Left Ventricle Phenotyping Utilizing Tissue Doppler Imaging in Premature Infants with Varying Severity of Bronchopulmonary Dysplasia
Abstract
:1. Introduction
2. Experimental Section
2.1. Design and Population
2.2. Patient Characteristics
2.3. Primary Exposure of BPD-PH
2.4. Echocardiography
2.5. Tissue Doppler Imaging
2.6. Main Outcome: Post Systolic Motion (PSM)
2.7. Statistical Analysis
3. Results
3.1. Patient Characteristics
3.2. Assessment of LV Tissue Doppler Indices
3.3. Assessment of Post Systolic Motion
3.4. Comparison of Tissue Doppler Indices between Term and Preterm Cohorts
3.5. Influence of Patent Ductus Arteriosus
4. Discussion
4.1. PSM in Neonates
4.2. Ventricular-Ventricular Interactions
4.3. TDI Measures at One Year of Age
4.4. Clinical Significance of PSM Evaluation in Neonates
4.5. Limitations
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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Group I No-Mild BPD (n = 33) | Group II Mod-Sev BPD (n = 33) | Group III BPD-PH (n = 11) | F-Ratio p Value | |
---|---|---|---|---|
Gestational age (weeks) | 27 (26–28) | 26 (25–27) ∞ | 26 (25–27) * | <0.01 |
Birth weight (grams) | 950 (818–1070) | 890 (670–985) | 920 (860–1030) | 0.58 |
Female, No. (%) | 19 (58%) | 17 (52%) | 2 (19%) * | 0.02 |
Infant Race, No. (%) | 0.14 | |||
White | 13 (39%) | 15 (45%) | 4 (36%) | |
Black | 20 (61%) | 18 (55%) | 7 (64%) | |
Antenatal Steroids—No. (%) | 29 (88%) | 23 (70%) | 8 (73%) | 0.51 |
Surfactant therapy (Yes) | 33 (100%) | 33 (100%) | 11 (100%) | >0.99 |
Cesarean section | 24 (73%) | 22 (67%) | 4 (36%) | |
Maternal complications, No. (%) | ||||
Gestational Diabetes Mellitus | 1 (3%) | 3 (10%) | 0 | 0.35 |
PROM | 5 (15%) | 2 (6%) | 2 (18%) | 0.61 |
Chorioamnionitis | 3 (10%) | 3 (10%) | 1 (9%) | 0.65 |
Pre-eclampsia | 4 (12%) | 5 (15%) | 3 (27%) | 0.78 |
Postnatal complications, No. (%) | ||||
Necrotizing enterocolitis | 2 (6%) | 3 (9%) | 1 (9%) | 0.65 |
ROP threshold (>Stage 2) | 9 (27%) | 13 (39%) | 4 (36%) | 0.15 |
IVH (Grade 3 or 4) | 5 (15%) | 6 (18%) | 6 (54%) *,† | 0.02 |
Presence of PDA at 36 weeks | 3 (9%) | 4 (12%) | 1 (9%) | 0.23 |
Postnatal steroid use | 3 (6%) | 17 (51%) ∞ | 4 (36%) * | <0.01 |
Mechanical ventilation days | 2 (1–5) | 18 (2–30) ∞ | 18 (2–41) * | <0.01 |
Total oxygen days (NICU) | 46 (28–76) | 98 (88–115) ∞ | 97 (66–118) * | <0.01 |
Length of stay (NICU) | 81 (69–101) | 113 (91–120) ∞ | 101 (66–119) * | <0.01 |
Patient | GA | BPD Severity | PH * | Designated Criteria for Diagnosis of PH | ||||||
