Echocardiographic estimation of pulmonary arterial and right atrial pressures in children with congenital heart disease: a comprehensive prospective study and introduction of novel equations
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Background Pediatric pulmonary hypertension (PH) is characterized by a mean pulmonary arterial pressure exceeding 20 mmHg. There is limited research on the suitability of adult-based methods for estimating PH in pediatric populations. Using established formulas for adults, this study aimed to evaluate the correlation between echocardiographic estimates of systolic, diastolic, and mean pulmonary arterial pressures, and mean right atrial pressures in children with congenital heart disease (CHD). Methods A prospective study was conducted involving children with CHD undergoing cardiac catheterization without prior cardiac surgery. We used echocardiography to estimate pulmonary and right atrial pressures and compared these with invasively measured values. Four reliable regression equations were developed to estimate systolic, diastolic, and mean pulmonary arterial pressures, and mean right atrial pressures. Cutoff values were determined to predict the occurrence of PH. Linear regression, Bland–Altman analysis, and receiver operating characteristic curve analysis were performed to assess the accuracy of echocardiography and establish diagnostic thresholds for PH. Results The study involved 55 children (23 with normal pulmonary arterial pressure and 32 with PH) with acyanotic CHD aged 1 to 192 months. Four equations were developed to detect high pulmonary arterial pressures, with cutoff values of 32.9 for systolic pulmonary arterial pressure, 14.95 for diastolic pulmonary arterial pressure, and 20.7 for mean pulmonary arterial pressure. The results showed high sensitivity and moderate specificity but a tendency to underestimate systolic and mean pulmonary arterial pressures at higher pressures. Conclusions The study provides valuable insights into the use of adult-based echocardiographic formulas for estimating PH in pediatric patients with acyanotic CHD.
Abstract
Background Pediatric pulmonary hypertension (PH) is characterized by a mean pulmonary arterial pressure exceeding 20 mmHg. There is limited research on the suitability of adult-based methods for estimating PH in pediatric populations. Using established formulas for adults, this study aimed to evaluate the correlation between echocardiographic estimates of systolic, diastolic, and mean pulmonary arterial pressures, and mean right atrial pressures in children with congenital heart disease (CHD). Methods A prospective study was conducted involving children with CHD undergoing cardiac catheterization without prior cardiac surgery. We used echocardiography to estimate pulmonary and right atrial pressures and compared these with invasively measured values. Four reliable regression equations were developed to estimate systolic, diastolic, and mean pulmonary arterial pressures, and mean right atrial pressures. Cutoff values were determined to predict the occurrence of PH. Linear regression, Bland–Altman analysis, and receiver operating characteristic curve analysis were performed to assess the accuracy of echocardiography and establish diagnostic thresholds for PH. Results The study involved 55 children (23 with normal pulmonary arterial pressure and 32 with PH) with acyanotic CHD aged 1 to 192 months. Four equations were developed to detect high pulmonary arterial pressures, with cutoff values of 32.9 for systolic pulmonary arterial pressure, 14.95 for diastolic pulmonary arterial pressure, and 20.7 for mean pulmonary arterial pressure. The results showed high sensitivity and moderate specificity but a tendency to underestimate systolic and mean pulmonary arterial pressures at higher pressures. Conclusions The study provides valuable insights into the use of adult-based echocardiographic formulas for estimating PH in pediatric patients with acyanotic CHD.
