Echocardiographic Assessment of Right Ventricular Afterload in Preterm Infants: Maturational Patterns of Pulmonary Artery Acceleration Time Over the First Year of Age and Implications for Pulmonary Hypertension

Meghna D. Patel; Colm R. Breatnach; Adam T. James; Swati Choudhry; Patrick J. McNamara; Amish Jain; Orla Franklin; Aaron Hamvas; Luc Mertens; Gautam K. Singh; Afif EL-Khuffash; Philip T. Levy

doi:10.1016/j.echo.2019.03.015

Echocardiographic Assessment of Right Ventricular Afterload in Preterm Infants: Maturational Patterns of Pulmonary Artery Acceleration Time Over the First Year of Age and Implications for Pulmonary Hypertension

Meghna D. Patel, Colm R. Breatnach, Adam T. James, Swati Choudhry, Patrick J. McNamara, Amish Jain, Orla Franklin, Aaron Hamvas, Luc Mertens, Gautam K. Singh, Afif EL-Khuffash, Philip T. Levy^*

^*Corresponding author for this work

Pediatrics

Research output: Contribution to journal › Article › peer-review

55 Scopus citations

Abstract

Background: Assessment of pulmonary hemodynamics is critical in the diagnosis and management of cardiopulmonary disease of premature infants, but reliable noninvasive indices of pulmonary hemodynamics in preterm infants are lacking. Because pulmonary artery acceleration time (PAAT) is a validated noninvasive method to assess right ventricular (RV) afterload in infants and children, the aim of this study was to investigate the maturational changes of PAAT measures in preterm infants over the first year of age and to discern the impact of typical cardiopulmonary abnormalities on these measures. Methods: In a prospective multicenter study of 239 preterm infants (<29 weeks at birth), PAAT was assessed at days 1, 2, and 5 to 7, at 32 and 36 weeks' postmenstrual age, and at 1-year corrected age. To account for heart rate variability, PAAT was adjusted for RV ejection time. Premature infants who developed bronchopulmonary dysplasia or had echocardiographic findings of pulmonary hypertension were analyzed separately. Intra- and interobserver reproducibility analysis was performed. Results: PAAT was feasible in 95% of the image acquisitions, and there was high intra- and interobserver agreement (intraclass correlation coefficients > 0.9 and coefficients of variation < 6%). In uncomplicated preterm infants (n = 103 [48%]) PAAT and PAAT adjusted for RV ejection time increased longitudinally from birth to 1-year corrected age (P < .001) and were linearly associated with gestational age at birth (r = 0.81 and r = 0.82, P < .001) and increasing postnatal weight and postnatal age (r > 0.81, P < .001). PAAT measures were significantly reduced (P < .001) in infants with bronchopulmonary dysplasia and/or pulmonary hypertension (n = 119 [51%]) beyond 1 week of age. Conclusions: PAAT measures increase in preterm infants from birth to 1-year corrected age, reflective of the physiologic postnatal drop in RV afterload. Bronchopulmonary dysplasia and pulmonary hypertension have a negative impact on PAAT measures. By demonstrating excellent reliability and establishing reference patterns of PAAT in preterm infants, this study suggests that PAAT and PAAT adjusted for RV ejection time can be used as complementary parameters to assess physiologic and pathologic changes in pulmonary hemodynamics in neonates.

Original language	English (US)
Pages (from-to)	884-894.e4
Journal	Journal of the American Society of Echocardiography
Volume	32
Issue number	7
DOIs	https://doi.org/10.1016/j.echo.2019.03.015
State	Published - Jul 2019

