Serial Tissue Doppler Imaging in the Evaluation of Bronchopulmonary Dysplasia-associated Pulmonary Hypertension Among Extremely Preterm Infants: a Prospective Observational Study

Overview

Journal Front Pediatr

Specialty Pediatrics

Date 2024 Apr 22

PMID 38646509

Authors

Krishna Revanna Gopagondanahalli

Abdul Alim Abdul Haium

Shrenik Jitendrakumar Vora

Sreekanthan Sundararaghavan

Wei Di Ng

Tze Liang Jonathan Choo

Wai Lin Ang

Nur Qaiyimah Binte Mohamad Taib

Nishanthi Han Ying Wijedasa

Victor Samuel Rajadurai

Kee Thai Yeo

Teng Hong Tan

Affiliations

Soon will be listed here.

Abstract

Objectives: To evaluate serial tissue Doppler cardiac imaging (TDI) in the evolution of bronchopulmonary dysplasia-associated pulmonary hypertension (BPD-PH) among extremely preterm infants.

Design: Prospective observational study.

Setting: Single-center, tertiary-level neonatal intensive care unit.

Patients: Infant born <28 weeks gestation.

Main Outcome Measures: Utility of TDI in the early diagnosis and prediction of BPD-PH and optimal timing for screening of BPD-PH.

Results: A total of 79 infants were included. Of them, 17 (23%) had BPD-PH. The mean gestational age was 25.9 ± 1.1 weeks, and mean birth weight was 830 ± 174 g. The BPD-PH group had a high incidence of hemodynamically significant patent ductus arteriosus (83% vs. 56%, < 0.018), longer oxygen days (96.16 ± 68.09 vs. 59.35 ± 52.1, < 0.008), and prolonged hospital stay (133.8 ± 45.9 vs. 106.5 ± 37.9 days, < 0.005). The left ventricular eccentricity index (0.99 ± 0.1 vs. 1.1 ± 0.7, < 0.01) and the ratio of acceleration time to right ventricular ejection time showed a statistically significant trend from 33 weeks (0.24 ± 0.05 vs. 0.28 ± 0.05, < 0.05). At 33 weeks, the BPD-PH group showed prolonged isovolumetric contraction time (27.84 ± 5.5 vs. 22.77 ± 4, < 0.001), prolonged isovolumetric relaxation time (40.3 ± 7.1 vs. 34.9 ± 5.3, < 0.003), and abnormal myocardial performance index (0.39 ± 0.05 vs. 0.32 ± 0.03, < 0.001). These differences persisted at 36 weeks after conceptional gestational age.

Conclusions: TDI parameters are sensitive in the early evolution of BPD-PH. Diagnostic accuracy can be increased by combining the TDI parameters with conventional echocardiographic parameters. BPD-PH can be recognizable as early as 33-34 weeks of gestation.

Citing Articles

Embolization treatment of right pulmonary artery agenisis with patent ductus arteriosus causing pulmonary hypertension and hemoptysis: a case report and literature review.

Wei F, Yaowen C, Wenhui W J Cardiothorac Surg. 2024; 19(1):391.

PMID: 38926785 PMC: 11209968. DOI: 10.1186/s13019-024-02883-9.

References

Yajamanyam P, Negrine R, Rasiah S, Zamora J, Ewer A . Assessment of myocardial function in preterm infants with chronic lung disease using tissue Doppler imaging. Arch Dis Child Fetal Neonatal Ed. 2016; 101(6):F527-F532. DOI: 10.1136/archdischild-2015-308929. View

Abraham S, Weismann C . Left Ventricular End-Systolic Eccentricity Index for Assessment of Pulmonary Hypertension in Infants. Echocardiography. 2016; 33(6):910-5. DOI: 10.1111/echo.13171. View

Patel N, Mills J, Cheung M . Use of the myocardial performance index to assess right ventricular function in infants with pulmonary hypertension. Pediatr Cardiol. 2008; 30(2):133-7. DOI: 10.1007/s00246-008-9285-1. View

Mourani P, Abman S . Pulmonary Hypertension and Vascular Abnormalities in Bronchopulmonary Dysplasia. Clin Perinatol. 2015; 42(4):839-55. PMC: 5863545. DOI: 10.1016/j.clp.2015.08.010. View

Lammers A, Haworth S, Riley G, Maslin K, Diller G, Marek J . Value of tissue Doppler echocardiography in children with pulmonary hypertension. J Am Soc Echocardiogr. 2012; 25(5):504-10. DOI: 10.1016/j.echo.2012.01.017. View

