BACKGROUND The clinical utility of echocardiography for the diagnosis of pulmonary vascular disease (PVD) in former preterm infants with bronchopulmonary dysplasia (BPD) is not established. Elevated pulmonary vascular resistance (PVR) rather than pulmonary artery pressure (PAP) is the hallmark of PVD. We evaluated the utility of echocardiography in infants with BPD in diagnosing pulmonary hypertension and PVD (PVR >3 Wood units × m2) assessed by cardiac catheterization. METHODS A retrospective single center study of 29 infants born ≤29 weeks of gestational age with BPD who underwent cardiac catheterization and echocardiography was performed. PVD was considered present by echocardiography if the tricuspid valve regurgitation jet peak velocity was >2.9 m/sec, post-tricuspid valve shunt systolic flow velocity estimated a right ventricular systolic pressure >35 mm Hg, or systolic septal flattening was present. The utility (accuracy, sensitivity, and positive predictive value [PPV]) of echocardiography in the diagnosis of PVD was tested. Subgroup analysis in patients without post-tricuspid valve shunts was performed. Echocardiographic estimations of right ventricular pressure, dimensions, function, and pulmonary flow measurements were evaluated for correlation with PVR. RESULTS The duration between echocardiography and cardiac catheterization was a median of 1 day (interquartile range, 1-4 days). Accuracy, sensitivity, and PPV of echocardiography in diagnosing PVD were 72%, 90.5%, and 76%, respectively. Accuracy, sensitivity, and PPV increased to 93%, 91.7%, and 100%, respectively, when infants with post-tricuspid valve shunts were excluded. Echocardiography had poor accuracy in estimating the degree of PAP elevation by cardiac catheterization. In infants without post-tricuspid valve shunts, there was moderate to good correlation between indexed PVR and right ventricular myocardial performance index (rho = 0.89, P = .005), systolic to diastolic time index (0.84, P < .001), right to left ventricular diameter ratio at end systole (0.66, P = .003), and pulmonary artery acceleration time (0.48, P = .05). CONCLUSIONS Echocardiography performs well in screening for PVD in infants with BPD and may be diagnostic in the absence of a post-tricuspid valve shunt. However, cardiac catheterization is needed to assess the degree of PAP elevation and PVR. The diagnostic utility of echocardiographic measurements that correlate with PVR should be evaluated prospectively in this patient population.

中文翻译：

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超声心动图在患有支气管肺发育不良的前早产儿中的临床应用。

背景超声心动图诊断支气管肺发育不良 (BPD) 早产儿肺血管疾病 (PVD) 的临床效用尚未确定。肺血管阻力 (PVR) 升高而不是肺动脉压力 (PAP) 升高是 PVD ​​的标志。我们评估了超声心动图在 BPD 婴儿中诊断肺动脉高压和 PVD（PVR >3 Wood 单位 × m2）的效用，通过心导管检查评估。方法 对 29 名出生胎龄≤29 周的 BPD 婴儿进行了一项回顾性单中心研究，这些婴儿接受了心导管检查和超声心动图检查。如果三尖瓣反流射流峰值速度 >2.9 m/sec，则超声心动图认为存在 PVD，三尖瓣后分流收缩期流速估计右心室收缩压>35 mm Hg，或存在收缩期室间隔扁平。测试了超声心动图在 PVD ​​诊断中的效用（准确度、灵敏度和阳性预测值 [PPV]）。对没有三尖瓣后分流术的患者进行了亚组分析。评估了右心室压力、尺寸、功能和肺流量测量的超声心动图估计值与 PVR 的相关性。结果 超声心动图和心导管插入术之间的持续时间中位数为 1 天（四分位间距为 1-4 天）。超声心动图诊断 PVD ​​的准确性、敏感性和 PPV 分别为 72%、90.5% 和 76%。准确性、灵敏度和 PPV 分别提高到 93%、91.7% 和 100%，当患有三尖瓣后分流的婴儿被排除在外时。超声心动图通过心导管术估计 PAP 升高程度的准确性较差。在没有三尖瓣后分流术的婴儿中，指数 PVR 与右心室心肌性能指数（rho = 0.89，P = .005）、收缩至舒张时间指数（0.84，P < .001）、右收缩末期左心室直径比值 (0.66, P = .003) 和肺动脉加速时间 (0.48, P = .05)。结论 超声心动图在筛查 BPD 婴儿的 PVD ​​方面表现良好，并且在没有三尖瓣后分流的情况下可能具有诊断意义。然而，需要心导管检查来评估 PAP 升高和 PVR 的程度。