may be further exaggerated in the setting of PDA, where both ongoing respiratory distress and diastolic dysfunction were seen more commonly in babies with a PDA. 5 Therefore, any echocardiography based definition of PH in this population should consider both pulmonary arterial and venous components and incorporate an assessment of LV diastolic dysfunction and left atrial pressure as they both have important clinical implications. 6 The authors speculate that the abolition of elevated pressure following PDA closure relates to a reduction in the flow-driven component; while this is very plausible, it is also possible that there may be an improvement in post-capillary hemodynamics with reduced pulmonary venous and subsequently arterial pressure.…”