---|---|---|---|---|---|---|---|---|---|---|
PDA Shunt ** | PFO/ASD Shunt ** | VSD Shunt ** | RVSP∞ > 40 mmHg | RVSP/sBP > 0.5 | RV Morphology Changes † | Septal Wall Flattening | ||||
1 | 28 | Mild | Yes | No | No | No | Yes | Yes | No | Moderate |
2 | 27 | Mild | Yes | No | No | No | Yes | Yes | No | None |
3 | 25 | Mild | Yes | No | No | No | Yes | Yes | No | Moderate |
4 | 25 | Mild | Yes | No | No | No | Yes | Yes | No | None |
5 | 27 | Moderate | Yes | No | No | No | Yes | Yes | No | None |
6 | 24 | Moderate | Yes | No | No | No | Yes | Yes | No | None |
7 | 27 | Moderate | Yes | No | No | No | Yes | Yes | No | None |
8 | 27 | Moderate | Yes | No | No | No | Yes | Yes | No | Moderate |
9 | 25 | Moderate | Yes | No | No | No | Yes | Yes | No | None |
10 | 25 | Severe | Yes | No | No | No | Yes | Yes | Yes | Moderate |
11 | 26 | Severe | Yes | No | No | No | Yes | Yes | No | Moderate |
Group I No-Mild BPD (n = 33) | Group II Mod-Sev BPD (n = 33) | Group III BPD-PH (n = 11) | F-Ratio p Value | |
---|---|---|---|---|
32 weeks PMA | ||||
LV e’ (cm/s) | 4.0 (4.0–5.0) | 4.0 (3.0–4.0) | 3.0 (3.0–4.0) | 0.19 |
LV a’ (cm/s) | 8.0 (7.0–9.0) | 7.0 (6.0–9.0) | 9.0 (8.0–10.0) | 0.23 |
LV s’ (cm/s) | 5.0 (4.0–5.0) | 5.0 (4.0–5.0) | 5.0 (4.0–5.0) | 0.98 |
LV e’/a’ | 0.57 (0.42–0.68) | 0.44 (0.37–0.62) | 0.46 (0.44–0.62) | 0.45 |
LV IVRT (ms) | 48 (45–58) | 52 (45–55) | 68 (60–69) *,† | <0.01 |
LV MPI | 0.49 (0.43–0.58) | 0.52 (0.44–0.65) | 0.51 (0.43–0.57) | 0.32 |
LV PSM (cm/s) | 2.5 (2.0–3.0) | 2.5 (2.0–3.0) | 4.0 (3.0–5.0) *,† | <0.01 |
36 weeks PMA | ||||
LV e’ (cm/s) | 4.0 (4.0–6.0) | 4.0 (3.0–4.0) | 3.0 (3.0–5.0) | 0.14 |
LV a’ (cm/s) | 8.0 (7.0–10.0) | 9.0 (7.0–10.0) | 7.0 (5.0 –10.0) | 0.56 |
LV s’ (cm/s) | 5.0 (4.0–5.0) | 5.0 (4.0–6.0) | 5.0 (4.0 –5.0) | 0.80 |
LV e’/a’ | 0.57 (0.50–0.67) | 0.46 (0.34–0.50) | 0.50 (0.40–0.60) | 0.67 |
LV IVRT (ms) | 52 (47–58) | 54 (47–61) | 67 (61–74) | <0.01 |
LV MPI | 0.54 (0.45–0.64) | 0.56 (0.49–0.62) | 0.52 (0.50–0.64) | 0.42 |
LV PSM (cm/s) | 3.0 (2.0–3.0) | 3.0 (2.0–4.0) | 4.0 (2.8–4.5) *,† | <0.01 |
One year CA | ||||
LV e’ (cm/s) | 12.0 (11.0–13.0) | 10.0 (8.0–13.0) | 12.0 (9.0–15.0)) | 0.4 |
LV a’ (cm/s) | 7.0 (6.0–8.0) | 7.0 (6.0–8.0) | 8.0 (6.0–0.0) | 0.93 |
LV s’ (cm/s) | 7.0 (6.0–8.0) | 7.0 (6.0–8.0) | 7.0 (6.0–8.0) | 0.20 |
LV e’/a’ | 1.44 (1.31–1.85) | 1.44 (1.31–1.85) | 1.38 (1.33–1.88) | 0.67 |
LV IVRT (ms) | 50 (45–57) | 49 (44–53) | 52 (48–57) | 0.43 |
