Abstract
Non-invasive evaluation of right ventricular (RV) systolic function in neonates with pulmonary hypertension (PH) with traditional metrics including RV fractional area change (FAC) and tricuspid annular systolic plane excursion (TAPSE) has improved outcomes. Apical three-chamber (3C) RV–FAC, a novel tripartite assessment of the RV, has recently been described in healthy infants. We assess the utility of 3C RV–FAC and biplane RV–FAC in delayed transitioning and neonatal PH. Echocardiograms for 22 normal infants and 22 infants with PH were retrospectively analyzed for RV systolic function indices including four chamber (4C), 3C, and biplane RV–FAC, TAPSE, Tei index, and RV systolic excursion velocity (S’). 4C, 3C, and biplane RV–FAC correlated with PH severity and was decreased in neonates with PH compared to normal neonates (biplane RV–FAC 31.7 ± 13.4% vs. 41 .9 ± 4.7%, p = 0.002). TAPSE was significantly decreased in neonates with PH, but did not correlate with PH severity. Other RV systolic function metrics were not significantly different between normal neonates and neonates with PH. 3C RV–FAC and biplane RV–FAC are lower in neonates with PH. 3C and biplane RV–FAC may allow for improved assessment of global RV systolic dysfunction in newborns with delayed transitioning or PH compared to the commonly used regional methods.
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References
Abman SH et al (2015) Pediatric pulmonary hypertension: guidelines from the american heart association and american thoracic society. Circulation 132(21):2037–2099
Smith A et al (2019) Accuracy and reliability of qualitative echocardiography assessment of right ventricular size and function in neonates. Echocardiography 36(7):1346–1352
Levy PT et al (2013) Feasibility and reproducibility of systolic right ventricular strain measurement by speckle-tracking echocardiography in premature infants. J Am Soc Echocardiogr 26(10):1201–1213
Czernik C et al (2012) Persistently elevated right ventricular index of myocardial performance in preterm infants with incipient bronchopulmonary dysplasia. PLoS ONE 7(6):e38352
Levy PT et al (2015) Right ventricular function in preterm and term neonates: reference values for right ventricle areas and fractional area of change. J Am Soc Echocardiogr 28(5):559–569
Koestenberger M et al (2011) Systolic right ventricular function in preterm and term neonates: reference values of the tricuspid annular plane systolic excursion (TAPSE) in 258 patients and calculation of Z-score values. Neonatology 100(1):85–92
Jain A et al (2014) A comprehensive echocardiographic protocol for assessing neonatal right ventricular dimensions and function in the transitional period: normative data and z scores. J Am Soc Echocardiogr 27(12):1293–1304
Shiran H et al (2014) Relationship between echocardiographic and magnetic resonance derived measures of right ventricular size and function in patients with pulmonary hypertension. J Am Soc Echocardiogr 27(4):405–412
Lopez, L., et al. (2010). Recommendations for quantification methods during the performance of a pediatric echocardiogram: a report from the Pediatric Measurements Writing Group of the American Society of Echocardiography Pediatric and Congenital Heart Disease Council. J Am Soc Echocardiogr, 23(5): 465–495, quiz 576–7.
Rudski, L.G., et al. (2010). Guidelines for the echocardiographic assessment of the right heart in adults: a report from the American Society of Echocardiography endorsed by the European Association of Echocardiography, a registered branch of the European Society of Cardiology, and the Canadian Society of Echocardiography. J Am Soc Echocardiogr, 23(7): 685–713, quiz 786–788.
Vonk MC et al (2007) Right ventricle Tei-index: a tool to increase the accuracy of non-invasive detection of pulmonary arterial hypertension in connective tissue diseases. Eur J Echocardiogr 8(5):317–321
Kossaify A (2015) Echocardiographic assessment of the right ventricle, from the conventional approach to speckle tracking and three-dimensional imaging, and insights into the "right way" to explore the forgotten chamber. Clin Med Insights Cardiol 9:65–75
Breatnach CR et al (2016) Novel echocardiography methods in the functional assessment of the newborn heart. Neonatology 110(4):248–260
Lai WW et al (2008) Accuracy of guideline recommendations for two-dimensional quantification of the right ventricle by echocardiography. Int J Cardiovasc Imaging 24(7):691–698
Sato T et al (2012) Validation study on the accuracy of echocardiographic measurements of right ventricular systolic function in pulmonary hypertension. J Am Soc Echocardiogr 25(3):280–286
Ghio S et al (2002) Usefulness and limits of transthoracic echocardiography in the evaluation of patients with primary and chronic thromboembolic pulmonary hypertension. J Am Soc Echocardiogr 15(11):1374–1380
Kassem E, Humpl T, Friedberg MK (2013) Prognostic significance of 2-dimensional, M-mode, and Doppler echo indices of right ventricular function in children with pulmonary arterial hypertension. Am Heart J 165(6):1024–1031
Hopper RK et al (2018) Right ventricular function mirrors clinical improvement with use of prostacyclin analogues in pediatric pulmonary hypertension. Pulm Circ 8(2):2045894018759247
Rajagopal S et al (2014) Comprehensive assessment of right ventricular function in patients with pulmonary hypertension with global longitudinal peak systolic strain derived from multiple right ventricular views. J Am Soc Echocardiogr 27(6):657–665.e3
Kurath-Koller S et al (2019) Normal pediatric values of the subcostal tricuspid annular plane systolic excursion (s-tapse) and its value in pediatric pulmonary hypertension. Can J Cardiol 35(7):899–906
Aggarwal S, Agarwal P, Natarajan G (2019) Echocardiographic prediction of severe pulmonary hypertension in neonates undergoing therapeutic hypothermia for hypoxic-ischemic encephalopathy. J Perinatol 39(12):1656–1662
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Chikkabyrappa, S.M., Critser, P., Roane, J. et al. Tripartite Assessment of Right Ventricular Systolic Function in Persistent Pulmonary Hypertension of the Newborn. Pediatr Cardiol 41, 1206–1211 (2020). https://doi.org/10.1007/s00246-020-02376-1
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DOI: https://doi.org/10.1007/s00246-020-02376-1