Schmitz L, Stiller B, Koch H, Koehne P, Lange P . Diastolic left ventricular function in preterm infants with a patent ductus arteriosus: a serial Doppler echocardiography study. Early Hum Dev. 2004; 76(2):91-100. DOI: 10.1016/j.earlhumdev.2003.11.002. View

Nestaas E, Schubert U, de Boode W, El-Khuffash A . Tissue Doppler velocity imaging and event timings in neonates: a guide to image acquisition, measurement, interpretation, and reference values. Pediatr Res. 2018; 84(Suppl 1):18-29. PMC: 6257218. DOI: 10.1038/s41390-018-0079-8. View

Chen Y, Zhang D, Li Y, Yan A, Wang X, Hu X . Risk Factors and Outcomes of Pulmonary Hypertension in Infants With Bronchopulmonary Dysplasia: A Meta-Analysis. Front Pediatr. 2021; 9:695610. PMC: 8267150. DOI: 10.3389/fped.2021.695610. View

Levy P, Patel M, Groh G, Choudhry S, Murphy J, Holland M . Pulmonary Artery Acceleration Time Provides a Reliable Estimate of Invasive Pulmonary Hemodynamics in Children. J Am Soc Echocardiogr. 2016; 29(11):1056-1065. PMC: 5408579. DOI: 10.1016/j.echo.2016.08.013. View

10.

Baker C, Abman S, Mourani P . Pulmonary Hypertension in Preterm Infants with Bronchopulmonary Dysplasia. Pediatr Allergy Immunol Pulmonol. 2014; 27(1):8-16. PMC: 3961769. DOI: 10.1089/ped.2013.0323. View

11.

Seo Y, Choi H . Clinical Utility of Echocardiography for Early and Late Pulmonary Hypertension in Preterm Infants: Relation with Bronchopulmonary Dysplasia. J Cardiovasc Ultrasound. 2018; 25(4):124-130. PMC: 5762695. DOI: 10.4250/jcu.2017.25.4.124. View

12.

Gentle S, Travers C, Clark M, Carlo W, Ambalavanan N . Patent Ductus Arteriosus and Development of Bronchopulmonary Dysplasia-associated Pulmonary Hypertension. Am J Respir Crit Care Med. 2022; 207(7):921-928. PMC: 10111998. DOI: 10.1164/rccm.202203-0570OC. View

13.

Mourani P, Sontag M, Younoszai A, Miller J, Kinsella J, Baker C . Early pulmonary vascular disease in preterm infants at risk for bronchopulmonary dysplasia. Am J Respir Crit Care Med. 2014; 191(1):87-95. PMC: 4299632. DOI: 10.1164/rccm.201409-1594OC. View

14.

Islam J, Keller R, Aschner J, Hartert T, Moore P . Understanding the Short- and Long-Term Respiratory Outcomes of Prematurity and Bronchopulmonary Dysplasia. Am J Respir Crit Care Med. 2015; 192(2):134-56. PMC: 4532824. DOI: 10.1164/rccm.201412-2142PP. View

15.

Pellett A, Tolar W, Merwin D, Kerut E . The Tei index: methodology and disease state values. Echocardiography. 2004; 21(7):669-72. DOI: 10.1111/j.0742-2822.2004.04052.x. View

16.

Bhat R, Salas A, Foster C, Carlo W, Ambalavanan N . Prospective analysis of pulmonary hypertension in extremely low birth weight infants. Pediatrics. 2012; 129(3):e682-9. PMC: 3289526. DOI: 10.1542/peds.2011-1827. View

17.

Khemani E, McElhinney D, Rhein L, Andrade O, Lacro R, Thomas K . Pulmonary artery hypertension in formerly premature infants with bronchopulmonary dysplasia: clinical features and outcomes in the surfactant era. Pediatrics. 2007; 120(6):1260-9. DOI: 10.1542/peds.2007-0971. View

18.

Ali Z, Schmidt P, Dodd J, Jeppesen D . Predictors of bronchopulmonary dysplasia and pulmonary hypertension in newborn children. Dan Med J. 2013; 60(8):A4688. View

19.

Koestenberger M, Grangl G, Avian A, Gamillscheg A, Grillitsch M, Cvirn G . Normal Reference Values and z Scores of the Pulmonary Artery Acceleration Time in Children and Its Importance for the Assessment of Pulmonary Hypertension. Circ Cardiovasc Imaging. 2016; 10(1). DOI: 10.1161/CIRCIMAGING.116.005336. View

20.

Czernik C, Rhode S, Metze B, Schmalisch G, Buhrer C . Persistently elevated right ventricular index of myocardial performance in preterm infants with incipient bronchopulmonary dysplasia. PLoS One. 2012; 7(6):e38352. PMC: 3365901. DOI: 10.1371/journal.pone.0038352. View