Maturational Patterns of Systolic Ventricular Deformation Mechanics by Two-Dimensional Speckle-Tracking Echocardiography in Preterm Infants over the First Year of Age.
Maturational Patterns of Systolic Ventricular Deformation Mechanics by Two-Dimensional Speckle-Tracking Echocardiography in Preterm Infants over the First Year of Age.
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DOI：
10.1016/j.echo.2017.03.003
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发表时间：
2017-07
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影响因子：
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通讯作者：
Singh GK
中科院分区：
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作者：
Levy PT;El-Khuffash A;Patel MD;Breatnach CR;James AT;Sanchez AA;Abuchabe C;Rogal SR;Holland MR;McNamara PJ;Jain A;Franklin O;Mertens L;Hamvas A;Singh GK
本研究旨在通过二维斑点跟踪超声心动图检测极早产儿从出生到1岁时收缩期室壁应变力学的成熟性变化，以了解常见的心肺异常对变形测量的影响。在一项前瞻性多中心研究中，对239名极早产儿(胎龄29周)在月经后第1、2、5-7、32周、36周和1岁校正年龄(CA)连续测量左心室(LV)整体纵向应变和收缩应变率(GLS)、室间隔(IVS)纵向应变和收缩应变率(GLS)、右室游离壁纵向应变率(RV FWLS、FWLSR)和节段性LS(SLS)。对发生支气管肺发育不良(BPD)或有肺动脉高压(PH)超声心动图表现的早产儿分别进行分析。在无并发症早产儿(n=103，48%)中，LV-GLS和GLSR在第5-7天至1岁CA期间无明显变化(p=0.60和0.59)。RV FWLS、FWLSR和IVS GLS和GLSR在同一时间段显著增加(P<；所有指标均为0.01)。在RVFW中存在显著的底部到顶点(从最高到最低)的SLS梯度(p<；0.01)，而在LVFW中存在反向的顶点到底部的梯度(p<；0.01)。在BPD和/或PH组(n=119，51%)，右室FWLS和IVS GLS显著降低(p<；0.01)，LV GLS和GLSR相似(p=0.56)，IVS SLS在32周PMA到一年CA期间持续作为RV主导的底部到尖端的梯度。本研究追踪了极端早产儿从出生到一岁CA的2DSTE的全球和区域畸形的成熟模式。成熟模式是特定于脑室的。BPD和PH对RV和IVS品系有负面影响，而LV品系保持稳定。
We aimed to determine the maturational changes in systolic ventricular strain mechanics by two-dimensional speckle tracking echocardiography in extreme preterm neonates from birth to one year of age, and discern the impact of common cardiopulmonary abnormalities on the deformation measures. In a prospective multi-center study of 239 extreme preterm infants (< 29 weeks gestation at birth), left ventricle (LV) global longitudinal strain and systolic strain rate (GLS, GLSRs), interventricular septal wall (IVS) GLS and GLSRs, right ventricle free wall longitudinal S and SR (RV FWLS, FWLSRs), and segmental LS (SLS) in the RVFW, LVFW and IVS were serially measured at Days 1, 2, 5–7, 32 weeks and 36 weeks post-menstrual age (PMA), and one year corrected age (CA). Premature infants who developed bronchopulmonary dysplasia (BPD) or had echocardiographic findings of pulmonary hypertension (PH) were analyzed separately. In uncomplicated preterm infants (n=103, 48%), LV GLS and GLSRs remained unchanged from Day 5–7 to one year CA (p=0.60 and 0.59). RV FWLS, FWLSRs and IVS GLS and GLSR significantly increased over the same time period (p < 0.01 for all measures). A significant base-to-apex (highest to lowest) SLS gradient (p < 0.01) in the RVFW and a reverse apex-to-base gradient (p < 0.01) existed in the LVFW. In infants with BPD and/or PH (n=119, 51%), RV FWLS and IVS GLS were significantly lower (p < 0.01), LV GLS and GLSRs were similar (p=0.56), and IVS SLS persisted as an RV dominant base-to-apex gradient from 32 weeks PMA to one year CA. This study tracks the maturational patterns of global and regional deformation by 2DSTE in extreme preterm infants from birth to one year CA. The maturational patterns are ventricular specific. BPD and PH leave a negative impact on RV and IVS strain, while LV strain remains stable.