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Maturational patterns of left ventricular rotational mechanics in pre-term infants through 1 year of age

Published online by Cambridge University Press:  15 July 2020

Gloria C. Lehmann*
Division of Pediatric Cardiology, Department of Pediatrics, Saint Louis University School of Medicine, Saint LouisMO, USA
Philip T. Levy
Division of Newborn Medicine, Department of Pediatrics, Harvard Medical School, Boston Children’s Hospital, BostonMA, USA
Meghna D. Patel
Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, USA
Timothy Sekarski
Department of Pediatrics, Washington University School of Medicine, Saint Louis, MO, USA
HongJie Gu
Division of Biostatistics, Washington University School of Medicine, Saint LouisMO, USA
Swati Choudhry
Section of Pediatric Cardiology, Department of Pediatrics, Baylor College of Medicine, HoustonTX, USA
Aaron Hamvas
Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
Gautam K. Singh
Department of Pediatrics, Washington University School of Medicine, Saint Louis, MO, USA Department of Pediatrics, Wayne State University School of Medicine, Detroit, MI, USA
Author for correspondence: Gloria C. Lehmann, MD, Division of Pediatric Cardiology, Saint Louis University School of Medicine, 1465 South Grand Blvd,Saint Louis, MO, USA. Tel: +1 314-577-5674. E-mail:



Pre-mature birth impacts left ventricular development, predisposing this population to long-term cardiovascular risk. The aims of this study were to investigate maturational changes in rotational properties from the neonatal period through 1 year of age and to discern the impact of cardiopulmonary complications of pre-maturity on these measures.


Pre-term infants (<29 weeks at birth, n = 117) were prospectively enrolled and followed to 1-year corrected age. Left ventricular basal and apical rotation, twist, and torsion were measured by two-dimensional speckle-tracking echocardiography and analysed at 32 and 36 weeks post-menstrual age and 1-year corrected age. A mixed random effects model with repeated measures analysis was used to compare rotational mechanics over time. Torsion was compared in infants with and without complications of cardiopulmonary diseases of pre-maturity, specifically bronchopulmonary dysplasia, pulmonary hypertension, and patent ductus arteriosus.


Torsion decreased from 32 weeks post-menstrual age to 1-year corrected age in all pre-term infants (p < 0.001). The decline from 32 to 36 weeks post-menstrual age was more pronounced in infants with cardiopulmonary complications, but was similar to healthy pre-term infants from 36 weeks post-menstrual age to 1-year corrected age. The decline was due to directional and magnitude changes in apical rotation over time (p < 0.05).


This study tracks maturational patterns of rotational mechanics in pre-term infants and reveals torsion declines from the neonatal period through 1 year. Cardiopulmonary diseases of pre-maturity may negatively impact rotational mechanics during the neonatal period, but the myocardium recovers by 1-year corrected age.

Original Article
© The Author(s), 2020. Published by Cambridge University Press

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