Pediatr Res

. 2025 Nov 12.

 doi: 10.1038/s41390-025-04560-6. Online ahead of print. https://pubmed.ncbi.nlm.nih.gov/41225136/

Early left ventricular diastolic function and disease severity in congenital diaphragmatic hernia

Giulia Vanina Cantone ¹, Abhijit Bhattacharya ², David Healy ², Dana Levinkopf ², Anna Claudia Massolo ³, Flaminia Pugnaloni ³, Giovanni Vento ⁴, Anne Marie Heuchan ², Florian Kipfmueller ⁵, Neil Patel ²

Affiliations Expand

• PMID: 41225136
• DOI: 10.1038/s41390-025-04560-6

Abstract

Background: Congenital diaphragmatic hernia (CDH) remains a major cause of neonatal mortality and morbidity. Early systolic left ventricular (LV) dysfunction is well described in CDH, while diastolic impairment remains unexplored. This study aimed to investigate the feasibility LV diastolic function assessment and to evaluate its relationship with clinical severity.

Methods: Observational, single-centre cohort study. In newborns with CDH, gestational age >32 weeks, echocardiographic assessment of diastolic function evaluation was performed at < 24 hours of age. Data were compared to normative values and correlated to clinical status and outcomes.

Results: Fifty-two infants were included, gestational age 38.0 (32.1-40.3) weeks. Diastolic function in CDH vs. normative controls were: LV mitral E wave 47 ( ± 14) vs. 56 ( ± 8) cm/sec, p < 0.001; LV tissue Doppler early diastolic velocity (e’) 4.1 ( ± 1.3) vs. 6.7 ( ± 1.4) cm/sec, p < 0.001; left atrial reservoir strain (LASr) 21.3 ( ± 8.7) vs 33.3 ( ± 4.4)%, p < 0.001; and E:e’ ratio 12 ( ± 4.2) vs. 33.3 ( ± 4.4), p < 0.001. LASr correlated with pCO₂ (r² = 0.22, p < 0.001) and FiO₂ (r² = 0.20, p < 0.001); was lower in non-survivors (p = 0.027) and infants requiring invasive ventilation at 14 days (p = 0.016).

Conclusions: Diastolic impairment is frequent in the first 24 hours of life in CDH and may contribute to disease severity.

Impact: Early cardiac ultrasound assessment is crucial in management of congenital diaphragmatic hernia (CDH). Our current investigation addresses the unanswered question of left ventricular (LV) diastolic function and its contribution to pulmonary hypertension and disease severity in CDH. We investigated the feasibility of assessing left ventricular (LV) diastolic function in infants with CDH in the first 24 hours of life. Using a panel of echocardiographic measures, including the innovative technique of left atrial strain analysis, assessment of diastolic function was feasible in this cohort. Reduced LV diastolic echocardiographic parameters were observed in >70% of the CDH cohort, compared to normative reference data. LV diastolic function parameters correlated with echocardiographic estimates of pulmonary artery pressure and measures of global LV systolic function, indicating potential mechanistic interactions and re-consideration of established therapies. In CDH cases, early LV diastolic function correlated with clinical parameters and outcomes. Specifically, left atrial strain (LASr) was lower in non-survivors and patients who remained ventilated at 14 days of age. LASr was inversely correlated with maximum arterial PaCO₂ and maximum inspired fraction of oxygen (FiO₂) values in the first 24 hours of life, and positively correlated with maximum post-ductal oxygen saturation of haemoglobin (SpO₂).

© 2025. The Author(s).