Doppler Echocardiography Inaccurately Estimates Right Ventricular Pressure in Children With Elevated Right Heart Pressure

Cardiomyopathy in children: Can we rely on echocardiographic tricuspid regurgitation gradient estimates of right ventricular and pulmonary arterial pressure?

“…Although the tricuspid regurgitation gradient showed a modest-to-good correlation with catheterisation-derived haemodynamics, the magnitude of the 95% limits of agreement was clinically significant, varying by as much as ±20 mmHg. These findings are in agreement with the recent literature questioning the accuracy of the tricuspid regurgitation gradient in the paediatric population, particularly in patients with elevated pulmonary pressures 7 15 To our knowledge, this is the first study to investigate the utility of tricuspid regurgitation gradient and Doppler echocardiography to estimate right heart pressures specifically in the paediatric cardiomyopathy population.…”

“…The tricuspid regurgitation gradient is often used interchangeably with catheterisation-derived right ventricular systolic pressure; however, there are limited data to support this level of agreement between the two modalities. Groh et al 7 found limited agreement between the two modalities in assessing pulmonary hypertension in a paediatric population. Similar findings have been reported in children with pulmonary hypertension and chronic lung disease, particularly in cases with elevated pulmonary pressures 5 .…”

“…Although commonly used in children, more recent studies have focussed on the use of echocardiography as a predictor of outcome in specific populations 5 6 Conflicting evidence exists regarding the absolute agreement between the tricuspid regurgitation gradient and right heart catheterisation-derived right ventricular systolic pressure in the paediatric CHD population, with almost no data on the paediatric cardiomyopathy population 7 8 Several studies looking at the tricuspid regurgitation gradient in the adult cardiomyopathy population have shown wide limits of agreement with pulmonary artery pressure and worse predictive value with more severe cases of pulmonary hypertension 9 …”

Pulmonary hypertension is an important co‐morbidity in developmental lung diseases of infancy: Bronchopulmonary dysplasia and congenital diaphragmatic hernia

“…Abnormal echocardiographic findings consistent with elevation of right‐sided pressure or resistance are often described as being diagnostic of PH in infants with developmental lung disease; Table 1 describes various published schema for this determination in these patients. However, published echocardiography data suggest that agreement and accuracy for diagnosis and severity of PH due to PVD in children is variable when compared to the gold standard of cardiac catheterization 34‐36 . The preponderance of pressure assessments resulting from conventional echocardiography, as well as the dynamic conditions affecting systemic vascular resistance and pressure in children during both echocardiography and cardiac catheterization are limitations in these comparisons.…”

Intermediate- and long-term follow-up of device closure of patent arterial duct with severe pulmonary hypertension: factors predicting outcome

“…Follow-up cardiac catheterisation has only been performed on patients with evidence of severe pulmonary arterial hypertension. The decision was supported by studies showing good correlation of right ventricular systolic pressure calculated through tricuspid regurgitant jet 31 . As higher values correlated poorly, only the patients with right ventricular systolic pressure >55 mmHg were re-catheterised.…”