Funding

This study was supported by grants from the Premature and Respiratory Outcomes Program ( National Institutes of Health grants 1U01 HL1014650 and U01 HL101794 ) and the Postdoctoral Mentored Training Program in Clinical Investigation ( National Institutes of Health grant UL1 TR000448 ). Dr. EL-Khuffash is funded by multiple sources: grant FP7/2007-2013 from the European Union (agreement 260777, The HIP Trial), the Friends of the Rotunda Research Grant (FoR/EQUIPMENT/101572), and Health Research Board Mother and Baby Clinical Trials Network Ireland ( CTN-2014-10 ). This study was supported by grants from the Premature and Respiratory Outcomes Program (National Institutes of Health grants 1U01 HL1014650 and U01 HL101794) and the Postdoctoral Mentored Training Program in Clinical Investigation (National Institutes of Health grant UL1 TR000448). Dr. EL-Khuffash is funded by multiple sources: grant FP7/2007-2013 from the European Union (agreement 260777, The HIP Trial), the Friends of the Rotunda Research Grant (FoR/EQUIPMENT/101572), and Health Research Board Mother and Baby Clinical Trials Network Ireland (CTN-2014-10). This study was supported by grants from the Premature and Respiratory Outcomes Program ( National Institutes of Health grants 1U01 HL1014650 and U01 HL101794) and the Postdoctoral Mentored Training Program in Clinical Investigation ( National Institutes of Health grant UL1 TR000448). Dr. EL-Khuffash is funded by multiple sources: grant FP7/2007-2013 from the European Union (agreement 260777, The HIP Trial), the Friends of the Rotunda Research Grant (FoR/EQUIPMENT/101572), and Health Research Board Mother and Baby Clinical Trials Network Ireland ( CTN-2014-10).

Keywords

Echocardiography
Prematurity
Pulmonary artery acceleration time
Pulmonary hemodynamics
Right ventricular afterload

ASJC Scopus subject areas

Radiology Nuclear Medicine and imaging
Cardiology and Cardiovascular Medicine

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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Patel, M. D., Breatnach, C. R., James, A. T., Choudhry, S., McNamara, P. J., Jain, A., Franklin, O., Hamvas, A., Mertens, L., Singh, G. K., EL-Khuffash, A., & Levy, P. T. (2019). Echocardiographic Assessment of Right Ventricular Afterload in Preterm Infants: Maturational Patterns of Pulmonary Artery Acceleration Time Over the First Year of Age and Implications for Pulmonary Hypertension. Journal of the American Society of Echocardiography, 32(7), 884-894.e4. https://doi.org/10.1016/j.echo.2019.03.015

Patel, Meghna D. ; Breatnach, Colm R. ; James, Adam T. et al. / Echocardiographic Assessment of Right Ventricular Afterload in Preterm Infants : Maturational Patterns of Pulmonary Artery Acceleration Time Over the First Year of Age and Implications for Pulmonary Hypertension. In: Journal of the American Society of Echocardiography. 2019 ; Vol. 32, No. 7. pp. 884-894.e4.

@article{133850a951994ee7bc1ecd91c441b6d1,

title = "Echocardiographic Assessment of Right Ventricular Afterload in Preterm Infants: Maturational Patterns of Pulmonary Artery Acceleration Time Over the First Year of Age and Implications for Pulmonary Hypertension",

abstract = "Background: Assessment of pulmonary hemodynamics is critical in the diagnosis and management of cardiopulmonary disease of premature infants, but reliable noninvasive indices of pulmonary hemodynamics in preterm infants are lacking. Because pulmonary artery acceleration time (PAAT) is a validated noninvasive method to assess right ventricular (RV) afterload in infants and children, the aim of this study was to investigate the maturational changes of PAAT measures in preterm infants over the first year of age and to discern the impact of typical cardiopulmonary abnormalities on these measures. Methods: In a prospective multicenter study of 239 preterm infants (<29 weeks at birth), PAAT was assessed at days 1, 2, and 5 to 7, at 32 and 36 weeks' postmenstrual age, and at 1-year corrected age. To account for heart rate variability, PAAT was adjusted for RV ejection time. Premature infants who developed bronchopulmonary dysplasia or had echocardiographic findings of pulmonary hypertension were analyzed separately. Intra- and interobserver reproducibility analysis was performed. Results: PAAT was feasible in 95% of the image acquisitions, and there was high intra- and interobserver agreement (intraclass correlation coefficients > 0.9 and coefficients of variation < 6%). In uncomplicated preterm infants (n = 103 [48%]) PAAT and PAAT adjusted for RV ejection time increased longitudinally from birth to 1-year corrected age (P < .001) and were linearly associated with gestational age at birth (r = 0.81 and r = 0.82, P < .001) and increasing postnatal weight and postnatal age (r > 0.81, P < .001). PAAT measures were significantly reduced (P < .001) in infants with bronchopulmonary dysplasia and/or pulmonary hypertension (n = 119 [51%]) beyond 1 week of age. Conclusions: PAAT measures increase in preterm infants from birth to 1-year corrected age, reflective of the physiologic postnatal drop in RV afterload. Bronchopulmonary dysplasia and pulmonary hypertension have a negative impact on PAAT measures. By demonstrating excellent reliability and establishing reference patterns of PAAT in preterm infants, this study suggests that PAAT and PAAT adjusted for RV ejection time can be used as complementary parameters to assess physiologic and pathologic changes in pulmonary hemodynamics in neonates.",

