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Duong SQ, Dominy C, Arivazhagan N, Barris DM, Hopkins K, Stern KWD, Choueiter N, Ezon D, Cohen J, Friedberg MK, Zaidi AN, Nadkarni GN. Machine learning prediction of right ventricular volume and ejection fraction from two-dimensional echocardiography in patients with pulmonary regurgitation. THE INTERNATIONAL JOURNAL OF CARDIOVASCULAR IMAGING 2025; 41:899-912. [PMID: 40080276 DOI: 10.1007/s10554-025-03368-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/02/2024] [Accepted: 02/24/2025] [Indexed: 03/15/2025]
Abstract
Right ventricular (RV) end-diastolic volume (RVEDV) and ejection fraction (RVEF) by cardiac MRI (cMRI) guide management in chronic pulmonary regurgitation (PR). Two-dimensional echocardiography suboptimally correlate with RV volumes. This study tested whether combination of guideline-directed RV measures in a machine learning (ML) framework improves quantitative assessment of RVEDV and RVEF. RV measurements were obtained on subjects with > mild PR who had cMRI and echocardiogram within 90 days. A gradient-boosted trees algorithm predicted cMRI RV dilation (RVEDV > 160 ml/m2) and RV dysfunction (RVEF<47%), first with "guideline-only" measures, and then with "expanded-features" to include 44 total echocardiographic, clinical, and demographic variables. Model performance was compared to clinician visual assessment. Of 232 studies (56% tetralogy of Fallot, 20% pulmonary stenosis), the median age was 21.5 years, 21 (9%) had RV dilation, and 42 (18%) had RV dysfunction. For RV dilation prediction, the guideline-only model area under the receiver operating characteristic (AUROC)=0.68, and expanded-features model AUROC=0.85. At 90% sensitivity, the expanded-features model had 73% specificity, 25% positive predictive value (PPV), and 99% negative predictive value (NPV) This was similar to clinician performance (sensitivity 81%, specificity 81%, PPV 29%, NPV 98%). For prediction of RV dysfunction, the guideline-only AUROC= 0.71, additional features did not improve the model, and clinicians outperformed the model. In patients with PR, a ML model combining guidelines for RV assessment with demographic and additional echocardiographic parameters may effectively rule-out those with significant RV dilation at clinical thresholds for intervention, and performs similarly to expert clinicians.
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Affiliation(s)
- Son Q Duong
- Department of Pediatrics (Cardiology), Icahn School of Medicine at Mount Sinai, 1468 Madison Ave, Annenberg 3rd Floor, New York, NY, 10029, USA.
- Mindich Child Health and Development Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
- Charles Bronfman Institute for Personalized Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
| | - Calista Dominy
- Department of Pediatrics (Cardiology), Icahn School of Medicine at Mount Sinai, 1468 Madison Ave, Annenberg 3rd Floor, New York, NY, 10029, USA
| | - Naveen Arivazhagan
- Charles Bronfman Institute for Personalized Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - David M Barris
- Department of Pediatrics (Cardiology), Icahn School of Medicine at Mount Sinai, 1468 Madison Ave, Annenberg 3rd Floor, New York, NY, 10029, USA
| | - Kali Hopkins
- Department of Pediatrics (Cardiology), Icahn School of Medicine at Mount Sinai, 1468 Madison Ave, Annenberg 3rd Floor, New York, NY, 10029, USA
- Adult Congenital Heart Disease, Mount Sinai Fuster Heart Hospital, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Kenan W D Stern
- Department of Pediatrics (Cardiology), Icahn School of Medicine at Mount Sinai, 1468 Madison Ave, Annenberg 3rd Floor, New York, NY, 10029, USA
| | - Nadine Choueiter
- Department of Pediatrics (Cardiology), Icahn School of Medicine at Mount Sinai, 1468 Madison Ave, Annenberg 3rd Floor, New York, NY, 10029, USA
| | - David Ezon
- Department of Pediatrics (Cardiology), Icahn School of Medicine at Mount Sinai, 1468 Madison Ave, Annenberg 3rd Floor, New York, NY, 10029, USA
| | - Jennifer Cohen
- Department of Pediatrics (Cardiology), Icahn School of Medicine at Mount Sinai, 1468 Madison Ave, Annenberg 3rd Floor, New York, NY, 10029, USA
| | - Mark K Friedberg
- Division of Cardiology, Labatt Family Heart Centre, Hospital for Sick Children, Toronto, ON, Canada
| | - Ali N Zaidi
- Adult Congenital Heart Disease, Mount Sinai Fuster Heart Hospital, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Girish N Nadkarni
- Charles Bronfman Institute for Personalized Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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Li W, Shang W, Huang J. Pulmonary artery systolic pressure associated with inflammatory factors among pediatric congenital heart disease with pulmonary arterial hypertension after cardiopulmonary bypass. J Pediatr (Rio J) 2025; 101:438-444. [PMID: 40020755 PMCID: PMC12039507 DOI: 10.1016/j.jped.2025.01.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2024] [Revised: 01/06/2025] [Accepted: 01/06/2025] [Indexed: 03/03/2025] Open
Abstract
OBJECTIVE This study aimed to evaluate the perioperative inflammatory cytokines in pediatric patients with pulmonary arterial hypertension secondary to congenital heart disease and also sought to investigate the correlation between preoperative echocardiographic pulmonary artery systolic pressure and inflammatory factors after cardiopulmonary bypass in these patients. METHODS A retrospective observational study was conducted involving 59 children under 2 years old. Echocardiography was used to measure tricuspid annular peak systolic velocity. The levels of perioperative inflammatory cytokines in the plasma, including IL-6, IL-8, IL-10, IL-1β, and TNF-α, were measured. Additionally, postoperative ventilation time, length of intensive care unit stay, and ward stay were recorded. RESULTS Patients with pulmonary hypertension experience longer postoperative ventilation time, intensive care unit stay, and ward stay. Although no significant differences were observed in the cardiopulmonary bypass and aortic cross-clamping, there was a more pronounced increase in postoperative inflammatory cytokines, including IL-6, IL-8, and IL-10, in these patients following cardiopulmonary bypass (p < 0.05). Preoperative echocardiographic pulmonary artery systolic pressure was found to be associated with the levels of IL-6 and IL-10 after surgery in pulmonary hypertension patients. A pulmonary artery systolic pressure greater than 52 mmHg was able to predict a postoperative ventilation time exceeding 21 h. CONCLUSION Higher levels of inflammatory cytokines were observed in pediatric patients with pulmonary hypertension secondary to congenital heart disease following cardiopulmonary bypass. Additionally, preoperative elevation in echocardiographic pulmonary artery systolic pressure was associated with increased postoperative inflammatory markers, suggesting a potential correlation with adverse early postoperative clinical outcomes.