참고문헌 (47)
- Frank BS, "Pediatric pulmonary arterial hypertension", Pediatr Clin North Am, 67, pp.903~921 (2020)
- Olgunturk FR, "An update on the diagnosis and treatment of pediatric pulmonary hypertension", Expert Opin Pharmacother, 21, pp.1253~1268 (2020)
- Rudski LG, "Guidelines for the echocardiographic assessment of the right heart in adults : a report from the American Society of Echocardiography endorsed by the European Association of Echocardiography, a registered branch of the European Society of Cardiology, and the Canadian Society of Echocardiography", J Am Soc Echocardiogr, 23, pp.685~713 (2010)
- Parasuraman S, "Assessment of pulmonary artery pressure by echocardiography : a comprehensive review", Int J Cardiol Heart Vasc, 12, pp.45~51 (2016)
- Bossone E, "Echocardiography in pulmonary arterial hypertension : from diagnosis to prognosis", J Am Soc Echocardiogr, 26, pp.1~14 (2013)
- Augustine DX, "Echocardiographic assessment of pulmonary hypertension : a guideline protocol from the British Society of Echocardiography", Echo Res Pract, 5, pp.G11~G24 (2018)
- Jone PN, "Echocardiography in pediatric pulmonary hypertension", Front Pediatr, 2, pp.124~ (2014)
- Levy PT, "Pulmonary artery acceleration time provides a reliable estimate of invasive pulmonary hemodynamics in children", J Am Soc Echocardiogr, 29, pp.1056~1065 (2016)
- Zimbarra Cabrita I, "Validation of the isovolumetric relaxation time for the estimation of pulmonary systolic arterial blood pressure in chronic pulmonary hypertension", Eur Heart J Cardiovasc Imaging, 14, pp.51~55 (2013)
- Faul F, "G*Power 3 : a flexible statistical power analysis program for the social, behavioral, and biomedical sciences", Behav Res Methods, 39, pp.175~191 (2007)
- Lai WW, "Guidelines and standards for performance of a pediatric echocardiogram : a report from the Task Force of the Pediatric Council of the American Society of Echocardiography", J Am Soc Echocardiogr, 19, pp.1413~1430 (2006)
- Lopez L, "Recommendations for quantification methods during the performance of a pediatric echocardiogram : a report from the Pediatric Measurements Writing Group of the American Society of Echocardiography Pediatric and Congenital Heart Disease Council", J Am Soc Echocardiogr, 23, pp.465~495 (2010)
- Aessopos A, "Doppler-determined peak systolic tricuspid pressure gradient in persons with normal pulmonary function and tricuspid regurgitation", J Am Soc Echocardiogr, 13, pp.645~649 (2000)
- Amsallem M, "Addressing the controversy of estimating pulmonary arterial pressure by echocardiography", J Am Soc Echocardiogr, 29, pp.93~102 (2016)
- Aduen JF, "An alternative echocardiographic method to estimate mean pulmonary artery pressure : diagnostic and clinical implications", J Am Soc Echocardiogr, 22, pp.814~819 (2009)
- Jang AY, "Echocardiographic screening methods for pulmonary hypertension : a practical review", J Cardiovasc Imaging, 28, pp.1~9 (2020)
- Masuyama T, "Continuous-wave Doppler echocardiographic detection of pulmonary regurgitation and its application to noninvasive estimation of pulmonary artery pressure", Circulation, 74, pp.484~492 (1986)
- Stevenson JG, "Comparison of several noninvasive methods for estimation of pulmonary artery pressure", J Am Soc Echocardiogr, 2, pp.157~171 (1989)
- Steckelberg RC, "Derivation of mean pulmonary artery pressure from noninvasive parameters", J Am Soc Echocardiogr, 26, pp.464~468 (2013)
- Hellenkamp K, "Echocardiographic estimation of mean pulmonary artery pressure : a comparison of different approaches to assign the likelihood of pulmonary hypertension", J Am Soc Echocardiogr, 31, pp.89~98 (2018)
- Hansmann G, "2019 updated consensus statement on the diagnosis and treatment of pediatric pulmonary hypertension : the European Pediatric Pulmonary Vascular Disease Network(EPPVDN), endorsed by AEPC, ESPR and ISHLT", J Heart Lung Transplant, 38, pp.879~901 (2019)
- Tai C, "Pulmonary artery acceleration time in young children is determined by heart rate and transpulmonary gradient but not by pulmonary blood flow : a simultaneous echocardiography-cardiac catheterization study", Echocardiography, 39, pp.895~905 (2022)
