Right Ventricular Diastolic Performance in Children With Pulmonary Arterial Hypertension Associated With Congenital Heart Disease

Abstract

Background-Right ventricular diastolic dysfunction influences outcomes in pulmonary arterial hypertension (PAH), but echocardiographic parameters have not been investigated in relation to invasive reference standards in pediatric PAH. We investigated echocardiographic parameters of right ventricular diastolic function in children with PAH in relation to simultaneously measured invasive reference measures. Methods and Results-We prospectively recruited children undergoing a clinically indicated cardiac catheterization for evaluation of PAH and pulmonary vasoreactivity testing. Echocardiography was performed simultaneously with invasive reference measurements by high-fidelity micromanometer catheter. For analysis, patients were divided into shunt and nonshunt groups. Sixteen children were studied. In the group as a whole, significant correlations were found among τ and tricuspid deceleration time, E′, E/E′, Time E-E′ , A wave velocity, and global early and late diastolic strain rate. dp/dt minimum correlated significantly with late diastolic tricuspid annular velocity (A′), tissue Doppler imaging-derived systolic:diastolic duration ratio, and global late diastolic strain rate. End-diastolic pressure correlated significantly with tissue Doppler imaging-derived systolic:diastolic duration ratio. On multivariate analysis, tricuspid deceleration time, Time E-E′ , and global early diastolic strain rate were independent predictors of τ, whereas tissue Doppler imaging-derived systolic:diastolic duration ratio was an independent predictor of dp/dt minimum. In general, correlations between echocardiographic and invasive parameters were better in the shunt group than in the nonshunt group. Conclusions-Echocardiography

Abnormal Right Ventricular Relaxation in Pulmonary Hypertension

“…Although shorter than similar time periods in the left ventricle, these are still measurable with high-fidelity micromanometers, and our values for τ compare favorably to other recent studies. 25 Moreover, one could argue that, even if there are some patients in whom τ cannot be measured, Note: Data are mean value ± standard deviation, unless otherwise indicated. BMI: body mass index; NYHA: New York Heart Association; PASP: pulmonary artery systolic pressure; PADP: pulmonary artery diastolic pressure; mPAP: mean pulmonary artery pressure; PCWP: pulmonary capillary wedge pressure; PVR: pulmonary vascular resistance; HR: heart rate; CO: cardiac output; SV: stroke volume.…”

Right ventricular diastolic function and exercise capacity in COPD

“…16,17, 18 However, little is known about the pathophysiologic implications of RVDF in COPD. To our knowledge, this is the first study to examine the association between RVDF and exercise capacity in COPD.…”

Echocardiography in Pediatric Pulmonary Hypertension

“…In this study, the tricuspid valve E ′ was lower in worse functional class and the cumulative event-free survival rate was significantly lower when tricuspid valve E ′ was <8 cm/s (83). In a recent study, echocardiographic diastolic parameters of RV in children with PAH correlated with invasive measures of cardiac catheterization and tricuspid deceleration time with global early diastolic strain rate were independent predictors of tau (84). …”