Relationships between lung ultrasound, chest CT, and echocardiographic findings in children with bronchopulmonary dysplasia: A multimodal imaging study

This study investigates the use of integrated imaging and functional assessments to detect cardiopulmonary complications in children with bronchopulmonary dysplasia (BPD). Fifteen children with BPD (gestational age 23-30 weeks; assessed at age 7 months to 10 years; 11 severe and 4 moderate) underwent lung ultrasound (LUS), chest computed tomography (CT; available in 12), electrocardiography (ECG), and echocardiography. No healthy control group was included. LUS and CT scores were strongly correlated (r = 0.70, 95% CI 0.20-0.91, p = 0.012). LUS scores correlated with right ventricular (RV) fractional area change (FAC; r = -0.59, 95% CI -0.85 to -0.11, p = 0.022), indicating that worsening lung findings are associated with declining RV performance. TAPSE showed a non-significant trend. An age-dependent relationship between lung ultrasound findings and left ventricular mass index (LVMI) was observed, with younger children showing inverse relationships suggestive of septal displacement due to right-sided overload, while older children exhibited hypertrophic remodeling. ROC analysis identified s' RV velocity as a marker with good discriminatory ability (AUC = 0.828, 95% CI 0.536-1.071, p = 0.007) for distinguishing moderate-to-severe structural changes on CT. Eight of 15 children (53%) had elevated LVMI above the 95th percentile, with a clear age-related trajectory identified through regression analysis. These findings suggest that tissue Doppler s' RV velocity may serve as a non-invasive marker of CT-defined disease severity, and that LVMI monitoring may help identify cardiac remodeling in children with BPD. Larger prospective studies are needed to validate these findings.