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Affiliation(s)
- WenJuan Li
- Xinhua Hospital, Affiliated to Shanghai Jiao Tong University School of Medicine, Department of Pediatric Cardiology, Shanghai, China
| | - Wenyuan Shang
- Xinhua Hospital, Affiliated to Shanghai Jiao Tong University School of Medicine, Department of Pediatric Cardiology, Shanghai, China
| | - Jihong Huang
- Xinhua Hospital, Affiliated to Shanghai Jiao Tong University School of Medicine, Department of Pediatric Cardiology, Shanghai, China.
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3
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Lee JK, Chikkabyrappa SM, Bhat A, Buddhe S. Echocardiographic assessment of right ventricular volume in repaired tetralogy of Fallot: a novel approach to an older technique. J Echocardiogr 2021; 20:106-114. [PMID: 34850366 DOI: 10.1007/s12574-021-00558-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Revised: 09/30/2021] [Accepted: 11/10/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND In repaired tetralogy of Fallot (rTOF), right ventricular (RV) enlargement leads to poor outcomes. However, evaluating the RV has limitations; cardiac magnetic resonance (CMR) and 3D echocardiography have barriers including cost and accessibility. Traditional echocardiography is limited given the complex geometry and anterior location of the RV. We propose a novel echocardiographic evaluation of RV volume using 2 separate views. METHODS This is a retrospective study of rTOF patients with echocardiogram, CMR, and exercise tests. By echocardiogram, we collected RV length in parasternal long axis (PLAX), area in 4-chamber (4C) view, and measurements per standard guidelines. RV end-diastolic and end-systolic volume (RVEDV and RVESV) were calculated as 5/9 (4C area * PLAX length). RESULTS Forty-five patients with 66 sets of CMR, echocardiogram, and exercise tests were included (mean age 13.3 ± 3.2 years). The echocardiographic RVEDV and RVESV showed strong correlation with CMR parameters (r = 0.81 and 0.72; p≤ 0.0001), and moderate correlation with peak oxygen pulse (0.63 and 0.49; p≤0.0001). Guideline measurements had no significant correlation. Echocardiographic RVEDV and RVESV were higher in those requiring subsequent pulmonary valve replacement. Indexed echocardiographic RVEDV of 93 ml/m2 had 92% sensitivity and 50% specificity (area under curve 0.75 (p = 0.001)) in predicting CMR RV/LV EDV ratio > 2, which is an early indicator for pulmonary valve replacement. CONCLUSIONS This novel technique correlates strongly with CMR, better than traditional parameters. While echocardiogram will not replace CMR, this method would be useful in predicting the RV volume, progression of dilation, and timing of CMR.
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Affiliation(s)
- Joan K Lee
- Department of Pediatric Cardiology, Seattle Children's Hospital, University of Washington, 400 Sand Point Way NE, Seattle, WA, 98105, USA.
| | - Sathish Mallenahalli Chikkabyrappa
- Department of Pediatric Cardiology, Seattle Children's Hospital, University of Washington, 400 Sand Point Way NE, Seattle, WA, 98105, USA
| | - Aarti Bhat
- Department of Pediatric Cardiology, Seattle Children's Hospital, University of Washington, 400 Sand Point Way NE, Seattle, WA, 98105, USA
| | - Sujatha Buddhe
- Department of Pediatric Cardiology, Seattle Children's Hospital, University of Washington, 400 Sand Point Way NE, Seattle, WA, 98105, USA
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Cabral MB, Kozak MF, Afiune JY. Can we Trust in Routine Echocardiography to Assess the Right Ventricle and Pulmonary Insufficiency? A Comparative Study with Cardiac Magnetic Resonance. Arq Bras Cardiol 2021; 117:690-698. [PMID: 34709296 PMCID: PMC8528354 DOI: 10.36660/abc.20200377] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2020] [Revised: 09/08/2020] [Accepted: 11/04/2020] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Cardiac magnetic resonance (CMR) is the method of choice for assessing right ventricular (RV) dimensions and function, and pulmonary insufficiency (PI). OBJECTIVES To assess the accuracy of two-dimensional echocardiography (2D ECHO) in estimating RV function and dimensions, and the degree of PI, and compare the 2D ECHO and CMR findings. METHODS We compared ECHO and CMR reports of patients whose indication for CMR had been to assess RV and PI. A p-value < 0.05 was considered statistically significant. RESULTS We included 51 congenital heart disease patients, with a median age of 9.3 years (7-13.3 years). There was poor agreement between 2D ECHO and CMR for classification of the RV dimension (Kappa 0.19; 95% CI 0.05 to 0.33, p 0.004) and function (Kappa 0.16; 95% CI -0.01 to +0.34; p 0.034). The RV was undersized by 2D ECHO in 43% of the cases, and RV function was overestimated by ECHO in 29% of the cases. The degree of agreement between the methods in the classification of PI was not significant (Kappa 0.014; 95% CI -0.03 to +0.06, p 0.27). 2D ECHO tended to overestimate the degree of PI. CONCLUSIONS The 2D ECHO showed a low agreement with CMR regarding the RV dimensions and function, and degree of PI. In general, ECHO underestimated the dimensions of the RV and overestimated the function of the RV and the degree of PI as compared with CMR.
