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Left Ventricular Diastolic Dysfunction and Diastolic Heart Failure in Preterm Infants

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Abstract

Diastolic dysfunction is primarily an echocardiographic diagnosis. Its clinical counterpart is diastolic heart failure, where the heart has difficulty to fill at normal pressure and the patient develops signs of pulmonary edema. Although diastolic dysfunction is common in adults, limited information is available in preterm infants. The aim of this study is to explore left ventricular diastolic dysfunction and diastolic heart failure in preterm infants and describe clinical manifestations in this population. This is a retrospective observational study in preterm infants < 30 weeks’ gestation who received an echocardiography in the first 4 weeks after birth. Diastolic dysfunction was graded using a population-specific adapted version of the adult recommendations for the evaluation of left ventricular diastolic function by echocardiography. Left ventricular diastolic dysfunction was absent, indeterminate, and definite in 82%, 14%, and 4% of the 168 echocardiograms analyzed, and is associated with increased respiratory signs and respiratory deterioration at 48 h before echocardiogram. In seven infants, diastolic heart failure was diagnosed with both ultrasound and clinical signs. The cumulative risk of diastolic dysfunction increased with the increasing postnatal age and a patent ductus arteriosus. Evidence of left ventricular diastolic dysfunction on echocardiography is relatively common in preterm infants, while the left ventricular diastolic heart failure is less frequent. Prolonged exposure to volume load was the most common cause.

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Fig. 1

Abbreviations

A:

Mitral inflow peak late peak diastolic velocity

a’:

Mitral annular late peak diastolic velocity

E:

Mitral inflow early peak diastolic velocity

e’:

Mitral annular early peak diastolic velocity

LA:

Left atrium

LAvol:

Left atrium volume index

LV:

Left ventricular

LVO:

Left ventricular output

nCPAP:

Nasal continuous positive airway pressure

PDA:

Patent ductus arteriosus

RSS:

Respiratory severity score

TDI:

Tissue Doppler imaging

TR:

Tricuspid regurgitation

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Funding

This study was funded by the Hunter Medical Research Institute.

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Authors and Affiliations

  1. John Hunter Children’s Hospital and University of Newcastle, Newcastle, NSW, Australia

    Koert de Waal, Nicholas Costley, Nilkant Phad & Edward Crendal

Authors
  1. Koert de Waal
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  2. Nicholas Costley
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  3. Nilkant Phad
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  4. Edward Crendal
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Correspondence to Koert de Waal.

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All authors declare that they have no conflict of interest.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or National Research Committee and with the 1964 Helsinki declaration and its later amendments, or comparable ethical standards. This article does not contain any studies with animals, performed by any of the authors.

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Informed consent was obtained from all individual participants included in the study.

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de Waal, K., Costley, N., Phad, N. et al. Left Ventricular Diastolic Dysfunction and Diastolic Heart Failure in Preterm Infants. Pediatr Cardiol 40, 1709–1715 (2019). https://doi.org/10.1007/s00246-019-02208-x

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  • DOI: https://doi.org/10.1007/s00246-019-02208-x

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