Serial Assessment of Cardiac Function and Pulmonary Hemodynamics in Infants With Down Syndrome

Abstract

There is a dearth of longitudinal data describing the evolution of cardiopulmonary hemodynamics in infants with Down syndrome (DS) beyond infancy. We hypothesized that babies with DS, independent of the presence of congenital heart disease (CHD), demonstrate biventricular systolic and diastolic impairment and sustained elevation of pulmonary pressures compared with controls over the first 2years of age. This was a prospective observational cohort study of 70 infants with DS (48 with CHD and 22 without CHD) and 60 controls carried out in 3 tertiary neonatal intensive care units in Dublin, Ireland. Infants with DS with and without CHD and non-DS controls underwent serial echocardiograms at birth, 6months, 1year, and 2years of age to assess biventricular systolic and diastolic function using deformation analysis. Pulmonary vascular resistance was assessed using pulmonary artery acceleration time and left ventricular (LV) eccentricity index. Infants with DS exhibited smaller LV (birth: 27±4 vs 31±2mm, P<.01; 2years: 43±5 vs 48±4mm, P<.01) and right ventricular (birth: 28±3 vs 31±2mm, P<.01; 2years: 40±4 vs 44±3mm, P<.01) lengths and lower LV (birth: -19%±3% vs -22%±2%, P<.01; 2years: -24%±2% vs -26%±2%, P<.01) and right ventricular (birth: -19%±4% vs -22%±3%, P<.01; 2years: -29%±6% vs -33%±4%, P<.01) systolic strain over the 2-year period. Pulmonary artery acceleration time was lower in the DS group throughout the study period (birth: 44±10 vs 62±14ms, P<.01; 2years 71±12 vs 83±11ms, P<.01). No differences were observed between DS infants with and without CHD (all P>.05). Infants with DS exhibit impaired maturational changes in myocardial function and pulmonary vascular resistance. Such novel findings provide valuable insights into the pathophysiology affecting cardiorespiratory morbidity in this population.