Advertisement

Pediatric Cardiology

, Volume 36, Issue 1, pp 20–26 | Cite as

Longitudinal Systolic Left Ventricular Function in Preterm and Term Neonates: Reference Values of the Mitral Annular Plane Systolic Excursion (MAPSE) and Calculation of z-Scores

  • Martin KoestenbergerEmail author
  • Bert Nagel
  • William Ravekes
  • Andreas Gamillscheg
  • Corinna Binder
  • Alexander Avian
  • Jasmin Pansy
  • Gerhard Cvirn
  • Berndt Urlesberger
Original Article

Abstract

The mitral annular plane systolic excursion (MAPSE) is a quick and reliable echocardiographic tool for assessing longitudinal left ventricular (LV) systolic function in children and adults. Because this parameter is affected by the LV longitudinal dimension, pediatric and adult normal values are not suitable for preterm and term neonates. A prospective study investigated a large group of preterm and term neonates [gestational age (GA), 26/0–6 to 40/0–6; birth weight (BW), 670–4,140 g]. The growth- and BW-related changes in MAPSE were determined to establish normal z-score values for preterm and term neonates. The MAPSE ranged from a mean of 0.36 ± 0.05 cm in preterm neonates with a GA of 26/0–6 to 0.56 ± 0.08 cm in term neonates with a GA of 40/0–6. The findings showed MAPSE, GA, and BW to be moderately correlated. Pearson’s correlation coefficient was 0.56 for GA (MAPSE; p < 0.001) and 0.58 for BW (MAPSE; p < 0.001). The normal MAPSE values did not differ significantly between females and males (p = 0.946). The absolute values and z-scores of normal MAPSE values in healthy preterm and term neonates within the first 48 h of life were calculated, and percentile charts were established. Determination of LV function using MAPSE might be useful for vulnerable infants for whom a prolonged examination is inappropriate and for neonates with suboptimal visualization of the endocardium.

Keywords

Mitral annular plane systolic excursion Left ventricular long-axis function Preterm Neonates Reference values Birth weight M-mode z-Score 

Notes

Conflict of interest

All authors state that there are no financial, personal or other relationships with other people or organizations that could inappropriately influence our work to disclose.