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Affiliation(s)
- Manuela Baima Cabral
- Instituto de Cardiologia do Distrito FederalBrasíliaDFBrasilInstituto de Cardiologia do Distrito Federal – Cardiopediatria, Brasília, DF – Brasil
| | - Marcelo Felipe Kozak
- Instituto de Cardiologia do Distrito FederalBrasíliaDFBrasilInstituto de Cardiologia do Distrito Federal – Cardiopediatria, Brasília, DF – Brasil
| | - Jorge Yussef Afiune
- Instituto de Cardiologia do Distrito FederalBrasíliaDFBrasilInstituto de Cardiologia do Distrito Federal – Cardiopediatria, Brasília, DF – Brasil
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5
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Lammers AE, Apitz C, Michel-Behnke I, Koestenberger M. A guide to echocardiographic assessment in children and adolescents with pulmonary hypertension. Cardiovasc Diagn Ther 2021; 11:1160-1177. [PMID: 34527541 DOI: 10.21037/cdt-21-119] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Accepted: 06/23/2021] [Indexed: 12/14/2022]
Abstract
While the current definition of pulmonary hypertension (PH) is still based on haemodynamic variables, transthoracic echocardiography is the most important diagnostic clinical tool for the first assessment and evaluation of a patient, in whom PH is suspected. In addition, it is the most important clinical modality in long term follow-up and the utility of echocardiography has widely been demonstrated in patients with PH. Echocardiography not only reveals the underlying cardiac morphology and diagnosis of any associated cardiac defects. In most patients with PH right ventricular (RV) pressure estimation is feasible. In addition, ventricular systolic and diastolic function, as well as ventricular-ventricular interactions of both ventricles can be assessed by using echocardiography. Maximizing the use of echocardiography by reporting several measures to gain information and quantitatively describe the parameters, that are linked to prognosis, seem particularly appealing in these children, in whom other advanced imaging modalities requiring anaesthesia is associated with a considerable risk. Herein we provide a practical approach and a concise and clinically applicable echocardiographic guidance and present basic variables, which should be obtained at any assessment. Moreover, we present additional advanced echocardiographic measures, that can be applied in a research or clinical setting when progressive PH needs a deeper insight to assess heart function, estimation of pulmonary artery pressures among others, by echocardiography. Finally, clinically relevant studies in view of the prognostic properties with a focus on the most important echocardiographic variables in pediatric PH are summarized.
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Affiliation(s)
- Astrid E Lammers
- Pediatric Cardiology and Adult Congenital Heart Disease, University Hospital Münster, Münster, Germany
| | - Christian Apitz
- Pediatric Cardiology, University Children's Hospital Ulm, Ulm, Germany
| | - Ina Michel-Behnke
- Division of Pediatric Cardiology, University Hospital for Children and Adolescents, Pediatric Heart Centre Vienna, Medical University Vienna, Vienna, Austria
| | - Martin Koestenberger
- Division of Pediatric Cardiology and Pediatrics, Medical University Graz, Graz, Austria
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6
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Meinel K, Koestenberger M, Sallmon H, Hansmann G, Pieles GE. Echocardiography for the Assessment of Pulmonary Hypertension and Congenital Heart Disease in the Young. Diagnostics (Basel) 2020; 11:diagnostics11010049. [PMID: 33396225 PMCID: PMC7823322 DOI: 10.3390/diagnostics11010049] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2020] [Revised: 12/21/2020] [Accepted: 12/22/2020] [Indexed: 12/18/2022] Open
Abstract
While invasive assessment of hemodynamics and testing of acute vasoreactivity in the catheterization laboratory is the gold standard for diagnosing pulmonary hypertension (PH) and pulmonary vascular disease (PVD) in children, transthoracic echocardiography (TTE) serves as the initial diagnostic tool. International guidelines suggest several key echocardiographic variables and indices for the screening studies when PH is suspected. However, due to the complex anatomy and special physiological considerations, these may not apply to patients with congenital heart disease (CHD). Misinterpretation of TTE variables can lead to delayed diagnosis and therapy, with fatal consequences, or–on the other hand-unnecessary invasive diagnostic procedures that have relevant risks, especially in the pediatric age group. We herein provide an overview of the echocardiographic workup of children and adolescents with PH with a special focus on children with CHD, such as ventricular/atrial septal defects, tetralogy of Fallot or univentricular physiology. In addition, we address the use of echocardiography as a tool to assess eligibility for exercise and sports, a major determinant of quality of life and outcome in patients with PH associated with CHD.
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Affiliation(s)
- Katharina Meinel
- Division of Pediatric Cardiology, Department of Pediatrics, Medical University Graz, 8036 Graz, Austria; (K.M.); (M.K.)
- European Pediatric Pulmonary Vascular Disease Network, 13125 Berlin, Germany; (H.S.); (G.H.)
| | - Martin Koestenberger
- Division of Pediatric Cardiology, Department of Pediatrics, Medical University Graz, 8036 Graz, Austria; (K.M.); (M.K.)
- European Pediatric Pulmonary Vascular Disease Network, 13125 Berlin, Germany; (H.S.); (G.H.)
| | - Hannes Sallmon
- European Pediatric Pulmonary Vascular Disease Network, 13125 Berlin, Germany; (H.S.); (G.H.)
- Department of Pediatric Cardiology, Charité-Universitätsmedizin Berlin, 13353 Berlin, Germany
- Department of Congenital Heart Disease/Pediatric Cardiology, Deutsches Herzzentrum Berlin (DHZB), 13353 Berlin, Germany
| | - Georg Hansmann
- European Pediatric Pulmonary Vascular Disease Network, 13125 Berlin, Germany; (H.S.); (G.H.)
- Department of Pediatric Cardiology and Critical Care, Hannover Medical School, 30625 Hannover, Germany
| | - Guido E. Pieles
- European Pediatric Pulmonary Vascular Disease Network, 13125 Berlin, Germany; (H.S.); (G.H.)
