Myocardial Contractility in Premature Neonates With and Without Patent Ductus Arteriosus
Tóm tắt
Controversy exists as to whether a hemodynamically significant left-to-right shunt due to a patent ductus arteriosus (PDA) affects ventricular contractility. Load-dependent indices such as ejection fraction and shortening fraction have traditionally been used to assess contractility, but the relationship between the rate-corrected velocity of fiber shortening (MVCFc) and wall stress may be more suitable, as it is a preload-independent, afterload-adjusted method of assessing ventricular contractility. Age-related differences have been established for these variables in normal adults and children and it has been recommended for use in the premature neonate. The study was performed to assess left ventricular contractility in premature neonates with a significant left-to-right shunt due to a PDA. Using echocardiography, we measured the relationship of MVCFc to stress at peak systole (SPS) in two groups of premature infants. Group 1 consisted of 15 controls (680–1495 g, 25–32 weeks’ gestation), and Group 2 of 15 neonates with hemodynamically significant PDA (840–1635 g, 26–33 weeks’ gestation). In both groups, MVCFc was linearly and inversely related to SPS (p < 0.001). The regression equations were as follows: Group 1, MVCFc = −0.0153SPS + 1.70 (R
2 = 0.68); and Group 2, MVCF = − 0.019SPS + 1.89 (R
2 = 0.76). There was no significant difference in the relationship between the two groups, but their slopes were significantly steeper and had a higher Y-intercept than the relationship we previously reported for older children. This preliminary study establishes the normal MVCFc/SPS relationship in the premature neonate (25–33 weeks’ gestation) and suggests that premature infants function at a higher resting contractile state than older children. A hemodynamically significant PDA has no effect on contractility. These data will be useful in assessing left ventricular contractility in premature neonates with other types of ventricular loading and noncardiac stress.
Tài liệu tham khảo
Y Agata S Hiraishi K Oguchi H Misawa Y Horiguchi N Fujino K Yashiro N Shimada (1991) ArticleTitleChanges in left ventricular output from fetal to early neonatal life. J Pediatr 119 441–445 Occurrence Handle1:STN:280:By6A2cbps1w%3D Occurrence Handle1880660
B Baylen RA Meyer J Korfhagen G Benzing ME Bubb S Kaplin (1977) ArticleTitleLeft ventricular performance in the critically ill premature neonate with patent ductus arteriosus and pulmonary disease. Circulation 55 182–188
BG Baylen H Ogata M Ikegami H Jacobs A Kobe GC Emmanouilides (1986) ArticleTitleLeft ventricular performance and contractility before and after volume infusion: A comparative study of preterm and fullterm newborn lambs. Circulation 73 IssueID5 1042–1049
SD Colan KM Borow A Neumann (1984) ArticleTitleLeft ventricular end-systolic wall stress-velocity of fiber shortening relation: A load-independent index of myocardial contractility. J Am Coll Cardiol 4 715–724 Occurrence Handle1:STN:280:BiqD3cjovVY%3D Occurrence Handle6207218
SD Colan I Parness P Spevak S Sanders (1992) ArticleTitleDevelopmental modulation of myocardial mechanics: Age and growth-related alterations in afterload and contractility. J Am Coll Cardiol 19 IssueID3 619–629 Occurrence Handle1:STN:280:By2C28nhvFQ%3D Occurrence Handle1538019
RCG Franklin RCH Wyse V Gooch JE Deanfield (1990) ArticleTitleNormal values for noninvasive estimation of left ventricular contractile state and afterload in children. Am J Cardiol 65 505–510 Occurrence Handle1:STN:280:By%2BC28vkt1Y%3D Occurrence Handle2137667
LE Ginzton MM Laks M Brizendine R Conant I Mena (1984) ArticleTitleNoninvasive measurement of the rest and exercise peak systolic pressure/end systolic volume ratio. A sensitive two-dimensional echocardiographic indicator of left ventricular function. J Am Coll Cardiol 4 509–516 Occurrence Handle1:STN:280:BiuB1M%2Fjt1c%3D Occurrence Handle6470330
K Harada T Shiota Y Takahashi M Taura G Takada (1994) ArticleTitleChanges in left ventricular volume and performance of the left ventricle in the early neonatal period. Early Human Devel 39 201–209 Occurrence Handle1:STN:280:ByqB38flsFM%3D
