title: Right ventricular echocardiographic indices predict poor outcomes in infants with persistent pulmonary hypertension of the newborn.
abstract: OBJECTIVE
  Infants with persistent pulmonary hypertension of the newborn (PPHN) have elevated pulmonary vascular resistance that can lead to right ventricular (RV) failure and death. Clinicians must decide which infants will fail conventional therapy and require transfer to extra corporeal membrane oxygenation (ECMO) centres, but accurate echocardiographic predictors have not been identified. We assessed echocardiographic measurements of RV pressure and function in predicting progression to death or ECMO in infants with PPHN.
  
  
  RESULTS
  Echocardiograms for infants ≥35-week gestation with a clinical diagnosis of PPHN were retrospectively reviewed. Traditional and strain echocardiographic measures were compared for those with or without the primary outcome of ECMO/cardiovascular death. Receiver operator curves identified cut points for measures that were significantly different. Of the 86 subjects analysed, 25 (29%) of the patients had the primary outcome of ECMO/death. The ECMO/death group had diminished tricuspid annular plane systolic excursion (TAPSE; P = 0.002) and RV global longitudinal peak strain (GLPS; P = 0.03), a predominant right-to-left shunt across the patent ductus arteriosus (PDA; P = 0.05), and an elevated oxygenation index (OI; P < 0.001). Sensitivity/specificity for TAPSE <4 mm was 56 and 85%, and for GLPS greater than or equal to -9% was 52 and 77%.
  
  
  CONCLUSIONS
  TAPSE, GLPS, and right-to-left PDA shunting were associated with progression to death/ECMO. RV free wall strain was not associated with the outcome, suggesting that diminished global strain better reflects clinical outcomes in this group. These thresholds may assist in the decision-making to transfer high-risk infants to ECMO centres.
authors: Duke University Medical Center, 242 Erwin Road, Suite 504, Durham, NC 27710, USA jonathan.malowitz@duke.edu.
authors: Jonathan R
authors: JR
authors: Malowitz
authors: Duke University Medical Center, 242 Erwin Road, Suite 504, Durham, NC 27710, USA Children's Mercy Hospital, 2401 Gillham Rd, Kansas City, MO 64108, USA.
authors: Daniel E
authors: DE
authors: Forsha
authors: Duke University Medical Center, 242 Erwin Road, Suite 504, Durham, NC 27710, USA.
authors: P Brian
authors: PB
authors: Smith
authors: Duke University Medical Center, 242 Erwin Road, Suite 504, Durham, NC 27710, USA.
authors: C Michael
authors: CM
authors: Cotten
authors: Duke University Medical Center, 242 Erwin Road, Suite 504, Durham, NC 27710, USA.
authors: Piers C
authors: PC
authors: Barker
authors: Duke University Medical Center, 242 Erwin Road, Suite 504, Durham, NC 27710, USA.
authors: Gregory H
authors: GH
authors: Tatum
mesh_terms: D004452:Echocardiography / Q000379:methods*; D015199:Extracorporeal Membrane Oxygenation; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D008297:Male; D010547:Persistent Fetal Circulation Syndrome / Q000000981:diagnostic imaging* / Q000401:mortality / Q000503:physiopathology* / Q000628:therapy; D012189:Retrospective Studies; D015996:Survival Rate; D018497:Ventricular Dysfunction, Right / Q000000981:diagnostic imaging* / Q000401:mortality / Q000503:physiopathology* / Q000628:therapy
keywords: ECMO; echocardiogram; mortality; persistent pulmonary hypertension; strain