Application of Two-Dimensional Speckle Tracking Echocardiography in Evaluation of Neonatal Pulmonary Hypertension

doi:10.26599/AUDT.2025.240068

Abstract

Abstract:

Objective It is always a clinical challenge to identify neonatal pulmonary hypertension (NPH). Although the diagnostic gold standard of pulmonary hypertension (PH) is the true measurement of resting pulmonary arterial pressure (PAP) through cardiac catheterization, it is inappropriate for delicate newborns. Hence, echocardiography examination has become the most common inspection tool for NPH despite its limitations.
Methods After outlining the conventional echocardiographic parameters for detecting NPH and their drawbacks in newborns, this review mainly discussed the roles of two-dimensional speckle tracking echocardiography, including RV global longitudinal strain and segmental longitudinal strain, in the evaluation of NPH, hoping to provide more information for detecting NPH.
Results When combined with conventional echocardiographic parameters, RV longitudinal strain would be a great help for the evaluation of NPH. Furthermore, based on the preliminary research, our finding revealed that the magnitude of the apical segmental strain of RVFW was significantly lower, and the basal-to-apical strain ratio (Ratio bas/api) of RVFW was remarkably higher in infants with PH than those without PH.
Conclusion Based on the particularity of newborns, neonatal echocardiography is the preferred inspection method for NPH. It provides hemodynamic, morphological and functional information for evaluating NPH. RV longitudinal strain is sensitive to subtle changes of RV function and closely related to PH. It could be considered not only as the key factor affecting the prognosis of NPH but also as a potential index to detect and identify NPH.

Key words: Right ventricle; Longitudinal strain; Neonate pulmonary hypertension; Two-dimensional speckle tracking echocardiography

Feng Qing, Yang Huihui, Xu Wanting, He Yu. Application of Two-Dimensional Speckle Tracking Echocardiography in Evaluation of Neonatal Pulmonary Hypertension. Advanced Ultrasound in Diagnosis and Therapy, 2025, 9(3): 254-259.

