title: Serial measures of cardiac performance using tissue Doppler imaging velocity in preterm infants <29weeks gestations.
abstract: Tissue Doppler imaging (TDI) is a useful marker of myocardial performance in preterm infants. We aimed to demonstrate serial changes in TDI velocity in preterm infants <29weeks gestation, to assess the impact of inotropes and a haemodynamically significant patent ductus arteriosus (hsPDA).
  
  
  
  This was a prospective observational study of preterm infants <29weeks gestation. Echocardiography was performed at days 1, 2, 5-7 and at 36weeks, or before hospital discharge. Infants with hsPDA's on day 5-7 and those who received inotropes in the first week of life were not included in the Reference Cohort. Systolic (s`) and diastolic (e` and a`) velocity waves were assessed at the mitral and tricuspid annulus and basal septum.
  
  
  
  One hundred and thirty nine infants with a mean (SD) gestation and birthweight of 26.7 (1.5) weeks and 946 (247) grams were enrolled. The 66 infants (47%) in the Reference Cohort demonstrated an increase in functional parameters with increasing age [LV s`, Septal s`, and RV s`, Day 1-36weeks: 2.8 (0.6) to 4.7 (1.0), 2.4 (0.6) to 4.6 (0.8), 3.6 (0.6) to 6.9 (1.0) cm/s respectively; all p<0.05). The 24 infants who received inotropes had lower LV e` [2.9 vs. 3.6cm/s], Septal e` [2.3 vs. 2.8cm/s] and a` [3.2 vs. 3.9cm/s], and lower RV a` [3.3 vs. 3.9cm/s] on Day 1 (all p<0.05). Fifty five infants had a hsPDA on Day 5-7, demonstrating higher LV [4.7 vs. 4.0cm/s] and Septal e` [3.9 vs. 3.3cm/s], and a higher LV E/e` [13 vs. 10] (all p<0.05).
  
  
  
  Extremely preterm infants display a gradual increase in tissue Doppler velocities from birth until 36weeks corrected age. The presence of a hsPDA increases diastolic TDI velocities. Infants requiring inotropes have lower diastolic myocardial velocities on Day 1.
authors.affiliation: Department of Neonatology, The Rotunda Hospital, Dublin, Ireland. Electronic address: colm.breatnach@gmail.com.
authors.forename: Colm R
authors.initials: CR
authors.lastname: Breatnach
authors.affiliation: Department of Neonatology, The Rotunda Hospital, Dublin, Ireland; School of Medicine (Department of Paediatrics), Royal College of Surgeons in Ireland, Dublin, Ireland. Electronic address: afifelkhuffash@rcsi.ie.
authors.forename: Afif
authors.initials: A
authors.lastname: El-Khuffash
authors.affiliation: Department of Neonatology, The Rotunda Hospital, Dublin, Ireland.
authors.forename: Adam
authors.initials: A
authors.lastname: James
authors.affiliation: Department of Neonatology, The Rotunda Hospital, Dublin, Ireland; School of Medicine (Department of Paediatrics), Royal College of Surgeons in Ireland, Dublin, Ireland.
authors.forename: Naomi
authors.initials: N
authors.lastname: McCallion
authors.affiliation: Department of Cardiology, Our Lady's Children's Hospital Crumlin, Dublin, Ireland.
authors.forename: Orla
authors.initials: O
authors.lastname: Franklin
mesh_terms: D003971:Diastole; D004374:Ductus Arteriosus, Patent / Q000000981:diagnostic imaging* / Q000503:physiopathology; D015150:Echocardiography, Doppler; D005260:Female; D006801:Humans; D062071:Infant, Extremely Premature / Q000502:physiology*; D007231:Infant, Newborn; D008297:Male; D063177:Pulse Wave Analysis; D016276:Ventricular Function
keywords: Inotropes; Patent ductus arteriosus; Preterm infants; Tissue Doppler imaging