Early left ventricular diastolic function and disease severity in congenital diaphragmatic hernia

Early cardiac ultrasound assessment is crucial in management of congenital diaphragmatic hernia (CDH). Our current investigation addresses the unanswered question of left ventricular (LV) diastolic function and its contribution to pulmonary hypertension and disease severity in CDH. We investigated the feasibility of assessing left ventricular (LV) diastolic function in infants with CDH in the first 24 hours of life. Using a panel of echocardiographic measures, including the innovative technique of left atrial strain analysis, assessment of diastolic function was feasible in this cohort. Reduced LV diastolic echocardiographic parameters were observed in >70% of the CDH cohort, compared to normative reference data. LV diastolic function parameters correlated with echocardiographic estimates of pulmonary artery pressure and measures of global LV systolic function, indicating potential mechanistic interactions and re-consideration of established therapies. In CDH cases, early LV diastolic function correlated with clinical parameters and outcomes. Specifically, left atrial strain (LASr) was lower in non-survivors and patients who remained ventilated at 14 days of age. LASr was inversely correlated with maximum arterial PaCO₂ and maximum inspired fraction of oxygen (FiO₂) values in the first 24 hours of life, and positively correlated with maximum post-ductal oxygen saturation of haemoglobin (SpO₂).