Abstract:Objective: To evaluate the patent ductus arteriosus (PDA) on left ventricular (LV) systolic myocardial function in preterm infants with vector velocity imaging (VVI).Methods: Infants whose gestational age was less than 30 weeks and who were delivered in our hospital were enrolled in the study.Babies were categorized into three groups with the degrees of ductal patency evaluated with echocardiography on the third day after birth, ① Group hsPDA (hemodynamically significant PDA): PDA diameter≥1.5 mm and left atrium to aorta (LA:Ao) ratio ≥1.5; ② Group PDA: PDA diameter <1.5mm or LA:Ao ratio <1.5; ③ Group nPDA: No PDA was detected through examination.The clinical data, conventional echocardiographic parameters and LV longitudinal global peak systolic strain (LVS) and strain rate (LVSR) were recorded and compared within three groups, and analysis was conducted with one-way ANOVA.Results: The gestational age, birth weight and left ventricular ejection fraction (LVEF) were not different within the three groups (p>0.05).The conventional parameters such as LA:Ao, LV end-diastolic diameter (LVD) and E/e were significantly higher in group hsPDA than the other two groups (p<0.01), while those were not different between Group PDA and nPDA.The LV systolic myocardial function parameters LVS and LVSR were significantly lower in group hsPDA than in the other two groups (p<0.01), but those were not significant between group PDA and group nPDA although the former had lower trend (p>0.05).Conclusion: PDA in preterm infants have LV volume overload, the LV myocardial deformation already decreased despite preserved LVEF.
[1] Sallmon H, Koehne P, Hansmann G. Recent advances in the treatment of preterm newborn infants with patent ductus arteriosus [J]. Clin Perinatol,2016,43(1):113~129. [2] Deshpande P, Baczynski M, McNamara PJ, et al. Patent ductus arteriosus: the physiology of transition [J]. Semin Fetal Neonatal Med, 2018, 23(4):225~231. [3] Engur D, Deveci M, Turkmen MK. Early signs that predict later haemodynamically significant patent ductus arteriosus [J]. Cardiol Young, 2016, 26(3):439~445. [4] 何敏瑜,杨正春,冉素真,等.超声心动图检查参数预测早产儿动脉导管早期自然关闭[J].中国介入影像与治疗学,2018,15(11):679~682. [5] Shepherd JL, Noori S. What is a hemodynamically significant PDA in preterm infants [J]. Congenit Heart Dis, 2019, 14(1):21~26. [6] Elsayed YN, Fraser D. Patent ductus arteriosus in preterm infants, part 1: understanding the pathophysiologic link between the patent ductus arteriosus and clinical complications [J]. Neonatal Netw,2017,36(5):265~272. [7] Philip R, Towbin JA, Sathanandam S, et al. Effect of patent ductus arteriosus on the heart in preterm infants [J]. Congenit Heart Dis, 2019, 14(1):33~36. [8] de Waal K, Phad N, Lakkundi A, Tan P. Cardiac function after the immediate transitional period in very preterm infants using speckle tracking analysis [J]. PediatrCardiol, 2016, 37(2):295~303. [9] Parikh R, Negrine RJ, Chikermane A, et al. Assessment of myocardial function in preterm infants with patent ductus arteriosus using tissue Doppler imaging [J]. Cardiol Young, 2015, 25(1):70~75. [10] James AT, Corcoran JD, Breatnach CR, et al. Longitudinal assessment of left and right myocardial function in preterm infants using strain and strain rate imaging [J]. Neonatology, 2016, 109(1):69~75.