- Snider AR, "Echocardiography in pediatric heart disease" (1997), Mosby
- Cordina RL, "State-of-the-art review : echocardiography in pulmonary hypertension", Heart Lung Circ, 28, pp.1351~1364 (2019)
- Habash F, "Correlation between echocardiographic pulmonary artery pressure estimates and right heart catheterization measurement in liver transplant candidates", J Cardiovasc Imaging, 26, pp.75~84 (2018)
- Lafitte S, "Estimation of pulmonary pressures and diagnosis of pulmonary hypertension by Doppler echocardiography : a retrospective comparison of routine echocardiography and invasive hemodynamics", J Am Soc Echocardiogr, 26, pp.457~463 (2013)
- De Vecchis R, "Estimating right atrial pressure using ultrasounds : an old issue revisited with new methods", J Clin Med Res, 8, pp.569~574 (2016)
- Friedberg MK, "A novel echocardiographic Doppler method for estimation of pulmonary arterial pressures", J Am Soc Echocardiogr, 19, pp.559~562 (2006)
- Yared K, "Pulmonary artery acceleration time provides an accurate estimate of systolic pulmonary arterial pressure during transthoracic echocardiography", J Am Soc Echocardiogr, 24, pp.687~692 (2011)
- Bergersen L, "Congenital heart disease: the catheterization manual" (2009), Springer
- TA V, "Title" (1999), Williams &Wilkins
- Kirkpatrick EC, "Echocardiography in pediatric pulmonary hypertension", Paediatr Respir Rev, 14, pp.157~164 (2013)
- More K, "The role of bedside functional echocardiography in the assessment and management of pulmonary hypertension", Semin Fetal Neonatal Med, 27, pp.101366~ (2022)
- Vonk MC, "Right ventricle Tei-index : a tool to increase the accuracy of non-invasive detection of pulmonary arterial hypertension in connective tissue diseases", Eur J Echocardiogr, 8, pp.317~321 (2007)
- Shrestha B, "The Declaration of Helsinki on medical research involving human subjects : a review of seventh revision", J Nepal Health Res Counc, 17, pp.548~552 (2020)
- Dammassa V, "Pulmonary artery acceleration time accuracy for systolic pulmonary artery pressure estimation in critically ill patients", Ultrasound J, 14, pp.26~ (2022)
- von Elm E, "Strengthening the Reporting of Observational Studies in Epidemiology(STROBE)statement : guidelines for reporting observational studies", BMJ, 335, pp.806~808 (2007)
- Habash S, "Normal values of the pulmonary artery acceleration time(PAAT)and the right ventricular ejection time(RVET)in children and adolescents and the impact of the PAAT", RVET-index in the assessment of pulmonary hypertension, 2019, pp.35, 295~306
- Kutty S, "Systemic venous diameters, collapsibility indices, and right atrial measurements in normal pediatric subjects", J Am Soc Echocardiogr, 27, pp.155~162 (2014)
- Gamble G, "Estimation of arterial stiffness, compliance, and distensibility from M-mode ultrasound measurements of the common carotid artery", Stroke, 25, pp.11~16 (1994)
- Tryggestad JB, "Arterial compliance in obese children : implications for cardiovascular health", Exerc Sport Sci Rev, 42, pp.175~182 (2014)
- Townsend RR, "Recommendations for improving and standardizing vascular research on arterial stiffness : a scientific statement from the American Heart Association", Hypertension, 66, pp.698~722 (2015)
- de Souza TH, "Inferior vena cava ultrasound in children : comparing two common assessment methods", Pediatr Crit Care Med, 21, pp.e186~e191 (2020)
- Ayerza Casas A, "Dilatation of inferior vena cava in patients with anorexia nervosa", Med Clin(Barc), 147, pp.569~ (2016)
- Onizuka H, "Dilation of inferior vena cava and iliac veins in elite athlete", J Vasc Surg Venous Lymphat Disord, 5, pp.575~ (2017)
- Shivaram P, "Agerelated changes in inferior vena cava dimensions among children and adolescents with syncope", J Pediatr, 207, pp.49~53 (2019)
- Garcia RU, "Inferior vena cava collapsibility index to assess central venous pressure in perioperative period following cardiac surgery in children", Pediatr Cardiol, 42, pp.560~568 (2021)