Acute Vasoreactivity Testing during Cardiac Catheterization of Neonates with Bronchopulmonary Dysplasia-Associated Pulmonary Hypertension

Abstract

Objectives: To assess whether better baseline pulmonary hemodynamics or positive acute vasoreactivity testing (AVT) during cardiac catheterization are associated with improved outcomes in infants with bronchopulmonary dysplasia (BPD) and pulmonary hypertension (PH).

Study design: This retrospective, single-center study included 26 premature neonates with BPD who underwent catheterization to evaluate PH. AVT was assessed with exposure to 100% fractional inspired oxygen with or without inhaled nitric oxide. AVT was positive if the patient met the Barst criteria or increased shunt volume and decreased pulmonary vascular resistance index by >50%.

Results: At baseline, the median pulmonary artery mean pressure was 29 mm Hg (IQR, 24-35) and the pulmonary vascular resistance index was 5.3 units*m² (IQR, 3.5-6.9). Nine patients (35%) had a positive AVT response, which was associated with a decreased risk of death or tracheostomy by 2-year follow-up (hazard ratio, 0.15; P = .02). Baseline pulmonary hemodynamics and the presence of left ventricular diastolic dysfunction were not associated with late outcomes in this cohort.

Conclusions: We found that 35% of infants with BPD who underwent catheterization had positive AVT and that a positive response was associated with better long-term outcomes than nonresponders. AVT better distinguishes higher from lower risk PH in infants with BPD than baseline pulmonary hemodynamics. AVT may aid in the assessment of disease severity and management of BPD-associated PH.

Keywords: acute vasoreactivity testing; bronchopulmonary dysplasia; cardiac catheterization; echocardiography; neonatal; prematurity; pulmonary hypertension.