Echocardiographic Assessment of Right Ventricular Afterload in Preterm Infants: Maturational Patterns of Pulmonary Artery Acceleration Time Over the First Year of Age and Implications for Pulmonary Hypertension

Meghna D Patel; Colm R Breatnach; Adam T James; Swati Choudhry; Patrick J McNamara; Amish Jain; Orla Franklin; Aaron Hamvas; Luc Mertens; Gautam K Singh; Afif EL-Khuffash; Philip T Levy

doi:10.1016/j.echo.2019.03.015

Journal article

Echocardiographic Assessment of Right Ventricular Afterload in Preterm Infants: Maturational Patterns of Pulmonary Artery Acceleration Time Over the First Year of Age and Implications for Pulmonary Hypertension

Meghna D Patel, Colm R Breatnach, Adam T James, Swati Choudhry, Patrick J McNamara, Amish Jain, Orla Franklin, Aaron Hamvas, Luc Mertens, Gautam K Singh, …

Journal of the American Society of Echocardiography, Vol.32(7), pp.884-894.e4

07/2019

DOI: 10.1016/j.echo.2019.03.015

PMCID: PMC6613806

PMID: 31272593

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https://www.ncbi.nlm.nih.gov/pmc/articles/6613806View

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Abstract

Assessment of pulmonary hemodynamics is critical in the diagnosis and management of cardiopulmonary disease of premature infants, but reliable noninvasive indices of pulmonary hemodynamics in preterm infants are lacking. Because pulmonary artery acceleration time (PAAT) is a validated noninvasive method to assess right ventricular (RV) afterload in infants and children, the aim of this study was to investigate the maturational changes of PAAT measures in preterm infants over the first year of age and to discern the impact of typical cardiopulmonary abnormalities on these measures. In a prospective multicenter study of 239 preterm infants (<29 weeks at birth), PAAT was assessed at days 1, 2, and 5 to 7, at 32 and 36 weeks' postmenstrual age, and at 1-year corrected age. To account for heart rate variability, PAAT was adjusted for RV ejection time. Premature infants who developed bronchopulmonary dysplasia or had echocardiographic findings of pulmonary hypertension were analyzed separately. Intra- and interobserver reproducibility analysis was performed. PAAT was feasible in 95% of the image acquisitions, and there was high intra- and interobserver agreement (intraclass correlation coefficients > 0.9 and coefficients of variation < 6%). In uncomplicated preterm infants (n = 103 [48%]) PAAT and PAAT adjusted for RV ejection time increased longitudinally from birth to 1-year corrected age (P < .001) and were linearly associated with gestational age at birth (r = 0.81 and r = 0.82, P < .001) and increasing postnatal weight and postnatal age (r > 0.81, P < .001). PAAT measures were significantly reduced (P < .001) in infants with bronchopulmonary dysplasia and/or pulmonary hypertension (n = 119 [51%]) beyond 1 week of age. PAAT measures increase in preterm infants from birth to 1-year corrected age, reflective of the physiologic postnatal drop in RV afterload. Bronchopulmonary dysplasia and pulmonary hypertension have a negative impact on PAAT measures. By demonstrating excellent reliability and establishing reference patterns of PAAT in preterm infants, this study suggests that PAAT and PAAT adjusted for RV ejection time can be used as complementary parameters to assess physiologic and pathologic changes in pulmonary hemodynamics in neonates. •PAAT is a reliable noninvasive tool to characterize pulmonary hemodynamics.•This study establishes PAAT measures from a large cohort of preterm infants.•PAAT increases over the first year, reflective of a postnatal drop in RV afterload.•BPD and PH have a negative impact on PAAT measures through the first year.

Pulmonary hemodynamics

Right ventricular afterload

Echocardiography

Prematurity

Pulmonary artery acceleration time

Details

Title: Subtitle: Echocardiographic Assessment of Right Ventricular Afterload in Preterm Infants: Maturational Patterns of Pulmonary Artery Acceleration Time Over the First Year of Age and Implications for Pulmonary Hypertension
Creators: Meghna D Patel - Department of Pediatrics, Washington University School of Medicine, Saint Louis, Missouri
Colm R Breatnach - Department of Neonatology, The Rotunda Hospital, Dublin, Ireland
Adam T James - Department of Neonatology, The Rotunda Hospital, Dublin, Ireland
Swati Choudhry - Department of Pediatrics, Washington University School of Medicine, Saint Louis, Missouri
Patrick J McNamara - Department of Paediatrics, University of Toronto and Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, Toronto, Ontario, Canada
Amish Jain - Department of Pediatrics, University of Iowa, Iowa City, Iowa
Orla Franklin - Department of Cardiology, Our Lady's Children's Hospital Crumlin, Dublin, Ireland
Aaron Hamvas - Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois
Luc Mertens - The Labatt Family Heart Centre, The Hospital for Children, Toronto, Ontario, Canada
Gautam K Singh - Department of Pediatrics, Washington University School of Medicine, Saint Louis, Missouri
Afif EL-Khuffash - Department of Neonatology, The Rotunda Hospital, Dublin, Ireland
Philip T Levy - Department of Pediatrics, Washington University School of Medicine, Saint Louis, Missouri
Resource Type: Journal article
Publication Details: Journal of the American Society of Echocardiography, Vol.32(7), pp.884-894.e4
DOI: 10.1016/j.echo.2019.03.015
PMID: 31272593
PMCID: PMC6613806
NLM abbreviation: J Am Soc Echocardiogr
ISSN: 0894-7317
eISSN: 1097-6795
Publisher: Elsevier Inc
Grant note: Friends of the Rotunda Research Grant CTN-2014-10 / Health Research Board Mother and Baby Clinical Trials Network Ireland UL1 TR000448 / National Institutes of Health (https://doi.org/10.13039/100000002) 1U01 HL1014650; U01 HL101794 / National Institutes of Health (https://doi.org/10.13039/100000002) FP7/2007-2013 / European Union
Language: English
Date published: 07/2019
Academic Unit: Stead Family Department of Pediatrics; Neonatology; Internal Medicine
Record Identifier: 9984093461102771

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