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The impact of a hyperdynamic left ventricle on right ventricular function measurements in preterm infants with a patent ductus arteriosus
  1. Colm R Breatnach1,
  2. Orla Franklin2,
  3. Adam T James1,
  4. Naomi McCallion1,3,
  5. Afif EL-Khuffash1,3
  1. 1 Department of Neonatology, The Rotunda Hospital, Dublin, Ireland
  2. 2 Department of Cardiology, Our Lady's Children's Hospital, Crumlin, Dublin, Ireland
  3. 3 School of Medicine (Department of Paediatrics), Royal College of Surgeons in Ireland, Dublin, Ireland
  1. Correspondence to Prof Afif EL-Khuffash, Department of Neonatology, The Rotunda Hospital, Parnell Street, Dublin 1, Ireland; afifelkhuffash{at}


Background and aims Right ventricular (RV) functional assessment in premature infants includes basal longitudinal strain (RV BLS), RV systolic tissue Doppler velocity (RV s′), tricuspid annular plane systolic excursion (TAPSE) and RV fractional area change (FAC). A hyperdynamic left ventricle (LV) may influence RV measures of displacement (TAPSE) and velocity (RV s′) but not measures of relative change of length (RV BLS) or area (FAC). We aimed to explore this hypothesis in preterm infants with a patent ductus arteriosus (PDA).

Methods We measured LV function (ejection fraction (LV EF); left ventricular output) and RV function (RV BLS; RV s′; TAPSE; FAC) on days 1, 2 and 5–7 in infants <29 weeks. The cohort was divided based on PDA presence by days 5–7. LV and RV function measurements were compared between the groups using two-way analysis of variance with repeated measures.

Results 121 infants with a mean (SD) gestation and birth weight of 26.8 (1.4) weeks and 968 (250) g were enrolled. By days 5–7, the PDA remained open in 83 (69%), with evidence of hyperdynamic LV function. There was no difference in RV s’ (5.3 (0.9) vs 5.1 (1.0) cm/s, p=0.3) or TAPSE (6.2 (1.3) vs 6.1 (1.2) mm, p=0.7) between infants with and without a PDA, but infants in the PDA group had lower RV FAC (41 (8) vs 47 (10) %, p<0.01) and lower RV BLS (−24.2 (5.0) vs −26.2 (4.1) %, p=0.03).

Conclusions LV influence on RV functional parameters must be taken into account when interpreting of RV function using those techniques.

  • RV function
  • Preterm Infants
  • LV function
  • Patent Ductus Arteriosus

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  • This work was presented in part at the European Academy of Paediatric Societies held in Geneva, Switzerland, in October 2016.

  • Contributors CRB and ATJ performed the echocardiography studies and the image analysis to obtain the functional measurement. CRB wrote the first draft of the manuscript. OF provided the support with the concept and cardiology expertise. NM aided with the writing of the first draft and AELK provided senior oversight to the project and performed the statistical analysis.

  • Funding AELK is in receipt of an Irish Health Research Board Mother and Baby Clinical Trials Network Grant (HRB CTN 2014-10), an EU FP7/2007-2013 grant (agreement no 260777, The HIP Trial) and a Rotunda Hospital Foundation Research Grant (Reference: FoR/EQUIPMENT/101572).

  • Competing interests None declared.

  • Patient consent Obtained.

  • Ethics approval Rotunda Hospital Ethics Committee.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement The data from the study are only available to the principal and senior author of the study.