J Pediatr Surg

. 2025 Oct 16:162746.

 doi: 10.1016/j.jpedsurg.2025.162746. Online ahead of print. https://pubmed.ncbi.nlm.nih.gov/41109519/

Prognostic Value of Fetal Left Ventricular Myocardial Performance Index for Mortality or ECMO in Congenital Diaphragmatic Hernia

Kyusang Yoo ¹, Soo Hyun Kim ², Jung Il Kwak ¹, Tae-Gyeong Kim ¹, Joo Hyung Roh ¹, Jeong Min Lee ¹, Ha Na Lee ¹, Jiyoon Jeong ¹, Chae Young Kim ¹, Mi-Young Lee ³, Euiseok Jung ¹, Byong Sop Lee ¹, Hye-Sung Won ³

Affiliations Expand

• PMID: 41109519
• DOI: 10.1016/j.jpedsurg.2025.162746

Abstract

Background: We aimed to determine whether fetal left ventricular myocardial performance index (LV MPI) at 30-34 weeks’ gestation predicts mortality or need for extracorporeal membrane oxygenation (ECMO) in congenital diaphragmatic hernia (CDH), and whether it adds predictive value beyond the observed-to-expected lung-to-head ratio (O/E LHR).

Methods: Retrospective single-center cohort (2017-2024) of prenatally diagnosed CDH with LV MPI measured at 30-34 weeks. The primary outcome was death before NICU discharge or ECMO. Multivariable logistic regression evaluated LV MPI adjusted for O/E LHR and liver herniation; discrimination was quantified by area under the ROC curve (AUC). An RV MPI subset assessed incremental value.

Results: Among 114 infants, 36 (31.6%) had death/ECMO. LV MPI was higher in infants who died or required ECMO than in survivors without ECMO (0.538±0.05 vs 0.480±0.05; p<0.001). In multivariable analysis, each 0.1-unit increase was associated with greater odds of death/ECMO (adjusted OR 9.42, 95% CI 2.26-39.18; p=0.002). AUCs were 0.78 for LV MPI and 0.85 for O/E LHR; combined, 0.89. Adding liver herniation improved discrimination (O/E LHR + liver herniation, 0.93; LV MPI + O/E LHR + liver herniation, 0.95). The optimal LV MPI threshold for mortality was 0.53. In the RV-MPI subset (n=66), RV MPI alone had an AUC of 0.74; adding RV MPI to LV MPI + O/E LHR increased AUC from 0.83 to 0.87.

Conclusions: Fetal LV MPI at 30-34 weeks independently predicts death/ECMO in CDH. Combining LV MPI with O/E LHR-particularly with liver herniation-enhances prenatal risk stratification.

Level of evidence: III.

Keywords: ECMO; congenital diaphragmatic hernia; echocardiography; mortality.

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