Table 1 Basic functional echocardiography assessment.
From: Neonatal sepsis and cardiovascular dysfunction II: assessment
Parameter | Measures | Change in neonatal sepsis | Modality | Advantages | Disadvantages |
|---|---|---|---|---|---|
Qualitative assessment | LV systolic function | Reduced | 2D echocardiography in multiple planes | Easy to perform, rapid, correlates with quantitative measures if experienced operator | Requires experienced operator, more likely to miss mild or moderate dysfunction, unable to accurately trend patient status |
LVO | LV CO (ml/kg/min) | Most commonly elevated but may be normal or reduced | PWD and M-mode | Can consider in combination with blood pressure when estimating organ perfusion. | Interpret with caution in presence of PDA since LVO will overestimate SBF. Small error in measurement of outflow tract diameter leads to large error in estimate of CO |
RVO | RV CO (ml/kg/min) | Most commonly elevated but may be normal or reduced | PWD and M-mode | Used to estimate systemic venous return. Not affected by PDA. | Interpret with caution in presence of atrial communication |
LVEF | LV systolic function | Limited neonatal studies show most commonly in normal range, occasionally reduced | Simpson biplane method | More accurate than M-mode LVEF as takes into account entire ventricle as opposed to wall movement at a single point. | More difficult to obtain as requires both apical 4 chamber and 2 chamber views with clear endocardial borders. Foreshortened views reduce accuracy. Time-consuming as requires tracing of endocardial borders. |
LVFS | LV systolic function | Limited neonatal studies show most commonly in normal range, occasionally reduced | M-mode | Easy to obtain | Affected by changes in heart rate, preload and afterload. Affected by increased RV pressure. |
TAPSE | RV longitudinal systolic function | Role in neonatal sepsis not yet established | M-mode | Easy to obtain. Shows good correlation with other measurements of global RV systolic function. Not heart rate dependent. | Angle-dependent, afterload dependent, assesses one region to assume function of whole RV |
FAC | RV systolic function | Role in neonatal sepsis not yet established | 2-D echocardiography | Highly reproducible measure of RV systolic function, accounts for regional abnormalities. | Affected by preload and afterload. Accurately identifying endocardial borders can be challenging and time-consuming |
E wave, A wave, E/A ratio | LV and RV diastolic function | LV indices reduced | PWD at mitral or tricuspid inflow | Easy to obtain | Highly preload and afterload dependent. |
