Changes in Ventricular Geometry Predict Severity of Right Ventricular Hypertension

Area of Science:

• Pediatric Cardiology
• Cardiovascular Imaging
• Pulmonary Hypertension

Background:

• Right ventricular hypertension (RVp) secondary to pulmonary hypertension (PH) causes changes in ventricular geometry.
• The left ventricular end-systolic eccentricity index (LVEI) quantifies systolic bowing of the interventricular septum.
• Limited data exist on the relationship between LVEI and invasive RVp in pediatric populations.

Purpose of the Study:

• To assess the correlation between echocardiographically derived LVEI and invasively measured peak systolic RVp to aortic pressure (pAo) ratio in children.
• To evaluate the predictive value of LVEI for elevated RVp/pAo ratio.

Main Methods:

• Retrospective review of medical records of patients undergoing echocardiography and cardiac catheterization for PH evaluation.
• Analysis of 46 studies in 29 pediatric subjects (median age 3.8 years).
• Correlation and ROC analyses to determine the relationship between LVEI and RVp/pAo ratio.

Main Results:

• A significant positive correlation (r = 0.76, p < 0.001) was found between LVEI and RVp/pAo ratio.
• ROC analysis showed an area under the curve of 0.91 for predicting RVp/pAo >0.50 using LVEI.
• An LVEI >1.48 demonstrated 76% sensitivity and 100% specificity for predicting RVp/pAo >0.50.

Conclusions:

• Echocardiographically derived LVEI is strongly correlated with invasively determined RVp/pAo ratio in children.
• LVEI may serve as a valuable noninvasive tool to estimate RVp in pediatric PH.
• LVEI, combined with other noninvasive measures, could potentially minimize the need for invasive hemodynamic assessment.