Short‐term ventriculo‐arterial coupling and myocardial work efficiency in preterm infants undergoing percutaneous patent ductus arteriosus closure

Abstract Definitive closure of a patent ductus arteriosus (PDA) causes significant changes in loading conditions of the left ventricle (LV) which can lead to cardiorespiratory instability including hypotension, low cardiac output, oxygenation, and ventilation impairment. Physiological insights of th...

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Autores principales:	Adrianne R. Bischoff, Amy H. Stanford, Patrick J. McNamara
Formato:	article
Lenguaje:	EN
Publicado:	Wiley 2021
Materias:	myocardial work patent ductus arteriosus percutaneous transcatheter ventriculo‐arterial coupling Physiology QP1-981
Acceso en línea:	https://doaj.org/article/4b8d470a1afe4f90a92cafcf0929bcd6
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spelling	oai:doaj.org-article:4b8d470a1afe4f90a92cafcf0929bcd62021-11-27T15:48:30ZShort‐term ventriculo‐arterial coupling and myocardial work efficiency in preterm infants undergoing percutaneous patent ductus arteriosus closure2051-817X10.14814/phy2.15108https://doaj.org/article/4b8d470a1afe4f90a92cafcf0929bcd62021-11-01T00:00:00Zhttps://doi.org/10.14814/phy2.15108https://doaj.org/toc/2051-817XAbstract Definitive closure of a patent ductus arteriosus (PDA) causes significant changes in loading conditions of the left ventricle (LV) which can lead to cardiorespiratory instability including hypotension, low cardiac output, oxygenation, and ventilation impairment. Physiological insights of the adaptation of the LV can be gained by looking at ventriculo‐arterial coupling (VAC) and myocardial work‐energetics. We conducted a retrospective cohort study of preterm infants with echocardiographic assessment of VAC parameters, including end‐systolic and arterial elastance (EES, EA), and myocardial work indices derived from longitudinal strain analysis before and 1‐h after percutaneous PDA closure. A total of 35 patients were included with mean [±SD] age at intervention of 30.8 ± 9.9 days and median [IQR] weight of 1130 [995, 1318] grams. There was a reduction in preload and stroke volume, an increase in EA (38.6 ± 11.4 vs. 60 ± 15.1 mmHg/ml/kg, p < 0.001) and in EES (72 [61.5, 109.8] vs. 91.6 [72.2, 125.2] mmHg/ml/kg, p = 0.003) post‐closure. Myocardial work indices reduced after PDA closure, including global work efficiency (93.9 ± 2.3 vs. 91.1 ± 3.6%, p < 0.001). A total of 17 (48.6%) patients developed post‐closure instability which was associated with younger age, lower preload, and higher EA and EES. Percutaneous PDA closure is associated with major short‐term changes in VAC and myocardium energetics, which may provide novel insights on the physiology of PDA closure and on the differential vulnerability to changes in loading conditions.Adrianne R. BischoffAmy H. StanfordPatrick J. McNamaraWileyarticlemyocardial workpatent ductus arteriosuspercutaneoustranscatheterventriculo‐arterial couplingPhysiologyQP1-981ENPhysiological Reports, Vol 9, Iss 22, Pp n/a-n/a (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	myocardial work patent ductus arteriosus percutaneous transcatheter ventriculo‐arterial coupling Physiology QP1-981
spellingShingle	myocardial work patent ductus arteriosus percutaneous transcatheter ventriculo‐arterial coupling Physiology QP1-981 Adrianne R. Bischoff Amy H. Stanford Patrick J. McNamara Short‐term ventriculo‐arterial coupling and myocardial work efficiency in preterm infants undergoing percutaneous patent ductus arteriosus closure
description	Abstract Definitive closure of a patent ductus arteriosus (PDA) causes significant changes in loading conditions of the left ventricle (LV) which can lead to cardiorespiratory instability including hypotension, low cardiac output, oxygenation, and ventilation impairment. Physiological insights of the adaptation of the LV can be gained by looking at ventriculo‐arterial coupling (VAC) and myocardial work‐energetics. We conducted a retrospective cohort study of preterm infants with echocardiographic assessment of VAC parameters, including end‐systolic and arterial elastance (EES, EA), and myocardial work indices derived from longitudinal strain analysis before and 1‐h after percutaneous PDA closure. A total of 35 patients were included with mean [±SD] age at intervention of 30.8 ± 9.9 days and median [IQR] weight of 1130 [995, 1318] grams. There was a reduction in preload and stroke volume, an increase in EA (38.6 ± 11.4 vs. 60 ± 15.1 mmHg/ml/kg, p < 0.001) and in EES (72 [61.5, 109.8] vs. 91.6 [72.2, 125.2] mmHg/ml/kg, p = 0.003) post‐closure. Myocardial work indices reduced after PDA closure, including global work efficiency (93.9 ± 2.3 vs. 91.1 ± 3.6%, p < 0.001). A total of 17 (48.6%) patients developed post‐closure instability which was associated with younger age, lower preload, and higher EA and EES. Percutaneous PDA closure is associated with major short‐term changes in VAC and myocardium energetics, which may provide novel insights on the physiology of PDA closure and on the differential vulnerability to changes in loading conditions.
format	article
author	Adrianne R. Bischoff Amy H. Stanford Patrick J. McNamara
author_facet	Adrianne R. Bischoff Amy H. Stanford Patrick J. McNamara
author_sort	Adrianne R. Bischoff
title	Short‐term ventriculo‐arterial coupling and myocardial work efficiency in preterm infants undergoing percutaneous patent ductus arteriosus closure
title_short	Short‐term ventriculo‐arterial coupling and myocardial work efficiency in preterm infants undergoing percutaneous patent ductus arteriosus closure
title_full	Short‐term ventriculo‐arterial coupling and myocardial work efficiency in preterm infants undergoing percutaneous patent ductus arteriosus closure
title_fullStr	Short‐term ventriculo‐arterial coupling and myocardial work efficiency in preterm infants undergoing percutaneous patent ductus arteriosus closure
title_full_unstemmed	Short‐term ventriculo‐arterial coupling and myocardial work efficiency in preterm infants undergoing percutaneous patent ductus arteriosus closure
title_sort	short‐term ventriculo‐arterial coupling and myocardial work efficiency in preterm infants undergoing percutaneous patent ductus arteriosus closure
publisher	Wiley
publishDate	2021
url	https://doaj.org/article/4b8d470a1afe4f90a92cafcf0929bcd6
work_keys_str_mv	AT adriannerbischoff shorttermventriculoarterialcouplingandmyocardialworkefficiencyinpreterminfantsundergoingpercutaneouspatentductusarteriosusclosure AT amyhstanford shorttermventriculoarterialcouplingandmyocardialworkefficiencyinpreterminfantsundergoingpercutaneouspatentductusarteriosusclosure AT patrickjmcnamara shorttermventriculoarterialcouplingandmyocardialworkefficiencyinpreterminfantsundergoingpercutaneouspatentductusarteriosusclosure
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Short‐term ventriculo‐arterial coupling and myocardial work efficiency in preterm infants undergoing percutaneous patent ductus arteriosus closure

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