新生儿脑病接受低温治疗的新生儿左、右心室应变力学的回顾性研究

IF 2.2 3区医学 Q2 OBSTETRICS & GYNECOLOGY

Early human development Pub Date : 2024-11-23 DOI:10.1016/j.earlhumdev.2024.106163

Justin B. Jin , Wei Liu , Sreenivas Karnati , Ibrahim Sammour , Rukmini Komarlu

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引用次数: 0

摘要

目的对新生儿脑病（NE）患者早期诊断心肌功能受损并及时进行低温治疗至关重要。传统的心肌功能指标（左室射血分数）&；LV分数缩短（LV FS）可以不同程度地减少。斑点跟踪超声心动图（STE）是一种更敏感的损伤标志物，但在这类患者群体中仍未得到充分研究。方法回顾性研究2009 ~ 2020年因NE接受过低温治疗的新生儿与非NE适应症超声心动图正常的正常新生儿进行1:1匹配。配对是基于胎龄、出生体重、出生天数和性别。使用独立于供应商的应变软件（TomTec， GMBH, Munich, Germany）离线测量左心室4室（4Ch）应变、右心室4室（RV 4Ch）和RV游离壁应变（RV FWS）。结果对90对NE患者和对照组进行了研究。与对照组相比，NE病例的RV 4Ch菌株（- 17.3%比- 19.6%）、RV FWS（- 18.8%比- 21.9%）和RV分数面积变化（FAC）（35%比37%）较低(p <；0.001)，而LV 4Ch株、LV EF、LV FS的差异无统计学意义。与轻度NE相比，中度/重度NE（72%）与较低的LV 4Ch菌株相关（- 22.2% / - 19.3% vs. - 25.4%, p = 0.004）。RV 4Ch菌株（- 14.9%比- 18.8%,p = 0.020）和RV FAC（27%比36%，p = 0.006）在重度NE中低于轻度NE。较低的LV 4Ch与胸外按压（- 18.5%对- 23.3%）、分娩时使用肾上腺素（- 19.3%对- 23.4%）和出院时生存率降低（- 15.9%对- 22.7%）相关。结论NE患者srv和LV应变力学受损。较低的RV菌株和LV 4Ch菌株与需要增加的医疗支持和降低的出院存活率有关。

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Retrospective study of left and right ventricular strain mechanics among neonates undergoing therapeutic hypothermia for neonatal encephalopathy

Purpose

Early diagnosis of impaired myocardial function and timely therapeutic hypothermia is vital among patients with Neonatal Encephalopathy (NE). Traditional markers of myocardial function (Left Ventricular Ejection Fraction (LV EF) & LV Fractional Shortening (LV FS) can be variably reduced. Speckle tracking echocardiography (STE) is a more sensitive marker for impairment but remains inadequately studied in this patient population.

Methods

A retrospective study of neonates who underwent therapeutic hypothermia (TH) for NE from 2009 to2020 were matched 1:1 with normal neonates with normal echocardiograms performed for indications other than NE. Matching was based on gestational age, birth weight, days of age, and sex. Left ventricular 4 Chamber (4Ch) strain, right ventricular 4 Chamber (RV 4Ch), and RV free wall strain (RV FWS) were measured offline using vendor independent strain software (TomTec, GMBH, Munich, Germany).

Results

Ninety pairs of NE patients and controls were studied. Compared to controls, RV 4Ch strain (−17.3 % vs. -19.6 %), RV FWS (−18.8 % vs. -21.9 %), and RV fractional area change (FAC) (35 % vs. 37 %) were lower in NE cases (all p < 0.001), while differences in LV 4Ch strain, LV EF, and LV FS did not reach statistical significance. Moderate/severe NE (72 %) was associated with lower LV 4Ch strain compared to mild NE (−22.2 %/−19.3 % vs. -25.4 %, p = 0.004). RV 4Ch strain (−14.9 % vs. -18.8 %, p = 0.020) and RV FAC (27 % vs. 36 %, p = 0.006) were lower in severe NE compared to mild NE. Lower LV 4Ch was associated with need for chest compressions (−18.5 % vs. -23.3 %), epinephrine at delivery (−19.3 % vs. -23.4 %), and decreased survival to discharge (−15.9 % vs. -22.7 %).

Conclusions

RV and LV strain mechanics are impaired in NE patients. Lower RV Strain and LV 4Ch strain were associated with need for increased medical support and decreased survival to discharge.

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来源期刊

Early human development 医学-妇产科学

CiteScore

4.40

自引率

4.00%

发文量

100

审稿时长

46 days

期刊介绍： Established as an authoritative, highly cited voice on early human development, Early Human Development provides a unique opportunity for researchers and clinicians to bridge the communication gap between disciplines. Creating a forum for the productive exchange of ideas concerning early human growth and development, the journal publishes original research and clinical papers with particular emphasis on the continuum between fetal life and the perinatal period; aspects of postnatal growth influenced by early events; and the safeguarding of the quality of human survival. The first comprehensive and interdisciplinary journal in this area of growing importance, Early Human Development offers pertinent contributions to the following subject areas: Fetology; perinatology; pediatrics; growth and development; obstetrics; reproduction and fertility; epidemiology; behavioural sciences; nutrition and metabolism; teratology; neurology; brain biology; developmental psychology and screening.