LV MPI | 0.42 (0.38–0.46) | 0.43 (0.39–0.48) | 0.43 (0.39–0.51) | 0.64 |
LV PSM (cm/s) | 3.0 (2.0–4.0) | 3.0 (2.0–3.0) | 3.0 (2.0–3.0) | 0.56 |
Group I No-Mild BPD (n = 33) | Group II Mod-Sev BPD (n = 33) | Group III BPD-PH (n = 11) | F-Ratio p Value | |
---|---|---|---|---|
32 weeks PMA | ||||
Septal e’ (cm/s) | 4.0 (4.0–5.0) | 4.0 (3.0–4.0) | 5.0 (4.0–5.0) | 0.40 |
Septal a’ (cm/s) | 7.0 (6.0–8.0) | 6.0 (6.0–7.0) | 8.0 (6.0–8.0) | 0.42 |
Septal s’ (cm/s) | 4.0 (4.0–5.0) | 4.0 (4.0–5.0) | 4.0 (4.0–4.0) | 0.27 |
Septal e’/a’ | 0.56 (0.50–0.68) | 0.57 (0.50–0.67) | 0.65 (0.63–0.70) | 0.34 |
Septal IVRT (ms) | 45 (41–53) | 46 (40–53) | 52 (43–61) *,† | <0.01 |
Septal MPI | 0.43 (0.39–0.50) | 0.46 (0.41–0.50) | 0.46 (0.37–0.53) | 0.45 |
Septal PSM (cm/s) | 2.0 (2.0–2.0) | 2.0 (2.0–2.0) | 2.5 (2.0–3.0) *,† | <0.01 |
36 weeks PMA | ||||
Septal e’ (cm/s) | 5.0 (3.0–5.0) | 4.0 (3.0–4.0) | 4.0 (4.0–5.0) | 0.34 |
Septal a’ (cm/s) | 7.0 (6.0–8.0) | 7.0 (5.0–7.0) | 8.0 (7.0–9.0) | 0.65 |
Septal s’ (cm/s) | 5.0 (4.0–5.0) | 5.0 (4.0–5.0) | 5.0 (4.0–6.0) | 0.39 |
Septal e’/a’ | 0.63 (0.45–0.71) | 0.57 (0.43–0.71) | 0.56 (0.49–0.70) | 0.67 |
Septal IVRT (ms) | 46 (40–53) | 46 (41–54) | 52 (45–58) *,† | <0.01 |
Septal MPI | 0.44 (0.41–0.49) | 0.44 (0.40–0.51) | 0.44 (0.37–0.51) | 0.74 |
Septal PSM (cm/s) | 2.0 (2.0–3.0) | 2.0 (2.0–2.0) | 2.5 (2.0–3.3) *,† | <0.01 |
One year CA | ||||
Septal e’ (cm/s) | 10.0 (10.0–11.0) | 10.0 (9.0–11.0) | 10.0 (8.0–11.0) | 0.14 |
Septal a’ (cm/s) | 8.0 (6.0–9.0) | 9.0 (7.0–10.0) | 7.0 (6.0–9.0) | 0.24 |
Septal s’ (cm/s) | 7.0 (6.0–8.0) | 7.0 (6.0–8.0) | 7.0 (6.0–7.0) | 0.29 |
Septal e’/a’ | 1.4 (1.13–1.74) | 1.26 (0.88–1.67) | 1.25 (1.03– 1.86) | 0.67 |
Septal IVRT (ms) | 51 (46–54) | 50 (44–54) | 58 (44–64) *,† | <0.01 |
Septal MPI | 0.40 (0.35–0.44) | 0.40 (0.37–0.43) | 0.38 (0.33–0.45) | 0.50 |
Septal PSM (cm/s) | 2.0 (2.0–3.0) | 2.0 (2.0–3.0) | 3.0 (2.0–3.0) *,† | <0.01 |
Group I No-Mild BPD (n = 33) | Group II Mod-Sev BPD (n = 33) | Group III BPD-PH (n = 11) | Term Control (n = 50) | F-Ratio p Value | |
---|---|---|---|---|---|
LV medial (Septal) wall | |||||
Septal e’ (cm/s) | 10.0 (10.0–11.0) | 10.0 (9.0–11.0) | 10.0 (8.0–11.0) | 11.0 (9.0–12.0) | 0.11 |
Septal a’ (cm/s) | 8.0 (6.0–9.0) | 9.0 (7.0–10.0) | 7.0 (6.0–9.0) | 7.4 (6.3–9.5) | 0.29 |
Septal s’ (cm/s) | 7.0 (6.0–8.0) | 7.0 (6.0–8.0) | 7.0 (6.0–7.0) | 7.9 (6.5–9.0) | 0.24 |
Septal e’/a’ | 1.4 (1.13–1.74) | 1.26 (0.88–1.67) | 1.25 (1.03–1.86) | 1.40 (1.23–1.66) | 0.27 |
