Longitudinal Echocardiographic Evaluation of Pulmonary Hypertension Trajectories in Infants With Bronchopulmonary Dysplasia

PURPOSE: Describe longitudinal echocardiographic changes during the first year of life in infants with bronchopulmonary dysplasia (BPD)-associated pulmonary hypertension (PH) and assess the prognostic value of early echocardiographic parameters. METHODS: This study was a prospective longitudinal cohort study. Preterm infants with BPD underwent echocardiographic screening at 28 days of life and, if diagnosed with PH, were followed every 3 months until 12 months or death. RESULTS: During the first year of life, 40.9% of infants died, 52.3% survived with complete resolution of PH, and 6.8% survived with persistent mild PH. Severe BPD was significantly more prevalent among non-survivors. At the 28-day of life echocardiographic assessment, survivors exhibited higher tricuspid annular plane systolic excursion (8.67 vs. 7.45 mm) and lower left ventricular eccentricity index (1.05 vs. 1.30), whereas tricuspid regurgitation gradient and pulmonary artery acceleration time did not differ significantly. Serial echocardiography showed a consistent trend toward improvement in pulmonary artery acceleration time, left ventricular eccentricity index and tricuspid annular plane systolic excursion, suggesting a reduction in pulmonary vascular resistance and maturation of right ventricular systolic function. Receiver operating characteristic analysis showed that tricuspid annular plane systolic excursion at 28 days had modest discriminatory ability for predicting 1-year survival, with a cutoff value of 7.14 mm associated with improved survival. CONCLUSION: In infants with BPD-associated PH, echocardiographic abnormalities frequently improve over time among survivors. Longitudinal echocardiographic assessment may aid early risk stratification, with tricuspid annular plane systolic excursion providing supportive prognostic information when interpreted in conjunction with other echocardiographic parameters.