Left ventricular diastolic function influences right ventricular — Pulmonary vascular coupling in premature infants

Neidin Bussmann, Afif EL-Khuffash, Colm R. Breatnach, Naomi McCallion, Orla Franklin, Gautam K. Singh, Philip T. Levy

Research output: Contribution to journalArticlepeer-review

20 Scopus citations


Introduction: Reduced left ventricular (LV) diastolic function can exert significant load to the right ventricle (RV) that can affect RV–pulmonary vasculature (PV) coupling. RV–PV can be assessed with the RV length–force relationship (tricuspid annular plane systolic excursion [TAPSE] to pulmonary artery acceleration time [PAAT] ratio). We aimed to determine the association between LV diastolic function measured using tissue Doppler imaging (TDI) and TAPSE/PAAT. Methods: A study of premature infants <29 weeks gestation. TAPSE/PAAT, LV e′ and a′ waves were measured on Day 1 following birth. Correlation between diastolic indices and TAPSE/PAAT was performed. The independent effect of LV diastolic function and TAPSE/PAAT was assessed using linear regression. Results: One hundred and sixty-two infants with a mean ± SD gestation & birthweight of 26.6 ± 1.5 weeks & 938 ± 241 g. There was a significant positive correlation between LV e′ (r = 0.44, p < 0.01)/LV a′ (r = 0.44, p < 0.01) and TAPSE/PAAT. This relationship remained significant when adjusting for important confounders (all p < 0.01). Infants with LV a′ values in the lowest quartile had lower TAPSE values (4.2 ± 1.2 vs. 5.1 ± 1.1 mm, p < 0.01) without a difference in PAAT (41 ± 8 vs. 41 ± 10 ms, p = 0.97). Conclusions: We observed a direct correlation between LV diastolic function and RV–PV coupling in the first day of age, highlighting the importance ventricular interdependence in premature infants. TAPSE/PAAT, as the index of the RV–PV interaction may be further explored for its potential to assess RV reserve under stress with preterm infants in health and disease.

Original languageEnglish
Pages (from-to)35-40
Number of pages6
JournalEarly Human Development
StatePublished - Jan 2019


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