Echocardiographic Measures Predict Bronchopulmonary Dysplasia in Preterm InfantsHeart measurements help predict lung disease in preterm infants

BACKGROUND: To comprehensively determine whether echocardiographic measures of right-sided cardiac performance can identify premature neonates at risk of developing bronchopulmonary dysplasia. METHODS: We systematically queried 4 electronic databases - PubMed, Embase, the Cochrane Library, and Web of Science - from their respective launch dates through April 2025 to retrieve eligible studies examining whether echocardiographic markers of right-sided cardiac performance could anticipate bronchopulmonary dysplasia in premature neonates. Study rigor was evaluated with the Newcastle-Ottawa Scale, while the review was designed and reported in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidance and the Cochrane Handbook. Pooled effect estimates were calculated in RevMan 5.3, whereas sensitivity analyses and Egger regression test were performed with Stata/SE 15.1. RESULTS: Twelve studies were incorporated, involving 1316 preterm infants, with 414 of them diagnosed with bronchopulmonary dysplasia (BPD). Meta-analysis indicated that tricuspid annular plane systolic excursion (TAPSE) (weighted mean difference [WMD] = -0.08, 95% confidence interval [CI] -0.12 to -0.04, P = .0002), myocardial performance index (MPI) (WMD = 0.05, 95% CI 0.02-0.08, P = .004), fractional area change (FAC) (WMD = -3.51, 95% CI -6.68 to -0.33, P = .03), pulmonary artery acceleration time (PAAT) (WMD = -6.54, 95% CI -10.71 to -2.37, P = .002), and PAAT to right ventricular ejection time ratio (PAAT/RVET) (WMD = -0.04, 95% CI -0.07 to -0.01, P = .005) can aid BPD prediction. Subgroup analyses showed that measurements obtained before 36 weeks' postmenstrual age (PMA) had better predictive performance for TAPSE, MPI, and FAC than measurements obtained at 36 weeks' PMA. PAAT/RVET remained predictive of BPD both before 36 weeks' PMA and at 36 weeks' PMA. Among infants with birth weight ≥1000 g, MPI demonstrated better predictive performance for BPD. Sensitivity analyses (leave-one-out) showed that exclusion of individual studies had no meaningful effect on the summary estimates, supporting the stability of the results. CONCLUSION: TAPSE, MPI, FAC, PAAT, and PAAT/RVET have predictive value for BPD in preterm infants.