Myocardial strain on admission predicts disease severity in infants hospitalized for bronchiolitis

Abstract

Objective To assess cardiac function in infants with bronchiolitis and the association with disease severity and outcomes. Working Hypothesis Cardiac function may be impaired in bronchiolitis and represent an early predictor of disease severity. Study Design A prospective cohort study. Patient Selection Infants with suspected bronchiolitis were included. Methodology All cases received antigen detection and viral genome detection from nasal lavage or swabs and echocardiography within 24 hours from admission. Systolic and diastolic function in left ventricle (LV) and right ventricle (RV) were assessed using longitudinal strain (LS), a measure of myocardial deformation. Pulmonary artery pressures were estimated using tricuspid regurgitation jet (TR), when present, and end‐systolic eccentricity index (EI ES). Main outcomes (duration of respiratory support, length of stay [LOS], and type of respiratory support) were collected. Data were compared to normative existing data, and a group of healthy infants, matched in age. Results Twenty‐eight infants with bronchiolitis and 10 healthy comparators were included. Cases with bronchiolitis showed significantly lower values of RV LS and LV LS compared to healthy comparators (LV: p0.04 and RV: P < .001). Ten infants (36%) had a normal biventricular function, nine (32%) had LV impairment, and nine (32%) had a biventricular impairment. No significant differences were found in TR and EI ES. Infants with biventricular impairment demonstrated a significant increase in LOS (p0.04) and higher levels of respiratory support compared to the healthy comparators (P = .03). Conclusions Bronchiolitis is associated with myocardial impairment. Cardiac function is related to disease severity and outcome.

The Role of Lung Function Testing in Newborn Infants With Congenital Thoracic Arterial Anomalies

“…Based on our findings, LFTs are not associated with disease severity, although we speculate that LFTs may be combined with other bedside tools such as myocardial strain. Myocardial strain, evaluated by echocardiography, has been associated with several diseases in critically ill newborn infants ( 27 – 29 ). Previous studies conducted by our team showed a reduction in myocardial strain in infants with VR, particularly in those with a tracheal obstruction >50%, suggesting a secondary cardiac dysfunction related to severe tracheomalacia ( 12 ).…”

The Assessment of Myocardial Strain by Cardiac Imaging in Healthy Infants with Acute Bronchiolitis: A Systematic Review and Meta-Analysis

“…The ratings of the quality of the methods of the individual studies are presented in Table 1. Overall, the scores were generally fair, with only three out of the ten studies achieving a good methodological quality [28][29][30]. Studies typically lost points for internal validity and confounding and selection bias because of questions which were aimed at randomized and intervention trials.…”

“…Evaluation of the full texts of the remaining 23 articles led to the exclusion of 11 articles. Ultimately, 10 articles were included in this systematic literature review and meta-analysis [21][22][23][24][25][26][27][28][29][30] (Figure 1). Two studies were carried out by the same authors [28,29], but with two different cohorts, and therefore there were no overlapping data.…”

“…All 10 selected studies consisted of observational prospective cohort studies; three of them had control subjects [25,29,30]. The ratings of the quality of the methods of the individual studies are presented in Table 1.…”

“…Four studies [23,24,26,27] did not provide a representative of the study population; two of them [23,26] included participants with severe AB at the moment of the enrollment, and one of them [27] utilized a convenience sample. Only five studies [24,[27][28][29][30] could demonstrate that severe disease or adverse outcomes were not present at the start of the study. Comparability of the cohorts was possible in seven studies [21,24,25,[27][28][29][30].…”