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Echocardiographic evaluation of ventricular function in children with pulmonary hypertension
Erika E Vorhies1, Robert J Gajarski, Sunkyung Yu
1Division of Pediatric Cardiology, Department of Pediatrics and Communicable Diseases, University of Michigan Medical School and C. S. Mott Children's Hospital, 1540 E. Hospital Drive, Ann Arbor, MI, 48109-4204, USA, eeharder@gmail.com.
Insights
Pediatric pulmonary hypertension (PHN) patients show impaired ventricular function, particularly in older children. Echocardiographic indices can monitor disease severity in these young patients.
Area of Science:
- Cardiology
- Pediatric Medicine
- Echocardiography
Background:
- Ventricular dysfunction is known in adult pulmonary hypertension (PHN).
- Its presence in pediatric PHN patients is not well-established.
- Echocardiography is a key non-invasive tool for cardiac assessment.
Purpose of the Study:
- To identify differences in echocardiographic indices of ventricular function between pediatric PHN patients and controls.
- To assess the impact of age on these differences.
Main Methods:
- Retrospective case-control study (2009-2011) of 25 pediatric PHN patients and 75 age-matched controls.
- Diagnosis of PHN based on estimated right-ventricular pressure.
- Comparison of right and left ventricular systolic and diastolic function using tissue Doppler imaging (TDI) of mitral and tricuspid annuli.
Main Results:
- Pediatric PHN patients exhibited worse RV systolic and diastolic function compared to controls.
- Significant differences included decreased tricuspid valve inflow ratio, decreased TA TDI early diastolic and systolic velocities, increased tricuspid E/E' ratio, and increased myocardial performance index (all p < 0.01).
- Ventricular function differences were less pronounced in PHN patients under 1 year old, becoming more apparent in those aged 1 year and older.
Conclusions:
- Pediatric PHN patients demonstrate abnormal ventricular systolic and diastolic function via Doppler echocardiography.
- These abnormalities worsen with age, suggesting potential for non-invasive monitoring.
- Further validation with catheterization data is recommended.
Abstract:
Although described in adults, it remains unclear whether ventricular dysfunction exists in pediatric patients with pulmonary hypertension (PHN). The goal of this study was to identify differences in echocardiographic indices of ventricular function among pediatric PHN patients. From 2009 to 2011, pediatric PHN patients with normal intracardiac anatomy and age-matched controls (1:3 ratio) were enrolled in this retrospective case-control study. Diagnosis of PHN was based on tricuspid regurgitation velocity or septal position estimating right-ventricular (RV) pressure >50 % systemic. Measures of RV and left ventricular systolic and diastolic function, including tissue Doppler imaging (TDI) of the mitral annulus (MA) and tricuspid annulus (TA), were compared. Enrollees included 25 PHN patients and 75 age-matched controls (mean age 7.5 years [range 1 day to 19 years]). Parameters of RV systolic and diastolic function were worse in PHN patients. Compared with controls, PHN patients had significantly decreased tricuspid valve inflow ratio, decreased TA TDI early diastolic velocities, decreased systolic velocities, increased tricuspid E/E' ratio (all p < 0.01) and increased myocardial performance index. In an age-stratified analysis, TDI measures in PHN patients <1 year of age were similar to controls, whereas differences in TA TDI velocities and MA TDI velocities were noted in patients ≥1 year of age. Abnormalities in Doppler echocardiographic indices of ventricular systolic and diastolic function were identified in pediatric PHN patients and were more prominent with older age. These indices are promising for serial noninvasive monitoring of disease severity, but further correlation with catheterization-derived measures is needed.