keywords = "Echocardiography, Prematurity, Pulmonary artery acceleration time, Pulmonary hemodynamics, Right ventricular afterload",

author = "Patel, {Meghna D.} and Breatnach, {Colm R.} and James, {Adam T.} and Swati Choudhry and McNamara, {Patrick J.} and Amish Jain and Orla Franklin and Aaron Hamvas and Luc Mertens and Singh, {Gautam K.} and Afif EL-Khuffash and Levy, {Philip T.}",

note = "Publisher Copyright: {\textcopyright} 2019 American Society of Echocardiography",

year = "2019",

month = jul,

doi = "10.1016/j.echo.2019.03.015",

language = "English (US)",

volume = "32",

pages = "884--894.e4",

journal = "Journal of the American Society of Echocardiography",

issn = "0894-7317",

publisher = "Elsevier Inc.",

number = "7",

}

Patel, MD, Breatnach, CR, James, AT, Choudhry, S, McNamara, PJ, Jain, A, Franklin, O, Hamvas, A, Mertens, L, Singh, GK, EL-Khuffash, A & Levy, PT 2019, 'Echocardiographic Assessment of Right Ventricular Afterload in Preterm Infants: Maturational Patterns of Pulmonary Artery Acceleration Time Over the First Year of Age and Implications for Pulmonary Hypertension', Journal of the American Society of Echocardiography, vol. 32, no. 7, pp. 884-894.e4. https://doi.org/10.1016/j.echo.2019.03.015

Echocardiographic Assessment of Right Ventricular Afterload in Preterm Infants: Maturational Patterns of Pulmonary Artery Acceleration Time Over the First Year of Age and Implications for Pulmonary Hypertension. / Patel, Meghna D.; Breatnach, Colm R.; James, Adam T. et al.
In: Journal of the American Society of Echocardiography, Vol. 32, No. 7, 07.2019, p. 884-894.e4.

Research output: Contribution to journal › Article › peer-review

TY - JOUR

T1 - Echocardiographic Assessment of Right Ventricular Afterload in Preterm Infants

T2 - Maturational Patterns of Pulmonary Artery Acceleration Time Over the First Year of Age and Implications for Pulmonary Hypertension

AU - Patel, Meghna D.

AU - Breatnach, Colm R.

AU - James, Adam T.

AU - Choudhry, Swati

AU - McNamara, Patrick J.

AU - Jain, Amish

AU - Franklin, Orla

AU - Hamvas, Aaron

AU - Mertens, Luc

AU - Singh, Gautam K.

AU - EL-Khuffash, Afif

AU - Levy, Philip T.

