NEONATAL SOCIETY ABSTRACTS
Right ventricular and pulmonary vascular coupling is influenced by left ventricular diastolic function in premature infants
Presented at the Neonatal Society 2018 Summer Meeting (programme).
Bussmann N1,2, EL-Khuffash A1,3, Breatnach CR1, McCallion N1,3, Franklin O4, Singh GK5, Levy PT5
1 Department of Neonatology, The Rotunda Hospital, Dublin, Ireland
2 National Children’s Research Centre, Our Lady’s Children’s Hospital Crumlin, Dublin, Ireland
3 School of Medicine (Department of Pediatrics), Royal College of Surgeons in Ireland, Dublin, Ireland
4 Department of Pediatric Cardiology, Our Lady’s Children’s Hospital, Crumlin, Dublin, Ireland
5 Department of Pediatrics, Washington University School of Medicine, Saint Louis, MO, USA
Background: Reduced left ventricular (LV) diastolic function can exert significant load to the right ventricle (RV) that can affect RV–pulmonary vascular (PV) coupling. RV-PV can be assessed with the RV length–force relationship (tricuspid annular plane systolic excursion [TAPSE] to pulmonary artery acceleration time [PAAT] ratio). We aimed to determine the correlation between TAPSE:PAAT and LV diastolic function measured using tissue Doppler imaging (TDI) on Day 1 and its relationship with pulmonary haemorrhage.
Methods: A prospective study of 162 infants with a mean±SD gestation and birthweight of 26.6±1.5 weeks & 938±241 grams. TAPSE:PAAT, LV and septal e` and a` waves were measured on Day 1. PAAT was adjusted for heart rate variability by RV ejection time (PAAT:RVET). Correlation between diastolic indices and TAPSE:PAAT was performed. Receiver operating characteristic (ROC) curve was constructed for pulmonary haemorrhage prediction.
Results: There was a significant positive correlation between TAPSE:PAAT and TAPSE:(PAAT:RVET) with TDI indices of LV diastolic function. This relationship remained significant when adjusting for gestation and RV length (all p<0.01). TAPSE:(PAAT:RVET) was lower in infants who developed pulmonary haemorrhage (n=11, 7%): 11 [6–19] vs. 18 [14–23], p=0.02. For detection of pulmonary haemorrhage, a TAPSE:(PAAT:RVET) > 15 on Day 1 resulted in a sensitivity of 77% and a specificity of 67% with an area under ROC curve of 0.77 (0.59-0.95, 95% CI, p=0.02).
Conclusion: Those findings may have important clinical implications in understanding the role of left heart diseases with the evolution of pulmonary haemorrhage and RV-PV coupling in these infants.
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