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

• Published in: The Journal of pediatrics Vol. 203; pp. 210 - 217.e1
• Main Authors: Ehrmann, Daniel E., Mourani, Peter M., Abman, Steven H., Poindexter, Brenda B., Morrow, Lindsey A., Wagner, Brandie D., Di Maria, Michael V.
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.12.2018
• Subjects: bronchopulmonary dysplasia; Bronchopulmonary Dysplasia - complications; Bronchopulmonary Dysplasia - diagnosis; Cohort Studies; echocardiography; Echocardiography, Doppler; Female; Follow-Up Studies; Gestational Age; Humans; Infant, Newborn; Infant, Premature; Logistic Models; Male; Multivariate Analysis; Pregnancy; pulmonary vascular disease; Retrospective Studies; right ventricular mechanics; Risk Assessment; Time Factors; Ventricular Dysfunction, Right - diagnostic imaging; Ventricular Dysfunction, Right - etiology; Ventricular Function, Right - physiology; PAAT; RV; PMA; echocardiography; MPI; FAC; LV; TAPSE; bronchopulmonary dysplasia; pulmonary vascular disease; TRJV; ET; right ventricular mechanics; BPD; PH; GA; PVD
• ISSN: 0022-3476; 1097-6833
• DOI: 10.1016/j.jpeds.2018.08.005

To test the hypothesis that specific echocardiographic measurements of right ventricular (RV) mechanics at 36 weeks postmenstrual age (PMA) are associated with the severity of bronchopulmonary dysplasia (BPD). A subset of 93 preterm infants (born between 27 and 29 weeks of gestation) was selected retrospectively from a prospectively enrolled cohort. BPD was defined using the National Institutes of Health workshop definition, with modifications for oxygen reduction testing and altitude. The cohort was divided into no-BPD and BPD groups using previously published methodology for analyses. Echocardiographic measurements of RV function (ie, tricuspid annular plane systolic excursion, fractional area of change, systolic-to-diastolic ratio, tissue Doppler myocardial performance index, and RV strain), RV remodeling/morphology (end-systolic left ventricular eccentricity index), and RV afterload (pulmonary artery acceleration time measure) were evaluated at 36 weeks PMA. Multivariable logistic regression determined associations between RV measurements and BPD severity. Compared with the no-BPD cohort, the BPD group had lower birth weight z-scores (P = .04) and trended toward a male predominance (P = .08). After adjusting for birth weight z-score, gestational age, and sex, there were no between-group differences in echocardiographic measurements except for the eccentricity index (scaled OR [0.1-unit increase], 1.49; 95% CI, 1.13-2.12; P = .01). Among conventional and emerging echocardiographic measurements of RV mechanics, eccentricity index was the sole variable independently associated with BPD severity in this study. The eccentricity index may be a useful echocardiographic measurement for characterizing RV mechanics in patients with BPD at 36 weeks PMA.