Figures/Tables 1

References 37

[1]	Hu Z, Fan S. Progress in the application of echocardiography in neonatal pulmonary hypertension. J Matern Fetal Neonatal Med 2024; 37: 2320673.
[2]	Kim YJ, Shin SH, Park HW, Kim EK, Kim HS. Risk factors of early pulmonary hypertension and its clinical outcomes in preterm infants: a systematic review and meta-analysis. Sci Rep 2022; 12: 14186.
[3]	McNamara PJ, Jain A, El-Khuffash A, Giesinger R, Weisz D, Freud L, et al. Guidelines and recommendations for targeted neonatal echocardiography and cardiac point-of-care ultrasound in the neonatal intensive care unit: an update from the american society of echocardiography. J Am Soc Echocardiogr 2024; 37: 171-215.
[4]	Boyd SM, Kluckow M, McNamara PJ. Targeted neonatal echocardiography in the management of neonatal pulmonary hypertension. Clin Perinatol 2024; 51: 45-76.
[5]	Durward A, Macrae D. Long term outcome of babies with pulmonary hypertension. Semin Fetal Neonatal Med 2022; 27: 101384.
[6]	Jain L. Pulmonary hypertension of the newborn. Clin Perinatol 2024; 51: xv-xvii.
[7]	More K, Soni R, Gupta S. The role of bedside functional echocardiography in the assessment and management of pulmonary hypertension. Semin Fetal Neonatal Med 2022; 27: 101366.
[8]	Calcaterra G, Fanos V, Bassareo PP. Still puzzling about a clear definition of pulmonary arterial hypertension in newborns. Eur Respir J 2019; 53: 1900005.
[9]	Hekimsoy V, Kaya EB, Akdogan A, Sahiner L, Evranos B, Canpolat U, et al. Echocardiographic assessment of regional right ventricular systolic function using two-dimensional strain echocardiography and evaluation of the predictive ability of longitudinal 2D-strain imaging for pulmonary arterial hypertension in systemic sclerosis patients. Int J Cardiovasc Imaging 2018; 34: 883-892.
[10]	Yang H, Feng Q, Su Z, Chen S, Wu F, He Y. The increased longitudinal basal-to-apical strain ratio in the right ventricular free wall is associated with neonatal pulmonary hypertension. Eur J Pediatr 2024; 183: 5395-5404.
[11]	Pirat B, McCulloch ML, Zoghbi WA. Evaluation of global and regional right ventricular systolic function in patients with pulmonary hypertension using a novel speckle tracking method. Am J Cardiol 2006; 98: 699-704.
[12]	Askin DF. Fetal-to-neonatal transition--what is normal and what is not?? Neonatal Netw 2009; 28: e33-40.
[13]	Suciu LM, Hooper SB, McNamara PJ. Editorial: Transitional circulation. Front Pediatr 2023; 11: 1328201.
[14]	Sankaran D, Lakshminrusimha S. Pulmonary hypertension in the newborn- etiology and pathogenesis. Semin Fetal Neonatal Med 2022; 27: 101381.
[15]	Humbert M, Kovacs G, Hoeper MM, Badagliacca R, Berger RMF, Brida M, et al. 2022 ESC/ERS Guidelines for the diagnosis and treatment of pulmonary hypertension. Eur Heart J 2022; 43: 3618-3731.
[16]	Mourani PM, Sontag MK, Younoszai A, Ivy DD, Abman SH. Clinical utility of echocardiography for the diagnosis and management of pulmonary vascular disease in young children with chronic lung disease. Pediatrics 2008; 121: 317-325.
[17]	Groh GK, Levy PT, Holland MR, Murphy JJ, Sekarski TJ, Myers CL, et al. Doppler echocardiography inaccurately estimates right ventricular pressure in children with elevated right heart pressure. J Am Soc Echocardiogr 2014; 27: 163-171.
[18]	Altit G, Bhombal S, Feinstein J, Hopper RK, Tacy TA. Diminished right ventricular function at diagnosis of pulmonary hypertension is associated with mortality in bronchopulmonary dysplasia. Pulm Circ 2019; 9: 2045894019878598.
[19]	Hoit BD. Right ventricular strain comes of age. Circ Cardiovasc Imaging 2018; 11: e008382.
[20]	Liu Y, Wang Y, Wang Y, Wen Z. Evaluation of two-dimensional strain echocardiography for quantifying right ventricular function in patients with pulmonary arterial hypertension. Exp Ther Med 2017; 14: 1248-1252.
[21]	Levy PT, El-Khuffash A, Patel MD, Breatnach CR, James AT, Sanchez AA, et al. Maturational patterns of systolic ventricular deformation mechanics by two-dimensional speckle-tracking echocardiography in preterm infants over the first year of age. J Am Soc Echocardiogr 2017; 30: 685-698.e1.
[22]	Sanz J, Sánchez-Quintana D, Bossone E, Bogaard HJ, Naeije R. Anatomy, function, and dysfunction of the right ventricle: JACC state-of-the-art review. J Am Coll Cardiol 2019; 73: 1463-1482.
[23]	Badano LP, Muraru D, Parati G, Haugaa K, Voigt JU. How to do right ventricular strain. Eur Heart J Cardiovasc Imaging 2020; 21: 825-827.
[24]	Muraru D, Haugaa K, Donal E, Stankovic I, Voigt JU, Petersen SE, et al. Right ventricular longitudinal strain in the clinical routine: a state-of-the-art review. Eur Heart J Cardiovasc Imaging 2022; 23: 898-912.
[25]	Xia Y, Liu X. The value of lung ultrasound score combined with echocardiography in assessing right heart function in patients undergoing maintenance hemodialysis and experiencing pulmonary hypertension. BMC Cardiovasc Disord 2025; 25: 33.
[26]	Espinola-Zavaleta N, Antonio-Villa NE, Guerra EC, Nanda NC, Rudski L, Alvarez-Santana R, et al. Right heart chambers longitudinal strain provides enhanced diagnosis and categorization in patients with pulmonary hypertension. Front Cardiovasc Med 2022; 9: 841776.
[27]	Fukuda Y, Tanaka H, Sugiyama D, Ryo K, Onishi T, Fukuya H, et al. Utility of right ventricular free wall speckle-tracking strain for evaluation of right ventricular performance in patients with pulmonary hypertension. J Am Soc Echocardiogr 2011; 24: 1101-1108.
[28]	Tunthong R, Salama AA, Lane CM, Fine NM, Anand V, Padang R, et al. Right ventricular systolic strain in patients with pulmonary hypertension: clinical feasibility, reproducibility, and correlation with ejection fraction. J Echocardiogr 2023; 21: 105-112.
[29]	Muntean I, Benedek T, Melinte M, Suteu C, Togãnel R. Deformation pattern and predictive value of right ventricular longitudinal strain in children with pulmonary arterial hypertension. Cardiovasc Ultrasound 2016; 14: 27.
[30]	Liu Q, Hu Y, Chen W, Yao T, Li W, Xiao Z, et al. Evaluation of right ventricular longitudinal strain in pediatric patients with pulmonary hypertension by two-dimensional speckle-tracking echocardiography. Front Pediatr 2023; 11: 1189373.
[31]	Hulshof HG, Eijsvogels TMH, Kleinnibbelink G, van Dijk AP, George KP, Oxborough DL, et al. Prognostic value of right ventricular longitudinal strain in patients with pulmonary hypertension: a systematic review and meta-analysis. Eur Heart J Cardiovasc Imaging 2019; 20: 475-484.
[32]	Li Y, Xie M, Wang X, Lu Q, Fu M. Right ventricular regional and global systolic function is diminished in patients with pulmonary arterial hypertension: a 2-dimensional ultrasound speckle tracking echocardiography study. Int J Cardiovasc Imaging 2013; 29: 545-551.
[33]	Malowitz JR, Forsha DE, Smith PB, Cotten CM, Barker PC, Tatum GH. Right ventricular echocardiographic indices predict poor outcomes in infants with persistent pulmonary hypertension of the newborn. Eur Heart J Cardiovasc Imaging 2015; 16: 1224-1231.
[34]	Jain A, El-Khuffash AF, van Herpen CH, Resende MHF, Giesinger RE, Weisz D, et al. Cardiac function and ventricular interactions in persistent pulmonary hypertension of the newborn. Pediatr Crit Care Med 2021; 22: e145-e157.
[35]	Pena JL, da Silva MG, Alves JM Jr, Salemi VM, Mady C, Baltabaeva A, et al. Sequential changes of longitudinal and radial myocardial deformation indices in the healthy neonate heart. J Am Soc Echocardiogr 2010; 23: 294-300.
[36]	Ambalavanan N, Mourani P. Pulmonary hypertension in bronchopulmonary dysplasia. Birth Defects Res A Clin Mol Teratol 2014; 100: 240-246.
[37]	Kwon HW, Kim HS, An HS, et al. Long-term outcomes of pulmonary hypertension in preterm infants with bronchopulmonary dysplasia. Neonatology 2016; 110: 181-189.