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Myocardial contractility in premature neonates with and without patent ductus arteriosus.

Abstract：

:Controversy exists as to whether a hemodynamically significant left-to-right shunt due to a patent ductus arteriosus (PDA) affects ventricular contractility. Load-dependent indices such as ejection fraction and shortening fraction have traditionally been used to assess contractility, but the relationship between the rate-corrected velocity of fiber shortening (MVCFc) and wall stress may be more suitable, as it is a preload-independent, afterload-adjusted method of assessing ventricular contractility. Age-related differences have been established for these variables in normal adults and children and it has been recommended for use in the premature neonate. The study was performed to assess left ventricular contractility in premature neonates with a significant left-to-right shunt due to a PDA. Using echocardiography, we measured the relationship of MVCFc to stress at peak systole (SPS) in two groups of premature infants. Group 1 consisted of 15 controls (680-1495 g, 25-32 weeks' gestation), and Group 2 of 15 neonates with hemodynamically significant PDA (840-1635 g, 26-33 weeks' gestation). In both groups, MVCFc was linearly and inversely related to SPS ( p < 0.001). The regression equations were as follows: Group 1, MVCFc = -0.0153SPS + 1.70 ( R(2) = 0.68); and Group 2, MVCF = - 0.019SPS + 1.89 ( R(2) = 0.76). There was no significant difference in the relationship between the two groups, but their slopes were significantly steeper and had a higher Y-intercept than the relationship we previously reported for older children. This preliminary study establishes the normal MVCFc/SPS relationship in the premature neonate (25-33 weeks' gestation) and suggests that premature infants function at a higher resting contractile state than older children. A hemodynamically significant PDA has no effect on contractility. These data will be useful in assessing left ventricular contractility in premature neonates with other types of ventricular loading and noncardiac stress.

journal_name

Pediatr Cardiol

journal_title

Pediatric cardiology

authors

Barlow AJ,Ward C,Webber SA,Sinclair BG,Potts JE,Sandor GG

doi

10.1007/s00246-003-0452-0

subject

Has Abstract

pub_date

2004-03-01 00:00:00

pages

102-7

issue

eissn

0172-0643

issn

1432-1971

journal_volume

pub_type

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Myocardial contractility in premature neonates with and without patent ductus arteriosus.