References

  1. 1.
    Aggarwal S, Stockmann P, Klein MD, Natarajan G (2011) Echocardiographic measures of ventricular function and pulmonary artery size: prognostic markers of congenital diaphragmatic hernia? J Perinatol 31:561–566PubMedCrossRefGoogle Scholar
  2. 2.
    Alp H, Karaarslan S, Baysal T, Cimen D, Ors R, Oran B (2012) Normal values of left and right ventricular function measured by M-mode, pulsed Doppler, and Doppler tissue imaging in healthy term neonates during a 1-year period. Early Hum Dev 88:853–859PubMedCrossRefGoogle Scholar
  3. 3.
    Arce O, Knudson O, Ellison M, Baselga P, Ivy DD, DeGroff C et al (2002) Longitudinal motion of the atrioventricular annuli in children: reference values, growth-related changes, and effects of right ventricular volume and pressure overload. J Am Soc Echocardiogr 15:906–916PubMedCrossRefGoogle Scholar
  4. 4.
    Ciccone MM, Scicchitano P, Zito A, Gesualdo M, Sassara M, Calderoni G et al (2011) Different functional cardiac characteristics observed in term/preterm neonates by echocardiography and tissue Doppler imaging. Early Hum Dev 87:555–558PubMedCrossRefGoogle Scholar
  5. 5.
    Claure N, Bancalari E (2008) Mechanical ventilatory support in preterm infants. Minerva Pediatr 60:177–182PubMedGoogle Scholar
  6. 6.
    El-Khuffash AF, Jain A, Dragulescu A, McNamara PJ, Mertens L (2012) Acute changes in myocardial systolic function in preterm infants undergoing patent ductus arteriosus ligation: a tissue Doppler and myocardial deformation study. J Am Soc Echocardiogr 25:1058–1067PubMedCrossRefGoogle Scholar
  7. 7.
    Elnoamany MF, Abdelhameed AK (2006) Mitral annular motion as a surrogate for left ventricular function: correlation with brain natriuretic peptide levels. Eur J Echocardiogr 7:187–198PubMedCrossRefGoogle Scholar
  8. 8.
    Eriksen BH, Nestaas E, Hole T, Liestøl K, Støylen A, Fugelseth D (2013) Myocardial function in premature infants: a longitudinal observational study. BMJ Open 3(3)Google Scholar
  9. 9.
    Eriksen BH, Nestaas E, Hole T, Liestøl K, Støylen A, Fugelseth D (2013) Longitudinal assessment of atrioventricular annulus excursion by grey-scale M-mode and colour tissue Doppler imaging in premature infants. Early Hum Dev 89:977–982PubMedCrossRefGoogle Scholar
  10. 10.
    Evans N, Archer LN (1990) Postnatal circulatory adaptation in term and healthy preterm neonates. Arch Dis Child 65:24–26PubMedCentralPubMedCrossRefGoogle Scholar
  11. 11.
    Grossman W, Braunwald E, Mann T, McLaurin LP, Green LH (1977) Contractile state of the left ventricle in man as evaluated from end-systolic pressure-volume relations. Circulation 56:845–852PubMedCrossRefGoogle Scholar
  12. 12.
    Helfer S, Schmitz L, Bührer C, Czernik C (2013) Tissue Doppler-derived strain and strain rate during the first 28 days of life in very-low-birth-weight infants. Echocardiography. doi: 10.1111/echo.12463 Google Scholar
  13. 13.
    Henry WL, Ware J, Gardin JM, Hepner SI, McKay J, Weiner M (1978) Echocardiographic measurements in normal subjects: growth-related changes that occur between infancy and early adulthood. Circulation 57:278–285PubMedCrossRefGoogle Scholar
  14. 14.
    Iwashima S, Sekii K, Ishikawa T, Itou H (2013) Serial change in myocardial tissue Doppler imaging from fetus to neonate. Early Hum Dev 89:687–692PubMedCrossRefGoogle Scholar
  15. 15.
    Joshi S, Edwards JM, Wilson DG, Wong JK, Kotecha S, Fraser AG (2010) Reproducibility of myocardial velocity and deformation imaging in term and preterm infants. Eur J Echocardiogr 11:44–50PubMedCrossRefGoogle Scholar
  16. 16.
    Koestenberger M, Nagel B, Ravekes W, Urlesberger B, Raith W, Avian A, Halb V, Cvirn G, Fritsch P, Gamillscheg A (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 100:85–92PubMedCrossRefGoogle Scholar
  17. 17.
    Koestenberger M, Nagel B, Ravekes W, Avian A, Heinzl B, Fritsch P et al (2012) Left ventricular long-axis function: reference values of the mitral annular plane systolic excursion in 558 healthy children and calculation of z score values. Am Heart J 164:125–131PubMedCrossRefGoogle Scholar
  18. 18.
    Koestenberger M, Nagel B, Ravekes W, Gamillscheg A, Pichler G, Avian A, Heinzl B, Binder C, Cvirn G, Urlesberger B (2013) Right ventricular performance in preterm and term neonates: reference values of tricuspid annular peak systolic velocity (S′) measured by tissue Doppler imaging (TDI). Neonatology 103:281–286PubMedCrossRefGoogle Scholar
  19. 19.
    Lang RM, Bierig M, Devereux RB, Flachskampf FA, Foster E, Pellikka PA et al (2005) Recommendations for chamber quantifications: a report from the American Society of Echocardiography’s Guidelines and Standards Committee and the Chamber Quantification Writing Group, developed in conjunction with the European Association of Echocardiography, a branch of the European Society of Cardiology. J Am Soc Echocardiogr 18:1440–1463PubMedCrossRefGoogle Scholar
