Fetal pulmonary artery stiffness is a strong predictor of persistent pulmonary hypertension of the newborn - An echocardiographic study.

OBJECTIVE: Pulmonary artery stiffness (PAS) is a strong and independent predictor of mortality in adult patients with pulmonary hypertension (PH). But the change in PAS during perinatal period remains unknown. Here, we aimed to explore the feasibility and performance of PAS on predicting persistent pulmonary hypertension of the newborn (PPHN). METHODS: 1325 fetuses underwent a dedicated echocardiography screening for fetal heart defects during second trimester, third-trimester and neonatal period with the measurement of acceleration time (PAAT) and maximal frequency shift (MFS) of pulmonary artery flow. PAS (MFS/PAAT ratio) was calculated. RESULTS: Six fetuses were diagnosed as PPHN. Compared with the normal fetuses, those with PH had greater values of PAS during each period of time (second trimester, 52.6(46.2-54.5) vs. 32.4(28.0-39.4) kHz/s, p = 0.0003; third trimester, 52.9(46.1-55.3) vs. 29.7(27.3-33.3) kHz/s, p = 0.0002; neonatal period, 127.4(85.2-150.8) vs. 26.6(22.7-35.0) kHz/s, p < 0.0001). There was a statistically significant correlation between PAS and mean pulmonary artery pressure (p < 0.05) but no correlation between PAS and gestational age (p > 0.05) whether in normal fetuses or not. The area under receiver operating characteristic curve (AUC) of 0.97 for PAS during third trimester was superior to that for PAS during second trimester (AUC, 0.94) in predicting PPHN. The optimal cutoff value of PAS during third trimester was 37.40 KHz/s, with a sensitivity of 100%, a specificity of 91%, and an accuracy of 92%. CONCLUSION: There was a significant difference in PAS between normal fetuses and those with PH. PAS has a power performance on predicting PPHN.

Pulmonary transit time has close relation with pulmonary pulse wave transit time in normal subjects.

BACKGROUND: Pulmonary transit time (PTT) and pulmonary pulse wave transit time (pPTT) are useful parameters for the evaluation of cardiopulmonary circulation and vascular alterations, but their relationship remains unknown. The aim of this study was to investigate the correlation between PTT and pPTT. METHODS: A total of 60 healthy volunteers were involved in this study. They were divided into two groups (30 participants per group): <50 years and >50 years. They all underwent Doppler echocardiography of pulmonary vein flow and contrast echocardiography with the measurement of pPTT and PTT, respectively. The correlation between PTT and pPTT was deduced. RESULTS: Compared with Group of <50 years, there was a significant increment in left atrial volume index, left atrial pressure and pulmonary artery stiffness but a significant reduction in acceleration times of pulmonary artery flow in Group of >50 years (p < 0.05). Group >50 years had longer PTT and but reduced normalized PTT by R-R interval (NPTT), reduced normalized pPTT by R-R interval (NpPTT) than Group <50 years (p < 0.05), while there was no significant difference in pPTT between the two groups (p > 0.05). PTT and NPTT were all negatively correlated with pPTT and NpPTT. The statistically significant strongest correlation was observed between PTT and NpPTT (r = -0.886, p < 0.0001). The regression equation for them was y = 7.4396-13.095x (R2 = 0.785; p < 0.001), where x and y represent NpPTT and PTT, respectively. CONCLUSION: PTT had close relation with pPTT in normal subjects. From the regression equation for them, we can get the value of PTT simply and easily by non-invasively measured pPTT.

A Novel Approach to Assessing the Severity of Acute Stroke and Neurological Deficits in Patients with Acute Ischemic Stroke Using Myocardial Work Echocardiography.

BACKGROUND: We aimed to evaluate the feasibility and performance of myocardial work echocardiography in assessing the severity of acute stroke and neurological deficits in patients with acute ischemic stroke. METHODS: A total of 176 patients were examined by echocardiography within 24-48 hours of symptom onset with the measurement of global and regional myocardial work. The National Institutes of Health Stroke Scale score of each patient was documented. RESULTS: With the increase of the National Institutes of Health Stroke Scale score, myocardial constructive work or positive work decreased (P 15 or not. The optimal cutoff value was 3.89, with a sensitivity of 100%, a specificity of 93.0%, a positive predictive value of 84.9%, a negative predictive value of 100%, and an accuracy of 95.7%. CONCLUSION: Noninvasive myocardial work is highly competent in assessing the severity of acute stroke and neurological deficits, which can be used as a powerful supplement to the conventional scoring system.

Perinatal changes of right ventricle-pulmonary artery coupling and its value in predicting persistent pulmonary hypertension of the newborn.

BACKGROUND: Right ventricle-pulmonary artery (RV-PA) coupling is an independent predictor of outcome in pulmonary arterial hypertension in adults. Here, we aimed to investigate the changes in RV-PA coupling during the perinatal period, and to evaluate its performance on predicting persistent pulmonary hypertension of the newborn (PPHN). METHODS: A total of 1196 fetuses underwent a dedicated echocardiography screening for foetal heart defects during second trimester (24-27 weeks' gestation), third trimester (34-37 weeks' gestation) and neonatal period (within 14 days after delivery) with the measurement of tricuspid annular plane systolic excursion (TAPSE) and mean pulmonary artery pressure (MPAP). The RV-PA coupling (TAPSE/MPAP ratio) was calculated. RESULTS: Six fetuses were diagnosed as persistent pulmonary hypertension of the newborn (PPHN). In normal fetuses, RV-PA coupling had been increasing from the second trimester to the third trimester and then to the neonatal period (0.12 ± 0.02 vs. 0.18 ± 0.05 vs. 0.23 ± 0.08 mm/mmHg, p < 0.05), while it had been decreasing during the same period of time in abnormal fetuses (0.18 ± 0.02 vs. 0.17 ± 0.02 vs. 0.17 ± 0.01 mm/mmHg, p < 0.05). There was a strong positive correlation between RV-PA coupling and gestational age (GA) in normal fetuses (r = 0.71, p < 0.0001). The area under receiver operating characteristic curve (AUC) of 0.989 for RV-PA coupling during second trimester was superior to that for RV-PA coupling during third trimester (AUC: 0.536) in predicting PPHN. The optimal cutoff value was 0.16 mm/mmHg, with a sensitivity of 100.00%, a specificity of 96.36% and an accuracy of 97.73%. CONCLUSION: RV-PA coupling had close relation with GA in normal fetuses. It was a strong predictor of PPHN.