- National Institute for Health Research (NIHR) Cardiovascular Biomedical Research Centre, Congenital Heart Unit, Bristol Royal Hospital for Children and Bristol Heart Institute, Bristol BS2 8HW, UK
- Institute of Sport Exercise and Health (ISEH), University College London, London W1T 7HA, UK
- Correspondence:
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7
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Truong U, Meinel K, Haddad F, Koestenberger M, Carlsen J, Ivy D, Jone PN. Update on noninvasive imaging of right ventricle dysfunction in pulmonary hypertension. Cardiovasc Diagn Ther 2020; 10:1604-1624. [PMID: 33224776 DOI: 10.21037/cdt-20-272] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Pulmonary hypertension (PH) is a progressive disease affecting patients across the life span. The pathophysiology primarily involves the pulmonary vasculature and right ventricle (RV), but eventually affects the left ventricular (LV) function as well. Safe, accurate imaging modalities are critical for diagnosis, serial monitoring, and tailored therapy. While cardiac catheterization remains the conventional modality for establishing diagnosis and serial monitoring, noninvasive imaging has gained considerable momentum in providing accurate assessment of the entire RV-pulmonary axis. In this state-of-the-art review, we will discuss the most recent developments in echocardiography, magnetic resonance imaging, and computed tomography in PH evaluation from pediatric to adult population.
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Affiliation(s)
- Uyen Truong
- Division of Pediatric Cardiology, Children's Hospital of Richmond, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Katharina Meinel
- Division of Pediatric Cardiology, Medical University of Graz, Graz, Austria
| | - Francois Haddad
- Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, California, USA
| | | | - Jørn Carlsen
- Department of Cardiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.,Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Dunbar Ivy
- Division of Pediatric Cardiology, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Pei-Ni Jone
- Division of Pediatric Cardiology, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, Colorado, USA
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Meinel K, Noessler N, Koestenberger M. Perioperative Right Ventricular Systolic Function Determination in Children With Tetralogy of Fallot. J Cardiothorac Vasc Anesth 2020; 34:306-307. [DOI: 10.1053/j.jvca.2019.03.067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Accepted: 03/31/2019] [Indexed: 11/11/2022]
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9
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Kavurt AV, Paç FA, Koca S, Mutlu Mıhçıoğlu A, Yiğit H. The evaluation of right ventricular systolic function in patients with repaired Tetralogy of Fallot by conventional echocardiographic methods and speckle tracking echocardiography: Compared with the gold standard cardiac mangenetic resonance. Echocardiography 2019; 36:2251-2258. [PMID: 31755582 DOI: 10.1111/echo.14532] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2019] [Revised: 10/18/2019] [Accepted: 10/20/2019] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Right ventricular (RV) function is one of the important prognostic factors in patients with repaired Tetralogy of Fallot (TOF). We aimed to assess RV function by conventional echocardiography and two-dimensional speckle tracking echocardiography (2D-STE) in patients with repaired TOF. METHODS Twenty-seven (male 17) adolescents and young adult patients (mean age 22.7 ± 6.7 years) operated on for TOF and age- and gender-matched healthy controls were included. RV systolic function in both groups were evaluated by fractional area change (FAC), tricuspid annular plane systolic excursion (TAPSE), RV myocardial performance index (RVMPI) and tricuspid annular peak systolic velocity by pulsed tissue Doppler (tricuspid S'), and also RV global longitudinal strain (RV GLS) obtained from STE. These results were compared with RV ejection fraction (RVEF) measured by cardiac magnetic resonance imaging (CMRI) performed within 3 months in patient group. RESULTS Systolic RVGLS values were significantly lower in patients compared to controls (-17.4 ± 3.1% vs -25.6 ± 3%). Among the echocardiographic parameters, RVGLS had the best correlation with RV EF derived from CMRI (r: -.6). By receiver operating characteristics analysis (ROC), an RV GLS cutoff value of -17.4% had 75% sensitivity and 68.4% specificity in identifying RVEF <45% with an area under curve 0.743 (P < .05). The intra- and inter-observer agreement for RV GLS was excellent. CONCLUSION RVGLS is an easy, effective, feasible, and reproducible tool in the evaluation of RV systolic function. So, RVGLS measurement by STE may be one of the routine echocardiographic parameters in the evaluation of RV systolic function in patients with repaired TOF.
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Affiliation(s)
- Ahmet Vedat Kavurt
- Department of Pediatric Cardiology, Ankara City Hospital, University of Health Sciences, Ankara, Turkey
| | - Feyza Ayşenur Paç
- Department of Pediatric Cardiology, Ankara City Hospital, University of Health Sciences, Ankara, Turkey
| | - Serhat Koca
- Department of Pediatric Cardiology, Ankara City Hospital, University of Health Sciences, Ankara, Turkey
| | - Ajda Mutlu Mıhçıoğlu
- Department of Pediatric Cardiology, Bakırköy Dr. Sadi Konuk Training and Research Hospital, University of Health Sciences, İstanbul, Turkey
| | - Hasan Yiğit
- Department of Radiology, Ankara Training and Research Hospital, University of Health Sciences, Ankara, Turkey
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Koestenberger M, Sallmon H, Avian A, Cantinotti M, Gamillscheg A, Kurath-Koller S, Schweintzger S, Hansmann G. Ventricular-ventricular interaction variables correlate with surrogate variables of clinical outcome in children with pulmonary hypertension. Pulm Circ 2019; 9:2045894019854074. [PMID: 31099302 PMCID: PMC6542130 DOI: 10.1177/2045894019854074] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
Determination of biventricular dimensions, function, and ventricular–ventricular interactions (VVI) is an essential part of the echocardiographic examination in adults with pulmonary hypertension (PH); however, data from according pediatric studies are sparse. We hypothesized that left and right heart dimensions/function and VVI variables indicate disease severity and progression in children with PH. Left heart, right heart, and VVI variables (e.g. end-systolic LV eccentricity index [LVEI], right ventricular [RV]/left ventricular [LV] dimension ratio) were echocardiographically determined in 57 children with PH, and correlated with New York Heart Association (NYHA) functional class (FC), N-terminal-pro brain natriuretic peptide (NT-proBNP), and invasive hemodynamic variables (e.g. pulmonary vascular resistance index [PVRi]). Clinically sicker patients (higher NYHA FC) had lower LV ejection fraction (LVEF) and higher LVEI – a surrogate of LV compression. In PH children, the ratio of systolic pulmonary arterial pressure divided by systolic systemic arterial pressure (sPAP/sSAP) and the PVRi correlated well with the LVEI (P < 0.001). Patients with more severe PH (sPAP/sSAP ratio, PVRi) had increased RV/LV and right-to-left atrial dimension ratios (P < 0.01). When stratified using NYHA-FC, sicker PH children had greater RV and right atrial dimensions with lower exercise capacity, while the tricuspid annular plane systolic excursion as surrogate for longitudinal systolic RV function decreased. Consistent with previous studies, serum NT-proBNP correlated with both, sPAP/sSAP ratio (P < 0.001) and NYHA FC (P < 0.01). Taken together, the VVI variables LVEI and RV/LV dimension ratio are associated with lower FC, worse hemodynamics, and higher NT-proBNP levels, thus highlighting the importance of ventricular interdependence in pediatric PH.
