114 - Serial Tissue Doppler Imaging as a tool for screening and diagnosis of bronchopulmonary dysplasia associated pulmonary hypertension in extreme premature infants.

Monday, May 1, 2023

9:30 AM – 11:30 AM ET

Poster Number: 114
Publication Number: 114.426

Krishna Revanna. Gopagondanahalli, KK Women's and Children's Hospital, singapore, N/A, Singapore; Sreekanthan Sundararaghavan, Duke NUS School of Medicine, singapore, N/A, Singapore; Shrenik Jitendrakumar Vora, KK Women’s and Children’s Hospital, Singapore, N/A, Singapore; Abdul Alim Abdul Haium, KK Women's and Children's Hospital, Singapore, Singapore, N/A, Singapore; Kee Thai Yeo, Duke-NUS School of Medicine, Singapore, N/A, Singapore; Wei Di Ng, KK Women's and Children's Hospital, Singapore, N/A, Singapore; Wai Lin Ang, KK Women's and Children's Hospital, Singapore, N/A, Singapore; Jonathan Tze Liang Choo, KK Women's and Children's Hospital, Singapore, N/A, Singapore; victor samuel rajadurai, KK Women’s & Children’s Hospital, Singapore, N/A, Singapore; Teng Hong Tan, KK Women’s & Children’s Hospital, Singapore, N/A, Singapore

Presenting Author(s)

KG

Krishna Revanna Gopagondanahalli, MRCPCH (he/him/his)

Staff Physician
KK Women's and Children's Hospital
singapore, Singapore

Background: Bronchopulmonary dysplasia (BPD) is the most common respiratory disorder in surviving preterm infants. The onset of pulmonary hypertension (PH) in BPD often complicates the outcome. The optimal timing of echocardiographic screening is not well established. The conventional echocardiographic parameters lack sensitivity in diagnosing and predicting BPD associated PH (BPD-PH).

Objective: To evaluate the serial Tissue Doppler Imaging (TDI) parameters in extreme premature infants and its utility in diagnosis and predicting the onset of BPD-PH. The study aims to establish the optimal timing of echocardiographic screening.

Design/Methods:

Extreme premature infants (< 28 weeks of gestation) had serial comprehensive echocardiographic analysis including conventional and TDI scan at four-weekly intervals from birth till the corrected age of 36 weeks. At 36 weeks, BPD-PH was diagnosed based on standard conventional echocardiographic parameters (Tricuspid regurgitation jet Vmax >2.8m/sec, Left ventricular eccentricity index >1.15 and ratio of right ventricular (RV) acceleration time to ejection time (Acct/RVET) < 0.3). The conventional echocardiographic and TDI parameters were analysed between the BPD without PH and BPD-PH group. We hypothesize that TDI scans increase the sensitivity of diagnosing BPD-PH.

Results:

Total of 80 infants were recruited, 79 were included in the analysis. 30 (38%) infants in our study developed BPD-PH (conventional and TDI) compared to conventional alone (25%). Among the conventional echocardiographic parameters, higher left ventricle (LV) end systolic eccentricity index(EI) (0.96±0.13 vs 1.07±0.16, p < 0.008) and lower AccT/RVET (0.28±0.05 vs 0.24±0.05, p 0.04) were predictive of BPD PH from 33 weeks onwards. The prolonged RV isovolumetric contraction time (IVCT) (22.77±4 vs 27.84±5.5 p 0.001), RV isovolumetric relaxation time (IVRT) (34.9±5.3 vs 40.3±7.1 p 0.003) and RV myocardial performance index (0.32±0.03 vs 0.39±0.05 p 0.001) showed similar trend. These changes persisted at 36 weeks’ scan. The LV EI of 1.14-1.16 had 94% sensitivity and 96% specificity whereas RV MPI of 0.4 had 100% specificity and 94% sensitivity in diagnosing BPD-PH. The echocardiographic changes (conventional and TDI) showed similar trend when adjusted for gestational age at birth.

Conclusion(s): Tissue Doppler imaging along with standard conventional echocardiogram increases the diagnostic accuracy of BPD-PH in extremely premature infants. Echocardiographic screening can be initiated at 32- 33 weeks of gestation for early detection of PH.