PY - 2019/7

Y1 - 2019/7

N2 - Background: Assessment of pulmonary hemodynamics is critical in the diagnosis and management of cardiopulmonary disease of premature infants, but reliable noninvasive indices of pulmonary hemodynamics in preterm infants are lacking. Because pulmonary artery acceleration time (PAAT) is a validated noninvasive method to assess right ventricular (RV) afterload in infants and children, the aim of this study was to investigate the maturational changes of PAAT measures in preterm infants over the first year of age and to discern the impact of typical cardiopulmonary abnormalities on these measures. Methods: In a prospective multicenter study of 239 preterm infants (<29 weeks at birth), PAAT was assessed at days 1, 2, and 5 to 7, at 32 and 36 weeks' postmenstrual age, and at 1-year corrected age. To account for heart rate variability, PAAT was adjusted for RV ejection time. Premature infants who developed bronchopulmonary dysplasia or had echocardiographic findings of pulmonary hypertension were analyzed separately. Intra- and interobserver reproducibility analysis was performed. Results: PAAT was feasible in 95% of the image acquisitions, and there was high intra- and interobserver agreement (intraclass correlation coefficients > 0.9 and coefficients of variation < 6%). In uncomplicated preterm infants (n = 103 [48%]) PAAT and PAAT adjusted for RV ejection time increased longitudinally from birth to 1-year corrected age (P < .001) and were linearly associated with gestational age at birth (r = 0.81 and r = 0.82, P < .001) and increasing postnatal weight and postnatal age (r > 0.81, P < .001). PAAT measures were significantly reduced (P < .001) in infants with bronchopulmonary dysplasia and/or pulmonary hypertension (n = 119 [51%]) beyond 1 week of age. Conclusions: PAAT measures increase in preterm infants from birth to 1-year corrected age, reflective of the physiologic postnatal drop in RV afterload. Bronchopulmonary dysplasia and pulmonary hypertension have a negative impact on PAAT measures. By demonstrating excellent reliability and establishing reference patterns of PAAT in preterm infants, this study suggests that PAAT and PAAT adjusted for RV ejection time can be used as complementary parameters to assess physiologic and pathologic changes in pulmonary hemodynamics in neonates.

AB - Background: Assessment of pulmonary hemodynamics is critical in the diagnosis and management of cardiopulmonary disease of premature infants, but reliable noninvasive indices of pulmonary hemodynamics in preterm infants are lacking. Because pulmonary artery acceleration time (PAAT) is a validated noninvasive method to assess right ventricular (RV) afterload in infants and children, the aim of this study was to investigate the maturational changes of PAAT measures in preterm infants over the first year of age and to discern the impact of typical cardiopulmonary abnormalities on these measures. Methods: In a prospective multicenter study of 239 preterm infants (<29 weeks at birth), PAAT was assessed at days 1, 2, and 5 to 7, at 32 and 36 weeks' postmenstrual age, and at 1-year corrected age. To account for heart rate variability, PAAT was adjusted for RV ejection time. Premature infants who developed bronchopulmonary dysplasia or had echocardiographic findings of pulmonary hypertension were analyzed separately. Intra- and interobserver reproducibility analysis was performed. Results: PAAT was feasible in 95% of the image acquisitions, and there was high intra- and interobserver agreement (intraclass correlation coefficients > 0.9 and coefficients of variation < 6%). In uncomplicated preterm infants (n = 103 [48%]) PAAT and PAAT adjusted for RV ejection time increased longitudinally from birth to 1-year corrected age (P < .001) and were linearly associated with gestational age at birth (r = 0.81 and r = 0.82, P < .001) and increasing postnatal weight and postnatal age (r > 0.81, P < .001). PAAT measures were significantly reduced (P < .001) in infants with bronchopulmonary dysplasia and/or pulmonary hypertension (n = 119 [51%]) beyond 1 week of age. Conclusions: PAAT measures increase in preterm infants from birth to 1-year corrected age, reflective of the physiologic postnatal drop in RV afterload. Bronchopulmonary dysplasia and pulmonary hypertension have a negative impact on PAAT measures. By demonstrating excellent reliability and establishing reference patterns of PAAT in preterm infants, this study suggests that PAAT and PAAT adjusted for RV ejection time can be used as complementary parameters to assess physiologic and pathologic changes in pulmonary hemodynamics in neonates.

KW - Echocardiography

KW - Prematurity

KW - Pulmonary artery acceleration time

KW - Pulmonary hemodynamics

KW - Right ventricular afterload

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DO - 10.1016/j.echo.2019.03.015

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SN - 0894-7317

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Patel MD, Breatnach CR, James AT, Choudhry S, McNamara PJ, Jain A et al. Echocardiographic Assessment of Right Ventricular Afterload in Preterm Infants: Maturational Patterns of Pulmonary Artery Acceleration Time Over the First Year of Age and Implications for Pulmonary Hypertension. Journal of the American Society of Echocardiography. 2019 Jul;32(7):884-894.e4. doi: 10.1016/j.echo.2019.03.015

Echocardiographic Assessment of Right Ventricular Afterload in Preterm Infants: Maturational Patterns of Pulmonary Artery Acceleration Time Over the First Year of Age and Implications for Pulmonary Hypertension

Abstract

Funding

Keywords

ASJC Scopus subject areas

UN SDGs

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