Pediatr Res

. 2023 Jan 9.

 doi: 10.1038/s41390-022-02430-z. Online ahead of print. https://pubmed.ncbi.nlm.nih.gov/36624284/

Right to left ventricular volume ratio is associated with mortality in congenital diaphragmatic hernia

Katsuaki Toyoshima ¹, Tomoko Saito ², Tomoyuki Shimokaze ², Kaoru Katsumata ², Junya Ohmura ², Sasagu Kimura ², Hirosato Aoki ², Megumi Takahashi ², Jun Shibasaki ², Motoyoshi Kawataki ², Ki-Sung Kim ³, Masato Shinkai ⁴, Hiroshi Ishikawa ⁵, Naka Saito ⁶, Satoshi Masutani ⁷

Affiliations expand

• PMID: 36624284
• DOI: 10.1038/s41390-022-02430-z

Abstract

Background: Congenital diaphragmatic hernia (CDH) is associated with high neonatal mortality. We performed this study to test the hypothesis that left ventricular (LV) and right ventricular (RV) volumes assessed by three-dimensional echocardiography may be associated with mortality in CDH.

Methods: This study was a single-center retrospective cohort study involving 35 infants with CDH. RV and LV end-diastolic volume (RVEDV and LVEDV, respectively) were measured by three-dimensional echocardiography and were corrected by birth body weight (BBW) on day 1. RVEDV/BBW, LVEDV/BBW, and LVEDV/RVEDV were compared between CDH survivors and non-survivors. Receiver-operating characteristic curve analysis was performed to assess the predictive ability for mortality of the echocardiographic parameters.

Results: Comparing CDH non-survivors (n = 6) with survivors (n = 29), respectively, RVEDV/BBW was significantly larger (2.54 ± 0.33 vs 1.86 ± 0.35 ml/kg; P < 0.01), LVEDV/BBW was significantly smaller (0.86 ± 0.21 vs 1.22 ± 0.33 ml/kg; P < 0.001), and LVEDV/RVEDV was significantly lower (0.34 ± 0.06 vs 0.66 ± 0.18; P < 0.001). The area under the curve for LVEDV/RVEDV was the largest (0.98).

Conclusions: Three-dimensional echocardiographic volume imbalance between the RV and LV was remarkable in CDH non-survivors. The LVEDV/RVEDV ratio may be associated with mortality in CDH.

Impact: Mortality with congenital diaphragmatic hernia (CDH) is high, and evaluating left and right ventricular structures and functions may be helpful in assessing the prognosis. Three-dimensional (3D) echocardiography indicated that the left ventricular end-diastolic volume/right ventricular end-diastolic volume ratio within 24 h after birth was associated with mortality in CDH infants. The usefulness of this ratio should be validated in prospective multicenter studies involving larger numbers of patients.

© 2023. The Author(s).