H Igarashi H Shiraishi H Endoh M Yanagisawa (1991) ArticleTitleNoninvasive estimation of left ventricular contractile state and afterload in normal newborn infants. Am J Cardiol 68 413–415 Occurrence Handle1:STN:280:By6A3MvkslI%3D Occurrence Handle1858689
H Igarashi H Shiraishi H Endoh M Yanagisawa (1994) ArticleTitleLeft ventricular contractile state in preterm infants: Relation between wall stress and velocity of circumferential fiber shortening. Am J Cardiol 127 1336–1340 Occurrence Handle1:STN:280:ByuB38ngt1c%3D
TR Kimball SR Daniels P Khoury RA Meyer (1991) ArticleTitleAge-related variation in contractility estimate in patients. Am J Cardiol 68 1383–1387 Occurrence Handle1:STN:280:By2D2Mfns1U%3D Occurrence Handle1951129
TR Kimball MA Ralston P Khoury RG Crump FS Cho JH Reuter (1996) ArticleTitleEffect of ligation of patent ductus arteriosus on left ventricular performance and its determinants in premature neonates. J Am Coll Cardiol 27 193–197 Occurrence Handle10.1016/0735-1097(95)00452-1 Occurrence Handle1:STN:280:BymC387htVM%3D Occurrence Handle8522694
HS Klopfenstein AM Rudolph (1978) ArticleTitlePostnatal changes in the circulation and responses to volume loading in sheep. Circ Res 42 839–845
LA Lee TR Kimball SR Daniels P Khoury RA Meyer (1992) ArticleTitleLeft ventricular mechanics in the preterm infant and their effect on the measurement of cardiac performance. J Pediatr 120 114–119 Occurrence Handle1:STN:280:By2C3MzotVM%3D Occurrence Handle1731006
W Lindner M Seidel TH Versmold C Dohlemann KP Reigel (1990) ArticleTitleStroke volume and left ventricular output in preterm infants with patent ductus arteriosus. Pediatr Res 27 278–281 Occurrence Handle1:STN:280:By%2BB3cnntl0%3D Occurrence Handle2320395
T Nivatpumin S Katz J Scheuer (1979) ArticleTitlePeak left ventricular systolic pressures/end-systolic volume ratio: A sensitive detector of left ventricular disease. Am J Cardiol 43 969–974 Occurrence Handle1:STN:280:CSaC283ksFE%3D Occurrence Handle433779
N Reichek J Wilson M St. John Sutton TA Plappert S Goldberg JW Hirschfied (1982) ArticleTitleNoninvasive determination of left ventricular end-systolic stress: Validation of method and initial application. Circulation 65 99–108
AJJT Rein SP Sanders SD Colan IA Parness M Epstein (1987) ArticleTitleLeft ventricular mechanics in the normal newborn. Circulation 76 IssueID5 1029–1036
DG Rowland HP Gutgesell (1995) ArticleTitleNoninvasive assessment of myocardial contractility, preload and afterload in healthy newborn infants. J Am Coll Cardiol . IssueID75 818–821
K Sagawa (1981) ArticleTitleEditorial: The end-systolic pressure-volume relation of the ventricle: Definition, modifications and clinical use. Circulation 63 1223–1227
GGS Sandor R Popov E DeSouza S Morris B Johnston (1992) ArticleTitleRate-corrected mean velocity of fiber shortening-stress at peak systole as a load-independent measure of contractility. Am J Cardiol 69 403–407 Occurrence Handle1:STN:280:By2C3szltF0%3D Occurrence Handle1734656
Y Takahashi K Harada A Ishida M Tamura G Takada (1994) ArticleTitleLeft ventricular preload reserve in preterm infants with patent ductus arteriosus. Arch Dis Child 71 F118–F121 Occurrence Handle1:STN:280:ByqD2s%2Fitlc%3D Occurrence Handle7979465
Y Takahashi K Harada A Ishida M Tamura T Tanaka G Takada (1995) ArticleTitleChanges in left ventricular volume and systolic function before and after closure of ductus arteriosus in full term infants. Early Human Devel 44 77–85 Occurrence Handle10.1016/0378-3782(95)01695-3
Y Takahashi K Harada T Shiota M Tamura H Noguchi A Ishida G Takada (1994) ArticleTitleLeft ventricular contractile state of early human neonates with patent ductus arteriosus. Tokohu J Exp Med 172 155–161 Occurrence Handle1:STN:280:ByuA2MzjvFI%3D
P Winberg U Ergander (1992) ArticleTitleRelationship between heart rate, left ventricular output and stroke volume in preterm infants during fluctuations in heart rate. Pediatr Res 31 IssueID2 117–120 Occurrence Handle1:STN:280:By2C2sfosFI%3D Occurrence Handle1542538