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Affiliation(s)
- Martin Koestenberger
- 1 Division of Pediatric Cardiology, Department of Pediatrics, Medical University Graz, Austria.,2 European Pediatric Pulmonary Vascular Disease Network, Berlin, Germany
| | - Hannes Sallmon
- 2 European Pediatric Pulmonary Vascular Disease Network, Berlin, Germany.,3 Department of Pediatric Cardiology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Alexander Avian
- 4 Institute for Medical Informatics, Statistics and Documentation, Medical University Graz, Austria
| | | | - Andreas Gamillscheg
- 1 Division of Pediatric Cardiology, Department of Pediatrics, Medical University Graz, Austria.,2 European Pediatric Pulmonary Vascular Disease Network, Berlin, Germany
| | - Stefan Kurath-Koller
- 1 Division of Pediatric Cardiology, Department of Pediatrics, Medical University Graz, Austria.,2 European Pediatric Pulmonary Vascular Disease Network, Berlin, Germany
| | - Sabrina Schweintzger
- 1 Division of Pediatric Cardiology, Department of Pediatrics, Medical University Graz, Austria
| | - Georg Hansmann
- 2 European Pediatric Pulmonary Vascular Disease Network, Berlin, Germany.,6 Department of Pediatric Cardiology and Critical Care, Hannover Medical School, Hannover, Germany
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11
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Koestenberger M, Avian A, Gamillscheg A, Sallmon H, Grangl G, Burmas A, Schweintzger S, Kurath-Koller S, Cvirn G, Hansmann G. Right ventricular base/apex ratio in the assessment of pediatric pulmonary arterial hypertension: Results from the European Pediatric Pulmonary Vascular Disease Network. Clin Cardiol 2018; 41:1144-1149. [PMID: 29896859 DOI: 10.1002/clc.22994] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2018] [Revised: 05/18/2018] [Accepted: 06/10/2018] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Echocardiographic determination of RV end-systolic base/apex (RVES b/a) ratio was proposed to be of clinical value for assessment of pulmonary arterial hypertension (PAH) in adults. HYPOTHESIS We hypothesized that the RVES b/a ratio will be affected in children with PAH and aimed to correlate RVES b/a ratio with conventionally used echocardiographic and hemodynamic variables, and with New York Heart Association (NYHA) functional class. METHODS First we determined normal pediatric values for RVES b/a ratio in 157 healthy children (68 males; age range, 0.5-17.7 years). We then conducted an echocardiographic study in 51 children with PAH (29 males; age range, 0.3-17.8 years). RESULTS RVES b/a ratio was lower compared with age- and sex-matched healthy controls (P < 0.001). In children with PAH, RVES b/a ratio decreased with worsening NYHA class. RVES b/a ratio inversely correlated with RV/LV end-systolic diameter ratio (ρ = -0.450, P = 0.001) but did not correlate with RV systolic function parameters (eg, tricuspid annular plane systolic excursion) and correlated with cardiac catheterization-determined pulmonary vascular resistance index (ρ = -0.571, P < 0.001). ROC analysis unraveled excellent performance of RVES b/a ratio to detect PAH in children (AUC: 0.95, 95% CI: 0.89-1.00, P < 0.001). CONCLUSIONS The RVES b/a ratio decreased in children with PAH compared with age- and sex-matched healthy subjects. The RVES b/a ratio inversely correlated with both echocardiographic and hemodynamic indicators of increased RV pressure afterload and with NYHA class, suggesting that RVES b/a ratio reflects disease severity in PAH children.
