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PS-013 Arterial-ventricular Coupling In Preterm Infants Below 30 Weeks Of Gestational Age
  1. S Baumgartner1,
  2. M Steiner1,
  3. M Olischar1,
  4. M Wald2,
  5. A Berger1,
  6. G Fischer3,
  7. T Waldhör4,
  8. U Salzer-Muhar1
  1. 1Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Vienna, Austria
  2. 2Department of Pediatrics and Adolescent Medicine, Salzburger Landeskliniken/Paracelsus Medical University, Salzburg, Austria
  3. 3Section for Medical Inforamtion Managment and Imaging, Medical University of Vienna, Vienna, Austria
  4. 4Department of Epidemiology, Medical University of Vienna, Vienna, Austria

Abstract

Background and aim The model of arterial-ventricular coupling (AVC) describes the interaction of the left ventricle (ELV) with the arterial system (EA) by the AVC-ratio (AVC = EA/ELV). Aim was to apply the model to preterm haemodynamics and to analyse time courses of AVC, EA and ELV in sick preterms with either pulmonary hypertension (PH-group) or haemodynamically significant patent ductus arteriosus (hPDA-group) and in stable preterms with uncomplicated postpartal course (control-group).

Methods Study period was from 10/2009 to 12/2012. Patient recruitment criteria were as follows: anti-PH treatment due to (supra-) systemic pulmonary pressure on echocardiography (PH-group); presence of PDA with an enddiastolic maximal velocity in the left pulmonary artery (LPAdia) ≥ 0,2 m/s and negative history of PH (hPDA-group); neither anti-PH treatment nor catecholamines, PDA with an LPAdia < 0,2 m/s and a ratio of the left atrium/aorta < 1,4 (control-group). AVC was calculated from blood pressure and M-mode measurements. Selected time points were set from days 1–3, 4–7 and 8–30 respectively.

Results Twentyone preterms were recruited to the PH-group, 19 to the hPDA-group and 63 to the control-group. AVC was lower in the PH- and hPDA-group than in the control-group (p = 0,05). ELV was higher in the PH-group (p = 0,007) and both EA and ELV were lower in the hPDA-group (EA: p = 0,0002; ELV: p = 0,02).

Conclusion The AVC-ratio was lower in sick preterms. Higher ELV in PH results from interventricular interdependence with decreased LV-filling. Lower ELV and EA in PDA result from LV-volume-overload and systemic steal-effect. Applying the AVC-model may facilitate explaining preterm haemodynamics.

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