  20. 20.
    Lee A, Nestaas E, Liestøl K, Brunvand L, Lindemann R, Fugelseth D (2014) Tissue Doppler imaging in very preterm infants during the first 24 h of life: an observational study. Arch Dis Child Fetal Neonatal Ed 99:F64–F69PubMedCrossRefGoogle Scholar
  21. 21.
    Matos J, Kronzon I, Panagopoulos G, Perk G (2012) Mitral annular plane systolic excursion as a surrogate for left ventricular ejection fraction. J Am Soc Echocardiogr 25:969–974PubMedCrossRefGoogle Scholar
  22. 22.
    Mertens L, Seri I, Marek J, Arlettaz R, Barker P, McNamara P, Writing Group of the American Society of Echocardiography, European Association of Echocardiography, Association for European Pediatric Cardiologists et al (2011) Targeted neonatal echocardiography in the neonatal intensive care unit: practice guidelines and recommendations for training. J Am Soc Echocardiogr 24:1057–1078PubMedCrossRefGoogle Scholar
  23. 23.
    Mondillo S, Galderisi M, Ballo P, Marino PN, Study Group of Echocardiography of the Italian Society of Cardiology (2006) Left ventricular systolic longitudinal function: comparison among simple M-mode, pulsed, and M-mode color tissue Doppler of mitral annulus in healthy individuals. J Am Soc Echocardiogr 19:1085–1091PubMedCrossRefGoogle Scholar
  24. 24.
    Moritz B, Fritz M, Mann C, Simma B (2008) Nasal continuous positive airway pressure (n-CPAP) does not change cardiac output in preterm infants. Am J Perinatol 25:105–109PubMedCrossRefGoogle Scholar
  25. 25.
    Murase M, Morisawa T, Ishida A (2013) Serial assessment of left-ventricular function using tissue Doppler imaging in premature infants within 7 days of life. Pediatr Cardiol 34:1491–1498PubMedCrossRefGoogle Scholar
  26. 26.
    Noori S, Wlodaver A, Gottipati V, McCoy M, Schultz D, Escobedo M (2012) Transitional changes in cardiac and cerebral hemodynamics in term neonates at birth. J Pediatr 160:943–948PubMedCrossRefGoogle Scholar
  27. 27.
    Popat H, Kluckow M (2012) Noninvasive assessment of the early transitional circulation in healthy term infants. Neonatology 101:166–171PubMedCrossRefGoogle Scholar
  28. 28.
    Qin JX, Shiota T, Tsujino H, Saracino G, White R, Greenberg N et al (2004) Mitral annular motion as a surrogate for left ventricular ejection fraction: real-time three-dimensional echocardiography and magnetic resonance imaging studies. Eur J Echocardiogr 5:407–415PubMedCrossRefGoogle Scholar
  29. 29.
    Resch B, Gusenleitner W, Müller W (2003) Procalcitonin and interleukin-6 in the diagnosis of early-onset sepsis of the neonate. Acta Paediatr 92:243–245PubMedCrossRefGoogle Scholar
  30. 30.
    Roberson DA, Cui W, Chen Z, Madronero LF, Cuneo BF (2007) Annular and septal Doppler tissue imaging in children: normal z score tables and effects of age, heart rate, and body surface area. J Am Soc Echocardiogr 20:1276–1284PubMedCrossRefGoogle Scholar
  31. 31.
    Schubert U, Müller M, Norman M, Abdul-Khaliq H (2013) Transition from fetal to neonatal life: changes in cardiac function assessed by speckle-tracking echocardiography. Early Hum Dev 89:803–808PubMedCrossRefGoogle Scholar
  32. 32.
    St John Sutton MG, Gewitz MH, Shah B, Cohen A, Reichek N, Gabbe S et al (1984) Quantitative assessment of growth and function of the cardiac chambers in the normal human fetus: a prospective longitudinal echocardiographic study. Circulation 69:645–654PubMedCrossRefGoogle Scholar
  33. 33.
    Støylen A, Skjaerpe T (2003) Systolic long axis function of the left ventricle: global and regional information. Scand Cardiovasc J 37:253–258PubMedCrossRefGoogle Scholar
  34. 34.
    Wei Y, Xu J, Xu T, Fan J, Tao S (2009) Left ventricular systolic function of newborns with asphyxia evaluated by tissue Doppler imaging. Pediatr Cardiol 30:741–746PubMedCrossRefGoogle Scholar
  35. 35.
    Willenheimer R, Cline C, Erhardt L, Israelsson B (1997) Left ventricular atrioventricular plane displacement: an echocardiographic technique for rapid assessment of prognosis in heart failure. Heart 78:230–236PubMedCentralPubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2014

Authors and Affiliations

  • Martin Koestenberger
    • 1
    Email author
  • Bert Nagel
    • 1
  • William Ravekes
    • 2
  • Andreas Gamillscheg
    • 1
  • Corinna Binder
    • 3
  • Alexander Avian
    • 4
  • Jasmin Pansy
    • 3
  • Gerhard Cvirn
    • 5
  • Berndt Urlesberger
    • 3
  1. 1.Division of Pediatric Cardiology, Department of PediatricsMedical University GrazGrazAustria
  2. 2.Division of Pediatric CardiologyJohns Hopkins University School of MedicineBaltimoreUSA
  3. 3.Division of Neonatology, Department of PediatricsMedical University GrazGrazAustria
  4. 4.Institute for Medical Informatics, Statistics and DocumentationMedical University GrazGrazAustria
  5. 5.Institute of Physiological Chemistry, Center of Physiological MedicineMedical University GrazGrazAustria

Personalised recommendations