Right ventricular base/apex ratio in the assessment of pediatric pulmonary arterial hypertension: Results from the European Pediatric Pulmonary Vascular Disease Network. Issue 9 (18th August 2018)

• Record Type: Journal Article
• Authors: Koestenberger, Martin; Avian, Alexander; Gamillscheg, Andreas; Sallmon, Hannes; Grangl, Gernot; Burmas, Ante; Schweintzger, Sabrina; Kurath‐Koller, Stefan; Cvirn, Gerhard; Hansmann, Georg
• Is Part Of: Clinical cardiology. Volume 41:Issue 9(2018)
• Page Start: 1144
• Page End: 1149
• Publication Date: 2018-08-18
• Subjects: Echocardiography -- End‐Systolic Base/Apex Ratio -- Pediatric -- Pulmonary Arterial Hypertension -- Right Ventricle; Cardiology -- Periodicals; 616.12005
• DOI: 10.1002/clc.22994
• Languages: English
• ISSNs: 0160-9289

Abstract

Abstract : Background: Echocardiographic determination of RV end‐systolic base/apex (RVES b/a) ratio was proposed to be of clinical value for assessment of pulmonary arterial hypertension (PAH) in adults. Hypothesis: We hypothesized that the RVES b/a ratio will be affected in children with PAH and aimed to correlate RVES b/a ratio with conventionally used echocardiographic and hemodynamic variables, and with New York Heart Association (NYHA) functional class. Methods: First we determined normal pediatric values for RVES b/a ratio in 157 healthy children (68 males; age range, 0.5–17.7 years). We then conducted an echocardiographic study in 51 children with PAH (29 males; age range, 0.3–17.8 years). Results: RVES b/a ratio was lower compared with age‐ and sex‐matched healthy controls ( P < 0.001). In children with PAH, RVES b/a ratio decreased with worsening NYHA class. RVES b/a ratio inversely correlated with RV/LV end‐systolic diameter ratio (ρ = −0.450, P = 0.001) but did not correlate with RV systolic function parameters (eg, tricuspid annular plane systolic excursion) and correlated with cardiac catheterization–determined pulmonary vascular resistance index (ρ = −0.571, P < 0.001). ROC analysis unraveled excellent performance of RVES b/a ratio to detect PAH in children (AUC: 0.95, 95% CI: 0.89–1.00, P < 0.001). Conclusions: The RVES b/a ratio decreased in children with PAH compared with age‐ and sex‐matched healthy subjects. The RVES b/a ratio inversely correlated with both echocardiographic and hemodynamic indicators of increased RV pressure afterload and with NYHA class, suggesting that RVES b/a ratio reflects disease severity in PAH children.