Abstract
BackgroundMany pathologies seen in the preterm population are associated with abnormal blood supply, yet robust evaluation of preterm cardiac function is scarce and consequently normative ranges in this population are limited. The aim of this study was to quantify and validate left ventricular dimension and function in preterm infants using cardiovascular magnetic resonance (CMR). An initial investigation of the impact of the common congenital defect patent ductus arteriosus (PDA) was then carried out.MethodsSteady State Free Procession short axis stacks were acquired. Normative ranges of left ventricular end diastolic volume (EDV), stroke volume (SV), left ventricular output (LVO), ejection fraction (EF), left ventricular (LV) mass, wall thickness and fractional thickening were determined in “healthy” (control) neonates. Left ventricular parameters were then investigated in PDA infants. Unpaired student t-tests compared the 2 groups. Multiple linear regression analysis assessed impact of shunt volume in PDA infants, p-value ≤ 0.05 being significant.Results29 control infants median (range) corrected gestational age at scan 34+6(31+1-39+3) weeks were scanned. EDV, SV, LVO, LV mass normalized by weight and EF were shown to decrease with increasing corrected gestational age (cGA) in controls. In 16 PDA infants (cGA 30+3(27+3-36+1) weeks) left ventricular dimension and output were significantly increased, yet there was no significant difference in ejection fraction and fractional thickening between the two groups. A significant association between shunt volume and increased left ventricular mass correcting for postnatal age and corrected gestational age existed.ConclusionCMR assessment of left ventricular function has been validated in neonates, providing more robust normative ranges of left ventricular dimension and function in this population. Initial investigation of PDA infants would suggest that function is relatively maintained.
Highlights
Many pathologies seen in the preterm population are associated with abnormal blood supply, yet robust evaluation of preterm cardiac function is scarce and normative ranges in this population are limited
10 control infants with median gestational age (GA) 33+2(26+2 – 35+4) weeks, corrected gestational age (cGA) 35+2(32+1 – 37+3) weeks, birth weight (BW) 1860 (1040 – 2770) grams and current weight at scan (CW) 1980(1060 – 2770) grams were assessed for intra- and inter-observer variability analysis
Unpaired Student’s t-tests showed that end diastolic volume (EDV), stroke volume (SV), left ventricular output (LVO), end diastolic (ED) wall thickness, LVmass and LVmass/ EDV are significantly increased in patent ductus arteriosus (PDA) infants
Summary
Many pathologies seen in the preterm population are associated with abnormal blood supply, yet robust evaluation of preterm cardiac function is scarce and normative ranges in this population are limited. It is common clinical belief that large ductal shunt volumes increase cardiac workload and are associated with congestive heart failure [2,4,7]; large shunt volumes are thought to lead to systemic hypo-perfusion and pulmonary hyper-perfusion due to cardiocirculatory dysfunction [8,9,10]. From observation in our previous study [12], infants with PDA appeared to have enlarged myocardium and larger ventricular cavity volumes than the “healthy” control preterm infants (Figure 1), yet the extent of dilatation and impact of shunt volume and increased work load on cardiac function has not been quantified and remains unclear
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