A Comprehensive Echocardiographic Protocol for Assessing Neonatal Right Ventricular Dimensions and Function in the Transitional Period: Normative Data and Z Scores
A Comprehensive Echocardiographic Protocol for Assessing Neonatal Right Ventricular Dimensions and Function in the Transitional Period: Normative Data and Z Scores
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DOI：
10.1016/j.echo.2014.08.018
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发表时间：
2014-12-01
影响因子：
6.5
通讯作者：
Mertens, Luc
中科院分区：
文献类型：
--
作者：
Jain, Amish;Mohamed, Adel;Mertens, Luc
背景：描述新生儿早期过渡时期右室大小和功能的超声心动图资料很少。方法：对50例健康足月新生儿在出生后15+/-2和35+/-2小时进行连续超声心动图检查。按照美国超声心动图学会最新指南中的建议测量右室内径和功能指数。其他新的参数包括右室前下方基底径、心尖三腔切面的面积变化分数(FAC)和斑点跟踪超声心动图得出的右室侧壁(心尖四腔切面)和下壁(心尖三腔切面)的峰值纵向应变。结果：线性内径和组织多普勒血流速度具有很高的重复性，而时间间隔和FAC测量具有更大的可变性。三腔FAC高于四腔FAC(36+/-5%vs.24+/-7%，P<；.001)。侧壁最大纵向应变与下壁相似(22+/-4%vs18+/-5%，P>；0.05)。生后第2天，右室内径略有增加(中腔直径，1.71±0.19vs1.55+/-0.19 cm，P&t；0.01；右室前下径，2.24±0.29vs2.06±0.24 cm，P<；0.01；心尖四腔切面的舒张末面积，4.32+/-0.64vs4.10+/-0.69 cm(2)，P=0.04)，但功能指数没有变化。右室内径和FAC与出生体重呈中度线性相关。结论：使用常规指标和新指标，研究人员描述了一种全面的新生儿右室超声心动图成像方案，建立了参考范围，并描述了生理性出生后转变对右室大小和功能的影响。这将有助于未来研究新生儿心肺疾病的右室功能障碍。
Background: There is a paucity of echocardiographic data describing right ventricular (RV) dimensions and function in the early transitional newborn period.Methods: Fifty healthy term newborns underwent serial echocardiography at a mean of 15 +/- 2 and 35 +/- 2 hours of age. RV dimensions and functional indices were measured as recommended in the American Society of Echocardiography's recent guidelines. Additional novel parameters included RV anteroinferior basal diameter, fractional area change (FAC) from the apical three-chamber view, and speckle-tracking echocardiography-derived peak longitudinal strain in the RV lateral (apical four-chamber view) and inferior (apical three-chamber view) walls. Results obtained at both time points were compared.Results: Linear dimensions and tissue Doppler velocities were highly reproducible, while time intervals and FAC measurements were more variable. Three-chamber FAC was higher than four-chamber FAC (36 +/- 5% vs. 24 +/- 7%, P < .001). Lateral wall peak longitudinal strain was similar to the value for the inferior wall (22 +/- 4% vs 18 +/- 5%, P > .05). A small increase in RV dimensions was noted on day 2 of life (midcavity diameter, 1.71 +/- 0.19 vs 1.55 +/- 0.19 cm, P < .01; RV anteroinferior basal diameter, 2.24 +/- 0.29 vs 2.06 +/- 0.24 cm, P < .01; end-diastolic-area in the apical four-chamber view, 4.32 +/- 0.64 vs 4.10 +/- 0.69 cm(2), P = .04), while no changes occurred in functional indices. RV dimensions and FAC showed moderate linear correlations with birth weight. Z scores could be computed for the majority of measured indices.Conclusions: Using conventional and novel indices, the investigators describe a comprehensive echocardiographic protocol for neonatal RV imaging, establish reference ranges, and describe the effect of physiologic postnatal transition on RV dimensions and function. This will facilitate future investigations of RV dysfunction in neonatal cardiopulmonary disorders.