Ductus diameter and left pulmonary artery end-diastolic velocity at 3 days of age predict the future need for surgical closure of patent ductus arteriosus in preterm infants: A post-hoc analysis of a prospective multicenter study
Ductus diameter and left pulmonary artery end-diastolic velocity at 3 days of age predict the future need for surgical closure of patent ductus arteriosus in preterm infants: A post-hoc analysis of a prospective multicenter study
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3日龄时的导管直径和左肺动脉舒张末期速度可预测早产儿未来是否需要手术闭合动脉导管未闭：一项前瞻性多中心研究的事后分析
DOI：
10.1016/j.jjcc.2021.08.007
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发表时间：
2021
影响因子：
2.5
通讯作者：
Toyoshima Katsuaki
中科院分区：
文献类型：
--
作者：
Masutani Satoshi;Isayama Tetsuya;Kobayashi Tohru;Pak Kyongsun;Mikami Masashi;Tomotaki Seiichi;Iwami Hiroko;Yokoyama Takehiko;Toyoshima Katsuaki
研究背景目前尚无一致的证据表明早期发现动脉导管未闭（PDA）手术的临床相关性。我们测试的假设，超声心动图指数在3天的年龄预测未来需要PDA surgery.MethodsWe分析了一个数据库，包括临床和超声心动图数据的710个早产儿的胎龄在23和29周之间的34个日本新生儿重症监护病房，并前瞻性地收集了超过14个月的数据。根据模型的受试者工作特征曲线（AUC）下的面积，采用多变量logistic回归分析，对3日龄时每个超声心动图指标对未来PDA手术闭合的预测或区分能力进行了评估，并对胎龄、性别和小于胎龄状态进行了调整。（中位胎龄：26周，出生时体重：843 g）进行分析，其中77例（11%）在充分考虑临床条件后接受PDA手术（中位胎龄：21 d）。PDA直径（PDAd）的AUC最大，其次是左肺动脉舒张末期流速（LPAedv）。与左房-主动脉直径比值（AUC0.76）相比，PDAd（AUC0.84，p < 0.001）和LPAedv（AUC0.82，p = 0.003）是预测PDA手术的更好指标。
BackgroundThere is inconsistent evidence suggesting the clinical relevance of the early detection of future needs of preterm patent ductus arteriosus (PDA) surgery. We tested the hypothesis that echocardiographic indices at 3 days of age predict the future need for PDA surgery.MethodsWe analyzed a database including the clinical and echocardiographic data of 710 preterm infants with gestational ages between 23 and 29 weeks in 34 Japanese neonatal intensive care units, and prospectively collected data over 14 months. The predictive or discriminative ability of each echocardiographic index at 3 days of age for future PDA surgical closure was evaluated using multivariable logistic regression analyses with adjustment for gestational age, sex, and small-for-gestational-age status, according to the areas under the receiver-operating characteristic curves (AUCs) of the models.ResultsA total of 688 eligible patients (median gestational age: 26 weeks, body weight at birth: 843 g) were analyzed, of whom 77 (11%) underwent PDA surgery (median age: 21 days) after full consideration of clinical conditions. The AUC of PDA diameter (PDAd) was the largest, followed by that of the left pulmonary artery end-diastolic velocity (LPAedv). Compared with the ratio of left atrial-to-aorta diameter (AUC 0.76), PDAd (AUC 0.84,p< 0.001) and LPAedv (AUC 0.82,p= 0.003) were significantly better predictors of future PDA surgery.ConclusionEchocardiographic indices at 3 days of age, especially PDAd and LPAedv, may predict the future need for surgical closure of PDA in preterm infants.