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Eccentricity Index Is Associated With Pulmonary Arterial Hypertension in Children After Repair of Complete
Charles T Simpkin1,2, Marissa DeLima1, Morgan MacBeth1
1Department of Pediatrics, University of Colorado Medical Campus, Aurora, Colorado, USA.
Insights
Eccentricity Index (EI) can help identify pulmonary arterial hypertension (PAH) in children after atrioventricular septal defect (AVSD) repair. An EI greater than 1.28 may indicate PAH, aiding non-invasive screening.
Area of Science:
- Pediatric Cardiology
- Echocardiography
- Congenital Heart Disease
Background:
- Pulmonary arterial hypertension (PAH) severity is linked to Eccentricity Index (EI).
- EI's role post-atrioventricular septal defect (AVSD) repair is unclear due to surgical effects.
- This study assesses EI's predictive value for hemodynamics after AVSD repair.
Purpose of the Study:
- To evaluate end-systolic (EIs) and maximal (EIm) Eccentricity Index as predictors of hemodynamics post-AVSD repair.
- To determine if EI can identify pulmonary arterial hypertension (PAH) in children after AVSD repair.
- To establish a threshold for EI to predict elevated right ventricular systolic pressure (RVSP) and pulmonary vascular resistance index (PVRi).
Main Methods:
- Two cohorts were studied: 89 children post-AVSD repair and 20 undergoing cardiac catheterization.
- EIs and EIm were calculated using echocardiography.
- Subgroups were defined based on echocardiographic markers of PAH and cardiac catheterization data.
Main Results:
- Children post-AVSD repair showed elevated EIs and EIm compared to controls.
- Both indices were highest in patients with PAH.
- An EIs threshold of 1.28 effectively predicted elevated RVSP and PVRi.
Conclusions:
- EIs and EIm are elevated after AVSD repair but can help differentiate PAH.
- An EIs > 1.28 is a useful non-invasive marker for identifying PAH in this population.
- A multiparametric approach may be needed for borderline EI values (1.09-1.28).
Introduction:
Eccentricity Index is an echocardiographic predictor of disease severity in children with pulmonary arterial hypertension (PAH). Its utility after atrioventricular septal defect (AVSD) repair remains unclear due to surgical manipulation of the ventricular septum. We evaluated end-systolic (EIs) and maximal (EIm) as predictors of hemodynamics post-AVSD repair.
Methods:
Cohort 1 was 89 children, 5-24 months after complete AVSD repair, and similarly aged controls. Subgroups of those with (+) and without (-) PAH were based on other echocardiographic markers of PAH. Cohort 2 was 20 children who underwent cardiac catheterization after AVSD repair. EIs and EIm were calculated as the ratio of the left ventricular diameter parallel to the septum divided by the perpendicular diameter measured at end systole and maximal post-systolic flattening, respectively.
Results:
In Cohort 1, EIs and EIm in AVSD cases were greater than in controls. Both were highest in PAH(+) patients, followed by PAH(-), followed by controls. EIs predicted echo-estimated right ventricular systolic pressure, while EIm did not. In Cohort 2, EIs and EIm predicted RVSP ≥ 35 mmHg, while only EIs predicted PVRi ≥3 Wu*m2. An EIs threshold of 1.28 optimally predicted elevated RVSP (AUC 0.761) and PVRi (AUC 0.779).
Conclusions:
After AVSD repair, EIs and EIm are elevated compared to those of otherwise healthy children. However, significant elevation (Eis > 1.28) may still be useful to differentiate those with and without PAH. A multiparametric approach may be needed for borderline EIs (1.09-1.28). These findings support EI as a non-invasive screening tool to identify PAH in children after AVSD repair.