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Affiliation(s)
- Martin Koestenberger
- Division of Pediatric Cardiology, Department of Pediatrics, Medical University Graz, Graz, Austria
| | - Alexander Avian
- Institute for Medical Informatics, Statistics and Documentation, Medical University Graz, Graz, Austria
| | - Andreas Gamillscheg
- Division of Pediatric Cardiology, Department of Pediatrics, Medical University Graz, Graz, Austria
| | - Hannes Sallmon
- Department of Pediatric Cardiology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Gernot Grangl
- Division of Pediatric Cardiology, Department of Pediatrics, Medical University Graz, Graz, Austria
| | - Ante Burmas
- Division of Pediatric Cardiology, Department of Pediatrics, Medical University Graz, Graz, Austria
| | - Sabrina Schweintzger
- Division of Pediatric Cardiology, Department of Pediatrics, Medical University Graz, Graz, Austria
| | - Stefan Kurath-Koller
- Division of Pediatric Cardiology, Department of Pediatrics, Medical University Graz, Graz, Austria
| | - Gerhard Cvirn
- Centre of Physiological Medicine, Medical University Graz, Graz, Austria
| | - Georg Hansmann
- Department of Pediatric Cardiology and Critical Care, Hannover Medical School, Hannover, Germany
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12
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Koestenberger M, Avian A, Sallmon H, Gamillscheg A, Grangl G, Kurath-Koller S, Schweintzger S, Burmas A, Hansmann G. The right ventricular outflow tract in pediatric pulmonary hypertension-Data from the European Pediatric Pulmonary Vascular Disease Network. Echocardiography 2018; 35:841-848. [PMID: 29505663 DOI: 10.1111/echo.13852] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE The right ventricular outflow tract (RVOT) is pivotal for adequate RV function and known to be adversely affected by elevated pulmonary arterial pressure (PAP) in adults with pulmonary hypertension (PH). Aim of this study was to determine the effects of increased RV pressure afterload in children with PH on RVOT size, function, and flow parameters. METHODS We conducted a transthoracic echocardiographic study in 51 children with PH (median age: 5.3 years; range 1.5 months to 18 years) and determined the following RVOT variables: RVOT diameter, RVOT velocity time integral (VTI), ratio of tricuspid regurgitation velocity (TRV)/RVOT VTI, and RVOT systolic excursion (SE). RESULTS In our pediatric PH cohort, the age-specific RVOT diameter z-score was higher compared to normal values. Deviation from normal RVOT diameter values increased with age, disease severity, and New York Heart Association functional class. Significant correlations were found between RVOT diameter and the RV end-diastolic area and right atrial area. The age-specific RVOT VTIz-score values were significantly lower in children with PH vs healthy controls. The TRV/RVOT VTI ratio increased with rising systolic RV pressure, while the RVOT SE was similar between PH children and control subjects. CONCLUSIONS In pediatric PH cohort, the RVOT VTI is decreased, and the TRV/RVOT VTI ratio and the RVOT diameter increased compared to healthy subjects. Assessment of RVOT variables, together with established RV parameters, allows for a comprehensive assessment of global right heart size and performance in children with PH.
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Affiliation(s)
- Martin Koestenberger
- Division of Pediatric Cardiology, Department of Pediatrics, Medical University Graz, Graz, Austria
| | - Alexander Avian
- Institute for Medical Informatics, Statistics and Documentation, Medical University Graz, Graz, Austria
| | - Hannes Sallmon
- Department of Neonatology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Andreas Gamillscheg
- Division of Pediatric Cardiology, Department of Pediatrics, Medical University Graz, Graz, Austria
| | - Gernot Grangl
- Division of Pediatric Cardiology, Department of Pediatrics, Medical University Graz, Graz, Austria
| | - Stefan Kurath-Koller
- Division of Pediatric Cardiology, Department of Pediatrics, Medical University Graz, Graz, Austria
| | - Sabrina Schweintzger
- Division of Pediatric Cardiology, Department of Pediatrics, Medical University Graz, Graz, Austria
| | - Ante Burmas
- Division of Pediatric Cardiology, Department of Pediatrics, Medical University Graz, Graz, Austria
| | - Georg Hansmann
- Department of Pediatric Cardiology and Critical Care, Hannover Medical School, Hannover, Germany
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13
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Hauck A, Guo R, Ivy DD, Younoszai A. Tricuspid annular plane systolic excursion is preserved in young patients with pulmonary hypertension except when associated with repaired congenital heart disease. Eur Heart J Cardiovasc Imaging 2018; 18:459-466. [PMID: 27099276 DOI: 10.1093/ehjci/jew068] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2015] [Accepted: 03/08/2016] [Indexed: 01/25/2023] Open
Abstract
Aims Tricuspid annular plane systolic excursion (TAPSE) is a measure of right ventricular (RV) longitudinal function that correlates with functional status and mortality in adults with pulmonary hypertension (PH). The diagnostic and predictive value of TAPSE in children with PH has not been fully examined. We aimed to define TAPSE across aetiologies of paediatric PH and assess the correlation between TAPSE and measures of disease severity. Methods and results TAPSE measurements were obtained in 84 children and young adults undergoing treatment for PH and 315 healthy children to establish z-scores at moderate altitude for comparison. The relationships between TAPSE and echocardiographic, biomarker, and functional measures of disease severity between aetiologies were assessed. TAPSE z-scores in PH patients with congenital heart disease (CHD) repaired with open cardiac surgery (n = 20, mean -2.73) were significantly decreased compared with normal children and patients with other aetiologies of PH (P < 0.001) but did not reflect poorer clinical status. TAPSE z-scores in children with idiopathic PH (n = 29, -0.41), unrepaired CHD (n = 11, -0.1), and PH related to systemic disease (n = 14, -0.39) were not different from normal. TAPSE correlated modestly with brain natriuretic peptide, echocardiographic function parameters, and functional class except in patients with repaired CHD. Conclusion Children with PH maintain normal TAPSE values early except when associated with repaired CHD. Superior RV adaptation to high afterload in children compared with adults may account for this finding. Reduced TAPSE after repair of CHD does not correlate with functional status and may reflect post-operative changes rather than poor function primarily due to PH.
