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Progression of left ventricular diastolic function in the neonate and early childhood from transmitral color M-mode filling analysis

Abstract

Background

We implemented sophisticated color M-mode analysis to assess age-dependent progression of left ventricular (LV) diastolic function.

Methods

Normal infants were prospectively enrolled for serial echocardiograms at 1 week, 1 month, 6 months, 1 year, and 2 years. From color M-mode scans, propagation velocity (VP), strength of filling (VS), and intraventricular pressure difference (IVPD) in 3 segments along apex-to-mitral valve scan line were measured.

Results

Age-wise comparisons of diastolic filling from 121 echocardiograms in 31 infants showed VP (cm/s), VS (cm2/s), and E-wave IVPD (mmHg) at 1 week to be 66.2 ± 11.9, 75.3 ± 19.9, and 1.5 ± 0.4, respectively, while VP, VS, and E-wave IVPD at 1 month were 80.3 ± 14.4, 101.2 ± 28.3, and 2.42 ± 1.1, respectively. There were significant differences in VP and segmental IVPD between first week and first month (p < 0.005) and IVPD between the age groups (p < 0.001).

Conclusions

Comprehensive analysis of transmitral color M-mode data is feasible in infants, enabling calculation of pressure drop between the LV base and apex and strength of propagation from two distinct slopes. Profound changes very early followed by relatively constant filling mechanics in later infancy indicate significant LV maturation occurring during the first month of life.

Impact

  • We implemented sophisticated analytic methods for color M-mode echocardiography in infants to assess age- and dimension-dependent changes in left ventricular diastolic function.

  • Comprehensive characterization of transmitral color M-mode flow was feasible, enabling calculation of pressure drop between left ventricular base and apex and strength of propagation.

  • Left ventricular diastolic filling function has predictable maturational progression, with significant differences in the intraventricular pressure between infants from birth to 2 years.

  • This study forms the basis for future studies to examine alteration of early diastolic filling in congenital heart disease.

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Fig. 1: Overview of the CMM analysis processing.
Fig. 2: Chart represents specific time points of imaging.
Fig. 3: (Top) Correlations of age with E-wave VP, VS, and breakpoint plotted on the logarithmic scale.
Fig. 4: (Top) Correlations of age with mitral valve E-wave mitral-to-apex IVPD and A-wave mitral-to-apex IVPD plotted on the logarithmic scale.
Fig. 5

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Acknowledgements

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. The authors acknowledge the support of the Children’s Hospital and Medical Center Foundation.

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C.T.E., B.M., P.V., and S.K. conceived and designed the study. C.T.E., B.M., L.L., V.J., and M.C. performed measurements. K.S.B.M., J.B., and D.A.D. performed statistical analysis. C.T.E., B.M., V.J., J.B., and S.K. wrote the manuscript. All authors revised the manuscript critically for important intellectual content, and all authors read and approved the final version to be published.

Corresponding author

Correspondence to Shelby Kutty.

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Erickson, C.T., Meyers, B., Li, L. et al. Progression of left ventricular diastolic function in the neonate and early childhood from transmitral color M-mode filling analysis. Pediatr Res 89, 987–995 (2021). https://doi.org/10.1038/s41390-020-1011-6

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