201 - Transition Of The Right Ventricle in SGA with late IUGR versus AGA infants: TDI and 2DSTE echocardiographic evaluation

Poster Number: 201
Publication Number: 201.219

Maria Elena Albani, Buzzi Children Hospital, Milan, Italy, milano, Lombardia, Italy; Savina Mannarino, Pediatric Cardiology hospital V Buzzi ASST FBF SACCO Milan Italy, Pavia, Lombardia, Italy; Massimo Garbin, Asst FBF Sacco Ospedale Buzzi, Milan, Lombardia, Italy; Francesca Castoldi, NICU V.Buzzi Children's Hospital, Milan, Lombardia, Italy; Francesco Cavigioli, V.Buzzi Children's Hospital, milan, Lombardia, Italy; Silvia Bianchi, NICU V.Buzzi Children's Hospital, Milan, Lombardia, Italy; Gianluca Lista, V.Buzzi Children's Hospital ASST-FBF-Sacco, Milan, Lombardia, Italy

Background: Neonatal transition is a time of dramatic cardiovascular changes. During fetal life, right ventricle (RV) accounts for about 60% of systemic cardiac output. In the early postnatal period pulmonary vascular resistances fall, systemic ones rise and ductus arteriosus close leading to changes in ventricular structure and functioning. In fetuses small for gestational age (SGA) with fetal growth restriction (FGR), the relative hypoxia may lead to cardiovascular dysfunction with ventricular remodeling. During the neonatal transitional period, RV dysfunction is thought to persist in this population.

Objective: To compare RV function in SGA infants with late FGR versus adequate for gestational age (AGA) infants, with traditional and advanced echocardiographic techniques.

Design/Methods: Prospective observational study on term newborn hospitalized in a third level NICU between April and August 2021. Echocardiographic evaluations were performed at T1 (within 6 hours) and at T2 (after 48 hours of life). RV was studied both with traditional parameters as fractional area change (FAC) and tricuspid annular plane excursion (TAPSE), and with advanced methods as Myocardial Performance Index (MPI), s', e', a' waves and myocardial strain of the RV free wall with two-dimensional speckle tracking echocardiography (2DSTE).

Results: 39 patients were enrolled: 20 (51%) SGA and 19 (49%) AGA. Median GA: 39 wks (1.6 IQR 35-41). Results in table1. There was a statistically significant difference in e’ and a’ waves, in elongated values of MPI and in the analysis of the 2DSTE strain between the two groups at T1. Those differences were no longer present at T2, although MPI in SGA groups was still prolonged. At T2, 2DSTE strain segmental trend showed a persistent altered basal segment strain in SGA group (basal RV strain AGA -31.5%6.69 vs SGA -27.11%3.27, p=0,012). 2DSTE strain and MPI values showed a good correlation.Conclusion(s): In the first hours of adaptation to extrauterine life, SGA newborns had elongated MPI and reduced e' and a' waves velocities, compatible with a predominantly diastolic RV dysfunction. Those differences were no longer present after 48 hours. RV dysfunction was confirmed by the results on RV free wall 2DSTE. On the third day of life, a relative dysfunction in the RV basal segment persisted, as if it was the last segment to adapt to extrauterine life. A long-term follow up could be useful to evaluate the possible persistency of this dysfunction.
RV echocardiographic parameters during transition in IUGR and AGA newbornstable strain and 2dste in aga vs sga.jpegRV, right ventricle; AGA, Appropriate for Gestational Age; SGA, Small for Gestational Age; FAC, Fractional Area Change; TAPSE, Tricuspid Annular Plane Systolic Excursion; MPI, Myocardial Performance Index; 2D-STE strain, 2D-Speckle Tracking Echocardiographic strain.