Tripartite Assessment of Right Ventricular Systolic Function in Persistent Pulmonary Hypertension of the Newborn
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ORIGINAL ARTICLE
Tripartite Assessment of Right Ventricular Systolic Function in Persistent Pulmonary Hypertension of the Newborn Sathish M. Chikkabyrappa1 · Paul Critser2 · Jaheedah Roane3 · Sujatha Buddhe1 · Justin T. Tretter2,4 Received: 7 January 2020 / Accepted: 22 May 2020 © Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Non-invasive evaluation of right ventricular (RV) systolic function in neonates with pulmonary hypertension (PH) with traditional metrics including RV fractional area change (FAC) and tricuspid annular systolic plane excursion (TAPSE) has improved outcomes. Apical three-chamber (3C) RV–FAC, a novel tripartite assessment of the RV, has recently been described in healthy infants. We assess the utility of 3C RV–FAC and biplane RV–FAC in delayed transitioning and neonatal PH. Echocardiograms for 22 normal infants and 22 infants with PH were retrospectively analyzed for RV systolic function indices including four chamber (4C), 3C, and biplane RV–FAC, TAPSE, Tei index, and RV systolic excursion velocity (S’). 4C, 3C, and biplane RV–FAC correlated with PH severity and was decreased in neonates with PH compared to normal neonates (biplane RV–FAC 31.7 ± 13.4% vs. 41 .9 ± 4.7%, p = 0.002). TAPSE was significantly decreased in neonates with PH, but did not correlate with PH severity. Other RV systolic function metrics were not significantly different between normal neonates and neonates with PH. 3C RV–FAC and biplane RV–FAC are lower in neonates with PH. 3C and biplane RV–FAC may allow for improved assessment of global RV systolic dysfunction in newborns with delayed transitioning or PH compared to the commonly used regional methods. Keywords Pulmonary hypertension · Right ventricular fractional area change · Transthoracic echocardiogram
Introduction Enhanced understanding in the non-invasive evaluation of neonatal pulmonary hypertension (PH) has led to improved diagnosis and management [1]. Complete evaluation requires quantitative assessment of right ventricular (RV) systolic function, due to limited accuracy and reliability of qualitative assessment [2]. Methods in the assessment of RV systolic function in neonates include tricuspid annular plane systolic excursion (TAPSE), RV fractional area of change
* Sathish M. Chikkabyrappa [email protected] 1
Pediatric Cardiology, Seattle Children’s Hospital, University of Washington, Seattle, WA, USA
2
Heart Institute, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
3
Children’s Heart Institute, Fredericksburg, VA, USA
4
Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
(RV–FAC), RV strain, and RV myocardial performance index [3–7]. TAPSE and RV–FAC are clinically accepted standards for the assessment of RV systolic function in the evaluation of PH with reported normative values in healthy term and preterm infants [5, 6]. Studies have shown a good correlation between MRI-derived RV ejection fraction (EF) and these echocardiographic ma
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