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Affiliation(s)
- Amanda Hauck
- Department of Pediatrics, The Heart Institute, Children's Hospital Colorado, 13123 East 16th Ave, Box 100, Aurora, CO 80045, USA
| | - Ruixin Guo
- Department of Biostatistics, Colorado School of Public Health, University of Colorado Denver, 13001 E. 17th Place, Campus Box B119, Aurora, CO 80045, USA
| | - D Dunbar Ivy
- Department of Pediatrics, The Heart Institute, Children's Hospital Colorado, 13123 East 16th Ave, Box 100, Aurora, CO 80045, USA
| | - Adel Younoszai
- Department of Pediatrics, The Heart Institute, Children's Hospital Colorado, 13123 East 16th Ave, Box 100, Aurora, CO 80045, USA
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14
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Pediatric echocardiographic nomograms: What has been done and what still needs to be done. Trends Cardiovasc Med 2017; 27:336-349. [DOI: 10.1016/j.tcm.2017.01.006] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2017] [Revised: 01/17/2017] [Accepted: 01/18/2017] [Indexed: 12/29/2022]
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15
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Koestenberger M, Hansmann G, Apitz C, Latus H, Lammers A. Diagnostics in Children and Adolescents with Suspected or Confirmed Pulmonary Hypertension. Paediatr Respir Rev 2017; 23:3-15. [PMID: 27964948 DOI: 10.1016/j.prrv.2016.10.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2016] [Accepted: 10/20/2016] [Indexed: 12/13/2022]
Abstract
We provide a practical approach on the initial assessment and diagnostic work-up of children and adolescents with pulmonary hypertension (PH). Transthoracic echocardiography (TTE) often serves as initial study tool before invasive cardiac catheterization. Misinterpretation of TTE variables may lead to missed or delayed diagnosis with devastating consequences, or unnecessary invasive diagnostics that have inherited risks. In addition to clinical and biochemical markers, serial examination of patients with PH using a standardized TTE approach, determining conventional and novel echocardiographic variables, may allow early diagnosis and treatment in paediatric PH. Cardiac magnetic resonance imaging and computed tomography represent important non-invasive imaging modalities, that together with TTE may enable comprehensive assessment of ventricular function and pulmonary hemodynamics. Invasive assessment of haemodynamics (ventricular, pulmonary) and testing of acute vasoreactivity in the catheterization laboratory is still the gold standard for the diagnosis of PH and pulmonary hypertensive vascular disease (PHVD) in children and for the initiation of specific PH therapy. We suggest the regular assessment of prognostic TTE variables as part of a standardized approach for initial diagnosis of children with PH. Overreliance on any single TTE variable should be avoided as it detracts from the overall diagnostic potential of a standardized TTE examination for PH.
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Affiliation(s)
- Martin Koestenberger
- Division of Pediatric Cardiology, Department of Pediatrics, Medical University Graz, Austria.
| | - Georg Hansmann
- Department of Pediatric Cardiology and Critical Care, Hannover Medical School, Germany
| | - Christian Apitz
- Department of Pediatric Cardiology, University Children's Hospital Ulm, Germany
| | - Heiner Latus
- Pediatric Heart Centre, Justus-Liebig-University, Giessen, Germany
| | - Astrid Lammers
- Department of Paediatric Cardiology, University of Münster, Germany
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16
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Koestenberger M, Apitz C, Abdul-Khaliq H, Hansmann G. Transthoracic echocardiography for the evaluation of children and adolescents with suspected or confirmed pulmonary hypertension. Expert consensus statement on the diagnosis and treatment of paediatric pulmonary hypertension. The European Paediatric Pulmonary Vascular Disease Network, endorsed by ISHLT and D6PK. Heart 2016; 102 Suppl 2:ii14-22. [PMID: 27053693 DOI: 10.1136/heartjnl-2014-307200] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2014] [Accepted: 12/23/2014] [Indexed: 11/03/2022] Open
Abstract
Transthoracic echocardiography (TTE) is a useful method for non-invasive screening of patients at risk of pulmonary hypertension (PH). Since TTE often serves as the initial study before invasive cardiac catheterisation, misinterpretation of TTE variables may lead to missed or delayed diagnosis with devastating consequences for the patients, or unnecessary invasive diagnostics that have inheriting risks. Due to the heterogeneous anatomy in congenital heart disease, particularly the assessment of myocardial function in children with PH is challenging. Here, we present recommendations on the use of TTE in the screening, diagnosis and follow-up of patients with PH, and discuss the limitations of this non-invasive imaging technique. This expert consensus statement focuses on key TTE variables used to determine the pressure in the pulmonary artery, myocardial contractility and systolic and diastolic function of the RV and LV. A particular focus is on the TTE assessment of RV function and geometry. According to the published data on the application of TTE in PH in childhood, we suggest a structured approach for non-invasive assessment of pulmonary artery pressure and myocardial function that may help to identify patients with early ventricular deterioration and their response to advanced pharmacotherapy. In addition to clinical and biochemical markers, serial examination of patients with PH using a standardised TTE approach, determining conventional and several more novel echocardiographic variables may allow early diagnosis and treatment, better recognition of disease progression and guide tailored therapy.
