Fellow Physician Cohen Children's Hospital, Northwell Health Steven and Alexandra Cohen Children's Medical Center Hempstead, New York, United States
Background: Aortic stiffness (AS) is a strong predictor of cardiovascular morbidity and mortality. Premature infants have increased AS compared to term infants and are at higher risk for cardiovascular disease in early adulthood. A patent ductus arteriosus (PDA) is a modifiable risk factor for AS, however its impact has not been studied in the premature population.
Objective: Assess the aortic stiffness index (ASI) before and after PDA closure in premature infants.
Design/Methods: This is a single center, retrospective study of premature infants status post transcatheter PDA closure from 5/2019 to 8/2020. ASI was calculated using 2D echocardiography and a simultaneous blood pressure (BP) cuff recording with the following formula: (ln(systolic BP/diastolic BP))/((aortic systolic diameter – aortic diastolic diameter)/aortic diastolic diameter)). Regional ASI was calculated at the ascending aorta at the level of the right pulmonary artery, transverse aorta between the innominate and left common carotid artery, and the juxtaductal descending aorta. Global ASI was calculated as the mean of the regional ASIs on each study. Time points were within one week of PDA closure, then post closure at one day, one week and one month. Variables collected were continuous and reported as medians and interquartile ranges (IQR: 25th percentile-75th percentile). Repeated measures ANOVA was performed using mixed models for the outcomes.
Results: Thirty-three subjects were included with a median gestational age of 25 weeks (IQR: 24-26) and median corrected age at time of closure of 31 weeks (IQR: 29-34). Median weight at time of closure was 1400 grams (IQR: 1040-1820).
There was no statistically significant change in global ASI at one day 2.59 (IQR: 1.99 to 3.20), one week 2.68 (IQR: 1.68 to 3.91) or one month 2.15 (IQR: 1.56 to 2.85) as compared to pre-closure 2.32 (IQR 2.06 to 2.96). Similarly, no statistically significant change was observed in the regional ASIs. Conclusion(s): To our knowledge, this study is the first to demonstrate that AS in the premature population is not significantly impacted by the presence of a PDA, at least within the first months of life. Previous pediatric studies have confirmed that over time the PDA will negatively affect AS. This study suggests that early PDA closure may have long term benefits by preserving the AS in an already high risk population.
Authors/Institutions: Siddharth Mahajan, Steven and Alexandra Cohen Children's Medical Center, Hempstead, New York, United States; Lindsey McPhillips, Steven and Alexandra Cohen Children's Medical Center, Hempstead, New York, United States; Shilpi M. Epstein, Steven and Alexandra Cohen Children's Medical Center, Hempstead, New York, United States; Dipak Kholwadwala, Steven and Alexandra Cohen Children's Medical Center, Hempstead, New York, United States; Robert I. Koppel, Cohen Children's Medical Center, New Hyde Park, New York, United States
