Exercise right heart catheterization for pulmonary hypertension identified on screening echocardiography in adult survivors of childhood cancer: A report from the St. Jude Lifetime Cohort

Abstract

Pulmonary hypertension, determined non-invasively by tricuspid regurgitant jet velocity on Doppler echocardiography, was previously identified in 25% of long-term survivors who received chest-directed radiotherapy. To validate non-invasively defined pulmonary hypertension ten survivors (mean age 48 years), exposed to chest radiotherapy underwent right heart catheterization with planned cardiopulmonary exercise testing during catheterization. Eight participants had an elevated mean pulmonary artery pressure at rest (≥25 mm Hg) or with subsequent exercise (>30 mm Hg), evidence of hemodynamically confirmed pulmonary hypertension by right heart catheterization. Cardiopulmonary exercise testing further defined the magnitude and etiology of cardiopulmonary limitations in this life-threatening late-effect.

The relationship between pulmonary artery wedge pressure and pulmonary blood volume derived from contrast echocardiography: A proof‐of‐concept study

“… BMI body mass index BPS Biplane Simpson’s method BSA body surface area E mitral inflow velocity E′ mitral annulus tissue Doppler velocity LVEF left ventricular ejection fraction LVOT left ventricular outflow tract RVFAC right-ventricular fractional area change SV stroke volume VTI velocity-time integral (method) * participant ID numbers from the prior study (8) are maintained here …”

“… CI cardiac index (Fick method) mPAP mean pulmonary arterial pressure MvO2 mixed venous oxygen saturation PAWP pulmonary arterial wedge pressure PVR pulmonary vascular resistance RAP right atrial pressure WU Wood Units * participant ID numbers from the prior study (8) are maintained here † thermodilution method …”

“… HR heart rate PBV pulmonary blood volume PTT pulmonary transit time rPBV pulmonary blood volume relative to stroke volume TTE-CCL interval between echocardiogram and cardiac catheterization * participant ID numbers from the prior study (8) are maintained here …”

“…The study population consisted of adult survivors of childhood cancer exposed to chest radiation (St Jude Lifetime Cohort) who underwent comprehensive right-heart catheterization at our institution as part of a definitive evaluation for pulmonary hypertension. 8 (1) The study protocol called for those individuals to undergo a standard TTE with echocardiographic contrast on the same day, prior to the catheterization procedure.…”

“…Demographic characteristics, anthropomorphic measurements, and medical history were abstracted from the electronic medical record. For consistency, the participant ID numbers from the prior study 8 are maintained (Tables 1-3).…”