Postnatal evolution of left ventricular rotational mechanics does not differ in extremely preterm infants with adverse short-term neurological outcome

BACKGROUND: brain injury in extremely preterm infants has been mainly linked to right ventricular (RV) dysfunction during postnatal transition, whereas the contribution of left ventricular rotational mechanics (LVRM) remains undefined. We aimed to characterize early postnatal evolution of LVRM and compare it between infants with and without adverse short-term outcome. METHODS: prospective observational cohort study. Targeted echocardiography was conducted within the first 24 h, at 24-72 h and on day 7. LV circumferential strain, radial displacement, basal/apical rotation, twist and torsion were evaluated using speckle-tracking. Adverse outcome was defined as the composite of death and/or adverse short-term neurological outcome, including significant interventricular hemorrhage, or white matter injury. RESULTS: among 63 infants, 29 (46%) presented the adverse outcome. During the first week, circumferential strain increased at all levels, radial displacement rose after 24 h and basal rotation shifted from mildly positive to negative. Apical rotation remained stable. LV twist and torsion increased within 72 h and then plateaued. No differences in LVRM parameters were noted between outcome groups. CONCLUSIONS: LVRM undergoes rapid maturation during early transition in extremely preterm infants. However, it is not associated with adverse outcome, consistent with a predominant role of RV function during this period. IMPACT: Left ventricular rotational mechanics (LVRM) demonstrate rapid maturation during the first postnatal week in extremely preterm infants, but do not differ between those with and without adverse short-term neurological outcome. This prospective longitudinal study shows that, despite dynamic changes in deformation and twist mechanics, LVRM is not associated with early brain injury or cerebral perfusion indices in ELGANs. The findings suggest limited early prognostic value of LVRM and reinforce the predominant role of right ventricular function in transitional hemodynamics and cardio-cerebral interactions in extremely preterm infants.