title: The right ventricular systolic to diastolic duration ratio: a simple prognostic marker in congenital diaphragmatic hernia?
abstract: OBJECTIVE
  (i) To compare the ratio of right ventricular systolic to diastolic duration (SD/DD) in infants with congenital diaphragmatic hernia (CDH) and normal controls and (ii) to examine its association, if any, with outcomes in CDH.
  
  
  METHODS
  Retrospective chart and echocardiographic review of consecutive neonates (<1 month old) with CDH and term controls without structural heart defects. Right ventricular SD/DD was calculated by a single reader.
  
  
  RESULTS
  Infants with CDH (n = 29) were comparable to controls (n = 27) in their mean (SD) age [2.2 (3.3) vs. 2 (4.0) days], birthweight [3 (0.67) vs. 3 (0.69) kg] and proportion of males (48.2% vs. 72.4%). The DD and SD/DD were significantly abnormal in the CDH group, compared to controls. Among infants with CDH, those who died (n = 15) and those who died or required ECMO (n = 17) had significantly shorter DD and higher SD/DD ratio. At a cut-off of 1.3, SD/DD ratio had a sensitivity of 92.8 (95% CI 64-99%) and specificity of 61.5 (32-85%) for prediction of mortality. Significant independent associations with mortality were observed with antenatal diagnosis (p = 0.003) and higher SD/DD ratio (p = 0.04).
  
  
  CONCLUSIONS
  The right ventricular SD/DD ratio is a sensitive objective prognostic marker in infants with CDH. Further studies incorporating SD/DD ratio as a guide to intervention are warranted.
authors: Department of Pediatrics, Children's Hospital of Michigan, Detroit, MI 48201, USA. ssanjeev@dmc.org
authors: Sanjeev
authors: S
authors: Aggarwal
authors: Paul T
authors: PT
authors: Stockman
authors: Michael D
authors: MD
authors: Klein
authors: Girija
authors: G
authors: Natarajan
mesh_terms: D016022:Case-Control Studies; D003971:Diastole / Q000502:physiology*; D005260:Female; D006548:Hernia, Diaphragmatic / Q000000981:diagnostic imaging / Q000401:mortality / Q000503:physiopathology; D065630:Hernias, Diaphragmatic, Congenital; D006801:Humans; D007231:Infant, Newborn; D008297:Male; D011379:Prognosis; D012372:ROC Curve; D012016:Reference Values; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D016019:Survival Analysis; D013599:Systole / Q000502:physiology*; D014463:Ultrasonography; D018497:Ventricular Dysfunction, Right / Q000000981:diagnostic imaging / Q000209:etiology; D016278:Ventricular Function, Right