Preoperative echocardiographic measures of left ventricular mechanics are associated with postoperative vasoactive support in preterm infants undergoing patent ductus arteriosus ligation.

OBJECTIVE: Preoperative risk factors associated with poor outcomes after patent ductus arteriosus ligation in preterm infants have not been well defined. The aim of this study was to determine the association between preoperative echocardiographic measures of left ventricular mechanics and postoperative clinical outcomes after patent ductus arteriosus ligation. METHODS: Preterm infants less than 90 days of age with no other significant congenital anomalies who underwent patent ductus arteriosus ligation between 2007 and 2015 were considered for retrospective analysis. The primary outcome was peak postoperative vasoactive inotropic score. Conventional echocardiographic measures of ventricular size, function, and patent ductus arteriosus size were performed. Echocardiographic single-beat, pressure-volume loop analysis estimates of contractility (end-systolic elastance) and afterload (arterial elastance) were calculated. Ventriculoarterial coupling was assessed using the arterial elastance/end-systolic elastance ratio. Multivariable linear regression was performed using clinical and echocardiographic data. RESULTS: Echocardiograms from 101 patients (42.5% male) were analyzed. We found a statistically significant association between vasoactive inotropic score and both end-systolic elastance and arterial elastance. No patient with arterial elastance/end-systolic elastance greater than 0.78 (n = 32) had a vasoactive inotropic score 20 or greater. Analysis of our secondary outcomes found associations between preoperative end-systolic elastance and postoperative urine output less than 1 mL/kg/h at 24 hours, creatinine change greater than 0.5 mg/dL, and time to first extubation. CONCLUSIONS: End-systolic elastance and arterial elastance were the only predictors of postoperative vasoactive inotropic score after patent ductus arteriosus ligation in preterm infants. Those neonates with increased contractility and low afterload were at highest risk for elevated inotropic support. These findings suggest a role for echocardiographic end-systolic elastance and arterial elastance in the preoperative assessment of preterm infants undergoing patent ductus arteriosus ligation.

Time-dependent alterations of select genes in streptozotocin-induced diabetic rat bladder.

OBJECTIVES: To investigate time-course changes in the expression of select genes and extracellular matrix proteins in the bladder of rats with streptozotocin-induced diabetes, so as to examine the mechanisms underlying changes in mechanical properties of the bladder due to diabetic cystopathy. METHODS: Female Sprague-Dawley rats were injected with streptozotocin (65 mg/kg). Rats that were fed with 5% sucrose in drinking water served as diuretic controls, in addition to normal control rats. At the end of 2, 4, and 8 weeks, total ribonucleic acid (RNA) isolated from the detrusor layer of the bladders was reverse transcribed, and then complementary deoxyribonucleic acid was amplified with polymerase chain reaction primer sets for type I collagen, type III collagen, tropoelastin, and transforming growth factor beta 1 (TGF-beta-1). Collagen and elastin contents of the bladders were quantified with commercially available assays. RESULTS: Both diabetic and diuretic rat bladders exhibited significantly (P <0.05) lower expression of type I collagen and TGF-beta-1 messenger RNA (mRNA) compared with normal controls at all time points tested. In contrast, downregulation of type III collagen mRNA expression in both diabetic and diuretic groups was seen at 4 and 8 weeks. Furthermore, tropoelastin mRNA expression in the diabetic rat bladders was, compared with normal and diuretic rats, significantly (P <0.05) greater at 2 weeks. Both diabetic and diuretic rat bladders exhibited significantly (P <0.05) decreased collagen and increased elastin protein content at 2 and 8 weeks. CONCLUSIONS: The results of the present study suggest that increases in compliance of the bladders in diabetic cystopathy result not only from diuresis-driven reduction of collagen synthesis but also from increased elastin synthesis.