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Right Atrial Strain in Pediatric Pulmonary Hypertension-A Prospective Observational Study
Subhrashis Guha Niyogi1, Avneet Singh2, Bhupesh Kumar3
1Department of Anaesthesia, All India Institute of Medical Sciences, Kalyani, West Bengal, India.
Insights
Right atrial strain effectively estimates pulmonary arterial pressure in children with congenital heart disease-associated pulmonary hypertension. This method shows promise for assessing pulmonary hypertension and predicting outcomes in pediatric patients.
Area of Science:
- Cardiology
- Pediatric Cardiology
- Echocardiography
Background:
- Pulmonary hypertension (PH) leads to right atrial (RA) remodeling and dysfunction.
- RA function correlates with pulmonary arterial (PA) pressures and outcomes in PH patients.
- Assessing PA pressures is crucial for managing PH in congenital heart disease (CHD).
Purpose of the Study:
- To investigate the utility of RA strain in estimating PA pressures in pediatric patients with CHD-associated PH.
- To evaluate the correlation between RA strain parameters and invasive PA pressure measurements.
- To determine if RA strain can predict postoperative PH and prognosis.
Main Methods:
- Transthoracic echocardiography was used to measure RA reservoir, conduit, and contractile strain in children under 12 years old with CHD and PH.
- Measurements were taken after anesthesia induction, with pre- and post-repair invasive PA pressures recorded.
- Conventional measures of right ventricular (RV) function and PA pressure were also assessed.
Main Results:
- Contractile RA strain demonstrated a significant correlation with pre-repair systolic PA pressure (r=0.59) and as a percentage of SBP (r=0.67).
- RA strain predicted persistent postoperative PH, similar to pulmonary artery acceleration time and RV systolic pressure.
- These findings suggest RA strain is a valuable echocardiographic marker in pediatric PH.
Conclusions:
- RA strain is a reliable echocardiographic tool for estimating PA pressures in children with CHD-associated PH.
- RA strain shows potential prognostic value and aids in the echocardiographic assessment of pediatric PH.
- Further research in larger cohorts is warranted to confirm these findings.
Abstract:
Right ventricular (RV) afterload due to elevated pulmonary arterial (PA) pressure in pulmonary hypertension (PH) causes long-term right atrial (RA) remodeling and dysfunction. RA function has been shown to correlate with PA pressures and outcome in both adult and pediatric patients with PH. We studied the role of RA strain in estimating PA pressures in congenital heart disease (CHD)-associated PH. Children below 12 years undergoing elective repair of CHD with left-to-right shunts and echocardiographic evidence of PH were included. RA reservoir, conduit and contractile strain along with conventional measures of RV function and PA pressure were measured using transthoracic echocardiography after induction of anaesthesia. Pre-and post-repair invasive PA pressures were measured after surgical exposure. 51 children with a median age of 24 months (range 4-144 months) were included, most of whom were undergoing VSD closure. Contractile RA strain showed good correlation with pre-repair systolic PA pressure in mmHg (r = 0.59, 95%CI 0.37-0.75) or expressed as a percentage of SBP (r = 0.67, 95%CI 0.49-0.80). It also predicted persistent postoperative PH as well as pre-repair pulmonary artery acceleration time and right ventricular systolic pressure measured from tricuspid regurgitation jet. The trends of correlation observed suggest a possible prognostic role of RA strain in ACHD with PH and potential utility in its echocardiographic assessment. The observed findings merit deeper evaluation in larger cohorts.
