Abstract 14661: Early Predictive Markers of Right Ventricular - Pulmonary Vascular Dysfunction in Preterm Infants With Bronchopulmonary Dysplasia

Abstract

Introduction: Improved survival of extremely preterm infants has led to an increased recognition of bronchopulmonary dysplasia (BPD) associated with abnormal cardio-pulmonary hemodynamics. Reliable non-invasive quantitative markers for early recognition of BPD in preterm infants are lacking. The aim of this study was to evaluate quantitative echocardiographic measures of right ventricular hemodynamics (RV) as early predictive markers in infants at risk for development of BPD. Methods: A prospective study was conducted in 115 preterm infants (< 29 weeks gestational age) enrolled through the Prematurity and Respiratory Outcomes Program (NCT01435187). Echocardiographic measures of RV function and pulmonary hemodynamics were evaluated at 32 and 36 weeks post-menstrual age (PMA). RV systolic function was assessed with fractional area of change (FAC), tricuspid annular plane systolic excursion (TAPSE), and global and free wall longitudinal strain. RV morphometrics were assessed with RV dimensions and areas. Pulmonary hemodynamics were assessed by pulmonary artery acceleration time (PAAT). Commonly used qualitative measures (tricuspid regurgitation velocity and septal flattening) were evaluated for comparison. BPD was classified by the NIH workshop definition. Results: RV global and free wall strain, FAC, TAPSE, and PAAT were significantly reduced, and RV morphometrics were significantly larger at 32 and 36 weeks PMA in preterm infants who developed BPD (Table 1). Qualitative measures were present in < 20% of patients, and only septal flattening was significant at 32 weeks PMA in the BPD group. Conclusions: Quantitative echocardiographic measures of RV function and pulmonary hemodynamics are reliable early predictive markers of subsequent development of BPD in preterm infants. These measures are superior to commonly used qualitative measures and can be useful tools for early identification of preterm infants at high risk for BPD.