Doppler Tissue Imaging Provides an Estimate of Pulmonary Arterial Pressure in Children with Pulmonary Hypertension Due to Congenital Intracardiac Shunts

Çevik, Ayhan; Kula, Serdar; Olguntürk, Rana; Şaylan, Berna; Pektas, Ayhan; Oğuz, Deniz; Tunaoğlu, Sedef

doi:10.1111/chd.12030

Cited by 13 publications

(8 citation statements)

References 25 publications

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“…80 RV TDI parameters such as S' correlate well with invasive pulmonary hemodynamics in pediatric PH-CHD patients and may therefore be useful for follow-up of these patients. 86 TDI velocities may also be useful markers of midterm outcomes in children with iPH. 87 Pediatric PH patients had lower S' and early-diastolic velocities ( E ) at the lateral tricuspid, septal, and lateral mitral walls, compared to controls.…”

Section: Global and Regional Functional Assessment Of The Rvmentioning

confidence: 99%

Transthoracic Echocardiography in the Evaluation of Pediatric Pulmonary Hypertension and Ventricular Dysfunction

et al. 2016

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Transthoracic echocardiography (TTE) is the most accessible noninvasive diagnostic procedure for the initial assessment of pediatric pulmonary hypertension (PH). This review focuses on principles and use of TTE to determine morphologic and functional parameters that are also useful for follow-up investigations in pediatric PH patients. A basic echocardiographic study of a patient with PH commonly includes the hemodynamic calculation of the systolic pulmonary artery pressure (PAP), the mean and diastolic PAP, the pulmonary artery acceleration time, and the presence of a pericardial effusion. A more detailed TTE investigation of the right ventricle (RV) includes assessment of its size and function. RV function can be evaluated by RV longitudinal systolic performance (e.g., tricuspid annular plane systolic excursion), the tricuspid regurgitation velocity/right ventricular outflow tract velocity time integral ratio, the fractional area change, tissue Doppler imaging-derived parameters, strain measurements, the systolic-to-diastolic duration ratio, the myocardial performance (Tei) index, the RV/left ventricle (LV) diameter ratio, the LV eccentricity index, determination of an enlarged right atrium and RV size, and RV volume determination by 3-dimensional echocardiography. Here, we discuss the potential use and limitations of TTE techniques in children with PH and/or ventricular dysfunction. We suggest a protocol for TTE assessment of PH and myocardial function that helps to identify PH patients and their response to pharmacotherapy. The outlined protocol focuses on the detailed assessment of the hypertensive RV; RV-LV crosstalk must be analyzed separately in the evaluation of different pathologies that account for pediatric PH.

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Section: Global and Regional Functional Assessment Of The Rvmentioning

confidence: 99%

Transthoracic Echocardiography in the Evaluation of Pediatric Pulmonary Hypertension and Ventricular Dysfunction

et al. 2016

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“…In addition to the previously discussed findings of Utsunomiya et al (15), evidence about the relationship between RAP and RV-E/e' in the setting of PH also comes from the study by Tsutsui et al (23), where the cohort had a mean pulmonary artery pressure of 36±10 mmHg, presumably due to the acute decompensated heart failure which they were reported to have. Unsurprisingly given both left and right heart pathophysiology, and as described above, a weak correlation was found between RV-E/e' and RAP, accuracy was modest and precision poor.In a study of paediatric PH, due to intracardiac shunt, Cevik et al (31) reported no association between RV-E/e' and RAP (r=-0.065, p=0.737). TTE and RHC measurements were made simultaneously but no ROC or Bland-Altman analyses were performed.…”

Section: Pulmonary Hypertension (Ph)mentioning

confidence: 96%

Echocardiographic RV-E/e′ for predicting right atrial pressure: a review

Fletcher

Robinson

Rana

2020

Echo Research and Practice

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Right atrial pressure (RAP) is a key cardiac parameter of diagnostic and prognostic significance, yet current two-dimensional echocardiographic methods are inadequate for the accurate estimation of this haemodynamic marker. Right-heart trans-tricuspid Doppler and tissue Doppler echocardiographic techniques can be combined to calculate the right ventricular (RV) E/e’ ratio – a reflection of RV filling pressure which is a surrogate of RAP. A systematic search was undertaken which found seventeen articles that compared invasively measured RAP with RV-E/e’ estimated RAP. Results commonly concerned pulmonary hypertension or advanced heart failure/transplantation populations. Reported receiver operator characteristic analyses showed reasonable diagnostic ability of RV-E/e’ for estimating RAP in patients with coronary artery disease and RV systolic dysfunction. The diagnostic ability of RV-E/e’ was generally poor in studies of paediatrics, heart failure and mitral stenosis, whilst results were equivocal in other diseases. Bland-Altman analyses showed good accuracy but poor precision of RV-E/e’ for estimating RAP, but were limited by only being reported in seven out of seventeen articles. This suggests that RV-E/e’ may be useful at a population level but not at an individual level for clinical decision making. Very little evidence was found about how atrial fibrillation may affect the estimation of RAP from RV-E/e’, nor about the independent prognostic ability of RV-E/e’ . Recommended areas for future research concerning RV-E/e’ include; non-sinus rhythm, valvular heart disease, short and long term prognostic ability, and validation over a wide range of RAP.

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“…Interestingly, in contrast to children with PH, in children with right ventricular volume overload due to an atrial septal defect (amenable to interventional repair and no pulmonary vascular disease), tricuspid peak S' has been reported to be increased and normalizes after shunt closure (53,54). A negative correlation of tricuspid diastolic TDI velocities with PAPs have also been reported in patients with atrial shunt lesions (55). The ratio of tricuspid E'/A' has been found to have the highest sensitivity and specificity, when used in conjunction with maximal tricuspid regurgitation velocity in distinguishing between patients with PH associated to congenital heart disease and healthy controls (55).…”

Section: Tissue Doppler Assessmentmentioning

confidence: 99%

A guide to echocardiographic assessment in children and adolescents with pulmonary hypertension

Lammers¹,

Apitz²,

Michel‐Behnke³

et al. 2021

Cardiovasc Diagn Ther

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Data from the TOPP registry suggested the potential combination of simple diagnostic non-invasive tests (chest X-ray, electrocardiography and echocardiography) to rule out the presence of PH. In fact, none of the 456 children with PH at the time of enrollment had all three tests considered normal (3).Echocardiography not only reveals the underlying cardiac morphology and diagnosis of any associated

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Doppler Tissue Imaging Provides an Estimate of Pulmonary Arterial Pressure in Children with Pulmonary Hypertension Due to Congenital Intracardiac Shunts

Abstract: When used in conjunction with conventional methods, TE'/TA' has the highest sensitivity and specificity in distinguishing between patients and healthy controls.

Cited by 13 publications

References 25 publications

Transthoracic Echocardiography in the Evaluation of Pediatric Pulmonary Hypertension and Ventricular Dysfunction

Transthoracic Echocardiography in the Evaluation of Pediatric Pulmonary Hypertension and Ventricular Dysfunction

Echocardiographic RV-E/e′ for predicting right atrial pressure: a review

A guide to echocardiographic assessment in children and adolescents with pulmonary hypertension

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