Left Ventricular End‐Systolic Eccentricity Index for Assessment of Pulmonary Hypertension in Infants

Abraham, Sharon; Weismann, Constance G.

doi:10.1111/echo.13171

Cited by 87 publications

(72 citation statements)

References 18 publications

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“…a left-ventricular end-systolic eccentricity index (sEI) ≥1.15] flattening of the interventricular septum in systole, which indicates more than half the systemic right-ventricular systolic pressure [7]. sEI was defined as the ratio between the left-ventricular anteroposterior and septolateral dimensions at the mid-ventricular level (online supplementary figure; see www.karger.com/doi/10.1159/000442043) [8]. Thus, the sEI of a circle would be 1.…”

Section: Methodsmentioning

confidence: 99%

Biochemical Screening for Pulmonary Hypertension in Preterm Infants with Bronchopulmonary Dysplasia

et al. 2016

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Background: Pulmonary hypertension (PH) in infants with bronchopulmonary dysplasia (BPD) is associated with increased morbidity and mortality. Elevated levels of N-terminal pro-B-type natriuretic peptide (NT-proBNP) and decreased levels of amino acid precursors of nitric oxide (NO) have been associated with PH, but have not been studied in infants with PH secondary to BPD. Objective: The aim of this study was to identify a biochemical marker for PH in infants with BPD. Methods: Twenty infants, born at <27 weeks' gestational age (GA) and/or with a birth weight (BW) ≤750 g, who met the criteria for BPD at 36 weeks' corrected GA (CGA) were enrolled in this cross-sectional pilot study. A screening echocardiogram was conducted at 36-38 weeks' CGA and plasma NT-proBNP and amino acid levels were obtained within 1 week of the screening echocardiogram. Results: Five infants (25%) had echocardiographic evidence of PH. GA and BW were not significantly different between the 2 groups (a PH group and a No PH group). NT-proBNP was significantly elevated in the PH group (median 1,650 vs. 520 pg/ml; p = 0.001) but citrulline levels were significantly lower (median 21 vs. 36 μmol/l; p = 0.005). Arginine levels were not significantly different between the groups (median 78 vs. 79 μmol/l; p = 1). Conclusion: NT-proBNP and the NO precursor citrulline may be cost-effective biochemical markers for screening for the presence of PH in preterm infants who have BPD. If validated in a larger study, such biochemical markers may, in part, replace PH screening echocardiograms in these patients.

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Section: Methodsmentioning

confidence: 99%

Biochemical Screening for Pulmonary Hypertension in Preterm Infants with Bronchopulmonary Dysplasia

et al. 2016

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“…33,34,39,40 But it is also now known that PH prevalence tends to be overestimated by 28 For >30 years, assessment of septal geometry continues to be recommended for noninvasive evaluation of PH at all ages. 12,16,26,27,41,42 Invasive studies in children with congenital heart disease have shown that LVEI correlates well with RVSP (r = 0.86, P < 0.001). 42 LVEI also correlates with RVSP-to-SBP ratio.…”

Section: Discussionmentioning

confidence: 98%

“…But no single noninvasive variable accurately predicts PAP in all cases . For >30 years, assessment of septal geometry continues to be recommended for noninvasive evaluation of PH at all ages . Invasive studies in children with congenital heart disease have shown that LVEI correlates well with RVSP (r = 0.86, P < 0.001) .…”

Section: Discussionmentioning

confidence: 99%

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A modified noninvasive screening protocol for pulmonary hypertension in children with sickle cell disease—Who should be sent for invasive evaluation?

Lilje

Harry

Gajewski

et al. 2017

Pediatric Blood & Cancer

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Our modified noninvasive screening protocol-if confirmed by invasive studies-may help to better identify a subgroup of pediatric SCD patients in whom evaluation by catheterization appears justified. Unlike estimates based on the conventional protocol, the size of the targeted subgroup compares favorably with catheterization-confirmed PH prevalence rates. Characteristics associated with an increased PH risk were also identified.

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“…From this projection, a “D”‐shaped left ventricle implies equal pressures and an inverted septum is consistent with severe/supra‐systemic pulmonary hypertension. Sharon et al reported that more than half‐systemic RV pressure became apparent at EIs ≥ 1.3. In a large PDA with severe pulmonary hypertension, the right to left shunt limits the RV pressure to near systemic levels and therefore the ventricular septum will flatten but not invert.…”

Section: Discussionmentioning

confidence: 99%

Echocardiography of the patent ductus arteriosus in premature infant

Paudel

Joshi

2019

Congenital Heart Disease

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Management of the patent ductus arteriosus (PDA) in the premature infant has been a point of controversy for decades as smaller and earlier gestational age infants have been surviving. Increasing experience with catheter‐based device closure has generated a new wave of interest in this subject. In this era, echocardiography plays a central role for collaboration within a multispecialty team. Reliability of echocardiography is improved by applying an institutionally derived standard approach to imaging, data collection, and reporting. The key aspects of both the physiology and anatomy of the PDA to distinguish infants that may benefit from intervention are described.

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Left Ventricular End‐Systolic Eccentricity Index for Assessment of Pulmonary Hypertension in Infants

Abstract: We suggest that EIs should be incorporated into routine protocols when there is a concern for PH in neonates. This may lead to a more reliable assessment of PH and may reduce inter-observer variability. Correlation of EIs with invasive hemodynamic data is needed to validate our results.

Cited by 87 publications

References 18 publications

Biochemical Screening for Pulmonary Hypertension in Preterm Infants with Bronchopulmonary Dysplasia

Biochemical Screening for Pulmonary Hypertension in Preterm Infants with Bronchopulmonary Dysplasia

A modified noninvasive screening protocol for pulmonary hypertension in children with sickle cell disease—Who should be sent for invasive evaluation?

Echocardiography of the patent ductus arteriosus in premature infant

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