Septal IVRT (ms) | 51 (46–54) | 50 (44–54) | 58 (44–64) *,† | 46 (40–54) c | <0.01 |
Septal MPI | 0.40 (0.35–0.44) | 0.40 (0.37–0.43) | 0.38 (0.33–0.45) | 0.35 (0.31–0.43) | 0.30 |
Septal PSM (cm/s) | 2.0 (2.0–3.0) | 2.0 (2.0–3.0) | 3.0 (2.0–3.0) *† | NR | NA |
LV lateral wall | |||||
LV e’ (cm/s) | 12.0 (11.0–13.0) | 10.0 (8.0–13.0) | 12.0 (9.0–15.0) | 12.9 (11.0–15.0) | <0.01 |
LV a’ (cm/s) | 7.0 (6.0–8.0) | 7.0 (6.0–8.0) | 8.0 (6.0–0.0) | 9.0 (7.0–10.0) | 0.23 |
LV s’ (cm/s) | 7.0 (6.0–8.0) | 7.0 (6.0–8.0) | 7.0 (6.0–8.0) | 8.5 (7.0–10.0) a,b,c | <0.01 |
LV e’/a’ | 1.44 (1.31–1.85) | 1.44 (1.31–1.85) | 1.38 (1.33–1.88) | 1.28 (113–1.68) a,b,c | <0.01 |
LV IVRT (ms) | 50 (45–57) | 49 (44–53) | 52 (48–57) | 44 (38–51) a,b,c | <0.01 |
LV MPI | 0.42 (0.38–0.46) | 0.43 (0.39–0.48) | 0.43 (0.39–0.51) | 0.36 (0.31–0.49) a,b,c | <0.01 |
LV PSM (cm/s) | 3.0 (2.0–4.0) | 3.0 (2.0–3.0) | 3.0 (2.0–3.0) | NR | NA |
Preterm | Term | |||||
---|---|---|---|---|---|---|
Torres * | Poon 2019 [43] ** | Torres | Alp 2012 [46] | Choi 2016 [45] | Poon 2019 [43] | |
LV a’ (cm/s) | 11.8 (1.7) | 10.8 (1.2) | 12.8 (1.2) | 13.3 (0.9) | 11.3 (1.5) | 11.7 (2.1) |
LV a’ (cm/s) | 7.2 (1.6) | 3.6 (1.0) | 8.2 (1.3) | 11.1 (1.2) | 6.2 (1.3) | 3.7 (1.6) |
LV s’ (cm/s) | 6.5 (0.8) | 4.7 (1.0) | 8.4 (0.9) | 9.9 (0.8) | 7.0 (0.79) | 4.8 (1.0) |
LV e’/a’ | 1.6 (0.3) | NR | 1.3 (0.2) | 1.2 (0.1) | NR | 1.4 (0.2) |
LV IVRT (s) | 50.2 (7.4) | NR | 45 (3) | NR | NR | NR |
LV PSM (cm/s) | 3.0 (1.0) | NR | NR | NR | NR | NR |
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Torres, E.; Levy, P.T.; El-Khuffash, A.; Gu, H.; Hamvas, A.; Singh, G.K. Left Ventricle Phenotyping Utilizing Tissue Doppler Imaging in Premature Infants with Varying Severity of Bronchopulmonary Dysplasia. J. Clin. Med. 2021, 10, 2211. https://doi.org/10.3390/jcm10102211
Torres E, Levy PT, El-Khuffash A, Gu H, Hamvas A, Singh GK. Left Ventricle Phenotyping Utilizing Tissue Doppler Imaging in Premature Infants with Varying Severity of Bronchopulmonary Dysplasia. Journal of Clinical Medicine. 2021; 10(10):2211. https://doi.org/10.3390/jcm10102211
Chicago/Turabian StyleTorres, Eunice, Philip T. Levy, Afif El-Khuffash, Hongjie Gu, Aaron Hamvas, and Gautam K. Singh. 2021. "Left Ventricle Phenotyping Utilizing Tissue Doppler Imaging in Premature Infants with Varying Severity of Bronchopulmonary Dysplasia" Journal of Clinical Medicine 10, no. 10: 2211. https://doi.org/10.3390/jcm10102211