What echocardiographic indices are predictive of patent ductus arteriosus surgical closure in early preterm infants? A prospective multicenter cohort study
What echocardiographic indices are predictive of patent ductus arteriosus surgical closure in early preterm infants? A prospective multicenter cohort study
复制标题
DOI：
10.1016/j.jjcc.2019.05.004
复制
发表时间：
2019-11-01
影响因子：
2.5
通讯作者：
Kato, Shin
中科院分区：
文献类型：
--
作者：
Toyoshima, Katsuaki;Isayama, Tetsuya;Kato, Shin
背景：没有超声心动图指标预测早产动脉导管未闭（PDA）手术的需要，并有足够的样本量进行测试。我们检验了一些超声心动图指标对PDA手术需求有更好的预测能力的假设。方法：我们前瞻性地收集了34个日本新生儿重症监护病房14个月以上的胎龄在23 ~ 29周的婴儿的数据。数据点为1、3、7和14天大，如果适用，在PDA手术前。我们评估了五项超声心动图指标。根据出生体重（BBW）调整体积和尺寸指数。各超声心动图指标取非手术患者所有数据点中最差值或手术患者术前最差值。采用多因素logistic回归并校正临床状态。结果：总共分析了691例患者，其中61例（8.8%）按照方案中的标准进行了手术。受者工作特征曲线下面积最大的是PDA直径（0.86）和PDA直径/BBW(0.86)，其次是左肺动脉舒张末流速（LPAedv）（0.80）和左心房容积/BBW（0.80）。结论：考虑到体尺测量的简单性和独立性，PDA直径和LPAedv可作为评估早期早产儿是否需要PDA手术的有用指标。(C) 2019日本心脏病学院。Elsevier Ltd.出版。版权所有。
Background: No echocardiographic indices for predicting the need for preterm patent ductus arteriosus (PDA) surgery have been tested with an adequate sample size. We tested the hypothesis that some echocardiographic indices have better predictive ability for the need for PDA surgery.Methods: We prospectively collected data from infants with gestational ages between 23 and 29 weeks at 34 Japanese neonatal intensive care units over 14 months. Data points were 1, 3, 7, and 14 days of age and, if applicable, before PDA surgery. We assessed five echocardiographic indices. Volume and dimension indices were adjusted for birth body weight (BBW). For each echocardiographic index, the worst value among all data points in nonsurgical patients or the value just before surgery in surgical patients was used.Multivariate logistic regression was applied with adjustment for clinical status.Results: In total, 691 patients were analyzed, of whom 61 (8.8%) underwent surgery, as guided using the criteria in the protocol. The areas under the receiver-operating characteristic curve for PDA diameter (0.86) and PDA diameter/BBW (0.86) were the largest, followed by those of left pulmonary artery end-diastolic velocity (LPAedv) (0.80), and left atrial volume/BBW (0.80).Conclusions: Considering the measurement's easiness and independence of body size, PDA diameter and LPAedv may serve as useful indices for assessing the need for PDA surgery in early preterm infants. (C) 2019 Japanese College of Cardiology. Published by Elsevier Ltd. All rights reserved.