Left ventricular rotational mechanics mature rapidly in extreme preterm infants – but do they matter for the brain?

Cardiovascular instability during the early days of extremely preterm life is a well-established contributor to brain injury later, mainly through changes in cerebral blood flow within a circulation that remains pressure-passive and only partially autoregulated. 1 , 2 Targeted neonatal echocardiography now plays an important role in characterizing this transitional physiology at the bedside. Right ventricular (RV) performance has regularly been shown as the most robust cardiac correlate of cerebral blood flow and adverse neurological outcomes, both in infants with hypoxic-ischemic encephalopathy undergoing therapeutic hypothermia and in extremely low gestational age neonates (ELGANs). 3 , 4 , 5 In contrast, the left ventricle (LV) is generally regarded as relatively protected during this period. However, conventional indices of LV performance may lack the sensitivity to detect slight disturbances, particularly given the LV’s complex double-helical myofiber architecture, where independent apical and basal rotation generate the twisting motion, i.e., LV twist and torsion, that underpins efficient ejection and diastolic recoil. 6 , 7 Whether this rotational signature provides early prognostic information in ELGANs had not been evaluated until now.