Predictors of Catastrophic Adverse Outcomes in Children With Pulmonary Hypertension Undergoing Cardiac Catheterization

Abstract

Background Cardiac catheterization is the standard of care procedure for diagnosis, choice of therapy, and longitudinal follow-up of children and adults with pulmonary hypertension (PH). However, the procedure is invasive and has risks associated with both the procedure and recovery period. Objectives Identify risk factors for catastrophic adverse outcome in children with PH undergoing cardiac catheterization. Methods We studied children and young adults 0-21 years of age with PH undergoing ≥1 cardiac catheterizations at centers participating in the Pediatric Health Information Systems (PHIS) database between 2007 and 2012. Using mixed effects multivariable regression, we assessed the association between pre-specified subject- and procedure-level covariates and the risk of the composite outcome of death and/or initiation of mechanical circulatory support within 1 day of cardiac catheterization after adjustment for patient- and procedure-level factors. Results 6,339 procedures performed on 4,401 patients with a diagnosis of PH from 38/43 centers contributing data to the PHIS database were included. The observed risk of composite outcome was 3.5%. In multivariate modeling, the adjusted risk of the composite outcome was 3.3%. Younger age at catheterization, cardiac operation in the same admission as the catheterization, pre-procedural systemic vasodilator infusion, and hemodialysis were independently associated with an increased risk of adverse outcomes. Pre-procedure use of pulmonary vasodilators was associated with reduced risk of composite outcome. Conclusions The risk of cardiac catheterization in children and young adults with PH is high relative to previously reported risk in other pediatric populations. The risk is influenced by patient-level factors. Further research is necessary to determine whether knowledge of these factors can be translated into practices that improve outcomes for children with PH.

Hepatoma-derived Growth Factor Predicts Disease Severity and Survival in Pulmonary Arterial Hypertension

“…NTproBNP is a cardiac biomarker of chamber distention and therefore is used as a general diagnostic standard for heart failure with poor discrimination of right or left ventricular etiology (8,9). Cardiac catheterization, the invasive method, can be complicated by accruing morbidity and mortality risk, particularly in pediatric patients (10)(11)(12).…”

Desenlaces críticos en pacientes pediátricos con hipertensión pulmonar y cardiopatía congénita llevados a cateterismo cardíaco diagnóstico en el Hospital Cardiovascular de Soacha entre 2013 y 2016

“…al 2007 realizado por medio de una cohorte retrospectiva en pacientes con y sin presencia de anomalía congénita sometidos a cateterismos cardíaco identifi có que los pacientes con hipertensión pulmonar en rangos sistémicos o supra-sistémicos se asociaron con mayor frecuencia a la presencia de complicaciones mayores (paro cardiaco, arritmias y muerte)(7); lo cual contrasta con los hallazgos aquí reportados donde ningún paciente falleció durante el procedimiento. De otro lado, la asociación de algún tipo de anomalía congénita con hipertensión pulmonar ha sido relacionado a un mayor riesgo anestésico durante el cateterismo cardíaco (2). Todos los anteriores factores de riesgo (HTP severa, anomalía congénita, alteraciones en los parámetros hemodinámicos) proveen un efecto que al fi nal puede ser aditivo, considerando un alto riesgo general de eventos críticos durante la anestesia en la población de estudio (8).…”

“…La principal complicación que se presentó en el estudio fue la crisis de hipertensión pulmonar (9%), no obstante, no se presentaron muertes intraoperatorias; resultados que están acordes a la evidencia de otros estudios no restringidos a pacientes con anomalías congénitas donde la mortalidad oscila entre 0.3 y 0.8% (2). E contraste, la mortalidad en la población analizada fue considerablemente mayor en el período postquirúrgico alcanzando un valor de 11% durante los 30 días posteriores al cateterismo; este valor tal elevado podría tener relación con alta complejidad que en general representan las patologías congénitas, el compromiso del estado basal de paciente, las múltiples comorbilidades y su condición sociocultural que podría impactar negativamente en la detección y atención temprana en este grupo de pacientes.…”

Pediatric and Adolescent Pulmonary Hypertension: What Is the Risk of Undergoing Invasive Hemodynamic Testing?

“…Both single‐center and pooled registry data have shown that children with PH undergoing HC have a high risk of major AEs (3.5%–6.2%) and death (0.2%–1.4%) 4, 6, 7, 8, 9, 10, 11, 12, 13, 14. However, there are limited data identifying important risk factors for major AE and death in the pediatric PH population.…”

“…Risk factors (OR)11: prematurity (4.95), infants without prematurity (1.61), cardiac surgery during the same admission, prior heart transplantation (2.78), hemodialysis (19.40)…”