Myocardial function in late preterm infants during the transitional period: comprehensive appraisal with deformation mechanics and non-invasive cardiac output monitoring
Myocardial function in late preterm infants during the transitional period: comprehensive appraisal with deformation mechanics and non-invasive cardiac output monitoring
复制标题
DOI：
10.1017/s1047951119003020
复制
发表时间：
2020-02-01
影响因子：
1
通讯作者：
EL-Khuffash, Afif
中科院分区：
文献类型：
--
作者：
Cappelleri, Alessia;Bussmann, Neidin;EL-Khuffash, Afif
背景：缺乏关于妊娠30（+0）至34（+6）周中晚期早产儿的功能数据。我们的目的是描述无症状中晚期早产儿在最初48小时内的过渡性心肺和血流动力学变化。方法：45例健康早产新生儿（平均±标准差）妊娠32.7±1.2周)在第1天和第2天接受超声心动图检查。通过斑点跟踪衍生的变形、旋转力学、组织多普勒成像和右心室聚焦测量（三尖瓣环平面收缩偏移、分数面积变化）评估心室力学。使用NICOM （TM）系统评估连续血流动力学，通过无创心输出量监测获得左心室输出量、卒中容量、心率和总外周阻力。结果：第1天至第2天，右心室功能增加（所有指标p < 0.005），左心室功能基本稳定。nicom衍生的左心室输出量[平均34%，95%可信区间21-47%]和卒中容量[29%，16- 42%]增加，心率无变化[5%，-2至12%]。平均血压升高[11%，1-21%]，但总外周阻力下降[-14%，-25 - -3%]。结论：中晚期早产儿左心室力学不变，但右心室功能增强。无创心输出量监测是可行的早产儿左心室输出量增加驱动的改善，在过渡时期。
Background: There is a paucity of functional data on mid-to-late preterm infants between 30(+0) and 34(+6) weeks gestation. We aimed to characterise transitional cardiopulmonary and haemodynamic changes during the first 48 hours in asymptomatic mid-to-late preterm infants. Methods: Forty-five healthy preterm newborns (mean +/- standard deviation) gestation of 32.7 +/- 1.2 weeks) underwent echocardiography on Days 1 and 2. Ventricular mechanics were assessed by speckle tracking-derived deformation, rotational mechanics, tissue Doppler imaging, and right ventricle-focused measures (tricuspid annular plane systolic excursion, fractional area change). Continuous haemodynamics were assessed using the NICOM (TM) system to obtain left ventricular output, stroke volume, heart rate, and total peripheral resistance by non-invasive cardiac output monitoring. Results: Right ventricular function increased (all measures p < 0.005) with mostly stable left ventricular performance between Day 1 and Day 2. NICOM-derived left ventricular output [mean 34%, 95% confidence interval 21-47%] and stroke volume [29%, 16- 42%] increased with no change in heart rate [5%, -2 to 12%]. There was a rise in mean blood pressure [11%, 1-21%], but a decline in total peripheral resistance [-14%, -25 to -3%]. Conclusion: Left ventricular mechanics remained persevered in mid-to-late premature infants, but right ventricular function increased. Non-invasive cardiac output monitoring is feasible in preterm infants with an increase in left ventricular output driven by an improvement in stroke volume during the transitional period.