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Affiliation(s)
- Martin Koestenberger
- Division of Paediatric Cardiology, Department of Paediatrics, Medical University Graz, Graz, Austria
| | - Christian Apitz
- Paediatric Heart Centre, Justus-Liebig-University, Giessen, Germany
| | - Hashim Abdul-Khaliq
- Department of Paediatric Cardiology, Saarland University Hospital, Homburg, Germany
| | - Georg Hansmann
- Department of Paediatric Cardiology and Critical Care, Hannover Medical School, Hannover, Germany
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17
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Koestenberger M, Friedberg MK, Nestaas E, Michel-Behnke I, Hansmann G. Transthoracic echocardiography in the evaluation of pediatric pulmonary hypertension and ventricular dysfunction. Pulm Circ 2016; 6:15-29. [PMID: 27162612 PMCID: PMC4860554 DOI: 10.1086/685051] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
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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Affiliation(s)
- Martin Koestenberger
- Division of Pediatric Cardiology, Department of Pediatrics, Medical University Graz, Graz, Austria
| | - Mark K Friedberg
- Labatt Family Heart Center, Hospital for Sick Children and University of Toronto, Toronto, Ontario, Canada
| | - Eirik Nestaas
- Center for Cardiological Innovation, Department of Cardiology, Oslo University Hospital Rikshospitalet, Oslo, Norway; and Department of Paediatrics, Vestfold Hospital Trust, Vestfold, Norway
| | - Ina Michel-Behnke
- Division of Pediatric Cardiology, Pediatric Heart Center Vienna, Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Vienna, Austria
| | - Georg Hansmann
- Department of Pediatric Cardiology and Critical Care, Hannover Medical School, Hannover, Germany
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18
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Yoshiyuki R, Tanaka R, Fukushima R, Machida N. Preventive effect of sildenafil on right ventricular function in rats with monocrotaline-induced pulmonary arterial hypertension. Exp Anim 2016; 65:215-22. [PMID: 26876436 PMCID: PMC4976235 DOI: 10.1538/expanim.15-0070] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
The present study aimed to evaluate the preventive effect of sildenafil treatment on pulmonary hypertension (PH) induced by monocrotaline (MCT) in rats. Fifty-four 12-week-old male Sprague-Dawley rats were injected with MCT or saline solution (MCT-injected rats: n=36; saline: n=18). Serial echocardiography and right ventricular systolic pressure (RVSP) measurements via a cardiac catheter were performed at 2, 4 and 6 weeks after the injection. After injection of MCT, rats received oral sildenafil (MCT/sildenafil group: n=18) or no treatment (MCT group: n=18) until undergoing echocardiography and cardiac catheterization. RVSP in the MCT/sildenafil group was lower than that in the MCT group at 4 (P<0.001) and 6 weeks (P<0.001). The septal curvature was improved in the MCT/sildenafil group compared with the MCT group. This finding showed that sildenafil prevented flattening of the interventricular septum because of right ventricular pressure overload. The ratio of peak trans-tricuspid early diastolic wave velocity to active filling with atrial systolic velocity showed that sildenafil improved diastolic function. Tricuspid annular plane systolic excursion and tricuspid annular systolic velocity in the MCT/sildenafil group did not show preserved myocardial contraction after administration of sildenafil. Administration of sildenafil leads to a reduction in RVSP and improvement in cardiac function in rats with PH induced by MCT. The vasodilatory action of sildenafil improves right ventricular diastolic function, but the intrinsic, positive, inotropic effect of sildenafil is minimal.
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Affiliation(s)
- Rieko Yoshiyuki
- Department of Veterinary Surgery, Faculty of Agriculture, Tokyo University of Agriculture and Technology, 3-5-8 Saiwai-cho, Fuchu-shi, Tokyo 183-8509, Japan
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19
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Koestenberger M, Schweintzger S. Pulmonary arterial wall thickness as a promising echocardiographic follow-up parameter in severe pediatric pulmonary hypertension. Pediatr Pulmonol 2015; 50:1176-7. [PMID: 26418946 DOI: 10.1002/ppul.23320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2015] [Accepted: 08/22/2015] [Indexed: 11/11/2022]
Affiliation(s)
- Martin Koestenberger
- Division of Pediatric Cardiology, Department of Pediatrics, Medical University Graz, Graz, Austria
| | - Sabrina Schweintzger
- Division of Pediatric Cardiology, Department of Pediatrics, Medical University Graz, Graz, Austria
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20
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Grangl G, Burmas A, Koestenberger M. Letter to the editor regarding "abnormalities in echocardiographic indices of right ventricular systolic function in children with elevated pulmonary artery pressure". Int J Pediatr Otorhinolaryngol 2015; 79:631. [PMID: 25639551 DOI: 10.1016/j.ijporl.2015.01.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2014] [Accepted: 01/13/2015] [Indexed: 11/19/2022]
Affiliation(s)
- Gernot Grangl
- Division of Pediatric Cardiology, Department of Pediatrics, Medical University Graz, Austria
| | - Ante Burmas
- Division of Pediatric Cardiology, Department of Pediatrics, Medical University Graz, Austria
| | - Martin Koestenberger
- Division of Pediatric Cardiology, Department of Pediatrics, Medical University Graz, Austria.
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21
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Exercise Echocardiography Demonstrates Biventricular Systolic Dysfunction and Reveals Decreased Left Ventricular Contractile Reserve in Children After Tetralogy of Fallot Repair. J Am Soc Echocardiogr 2015; 28:294-301. [DOI: 10.1016/j.echo.2014.10.008] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2014] [Indexed: 11/21/2022]
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22
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Li YD, Wang YD, Zhai ZG, Guo XJ, Wu YF, Yang YH, Lu XZ. Relationship between echocardiographic and cardiac magnetic resonance imaging-derived measures of right ventricular function in patients with chronic thromboembolic pulmonary hypertension. Thromb Res 2015; 135:602-6. [PMID: 25628143 DOI: 10.1016/j.thromres.2015.01.008] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2014] [Revised: 12/27/2014] [Accepted: 01/04/2015] [Indexed: 10/24/2022]
Abstract
BACKGROUND Echocardiography is widely used to evaluate right ventricular (RV) function. However, the value of echocardiographic parameters to assess RV function in patients with chronic thromboembolic pulmonary hypertension (CTEPH) is unknown. In this study, we analyzed the correlations between echocardiographic parameters and the RV ejection fraction (RVEF) as measured by cardiac magnetic resonance (CMR) imaging to systematically elucidate the role of echocardiographic parameters in the assessment of RV function in patients with CTEPH. METHODS Echocardiography was used to measure the tissue Doppler-derived tricuspid lateral annular systolic velocity (S'), fractional area change (FAC), myocardial performance index (MPI), and tricuspid annular plane systolic excursion (TAPSE). CMR was used to measure the RV end-diastolic volume (RVEDV) and end-systolic volume (RVESV), and the RVEF was calculated. RESULTS A significant positive correlation was found between S' and RVEF (r=0.689, P<0.0001) and between FAC and RVEF (r=0.423, P=0.022), a significant negative correlation was found between MPI and RVEF (r=-0.387, P=0.048), and no correlation was found between TAPSE and RVEF (r=0.451, P=0.22). CONCLUSION Echocardiography can be routinely used in the clinical setting to measure S', FAC, and MPI for the evaluation of right heart function in patients with CTEPH.
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Affiliation(s)
- Yi-dan Li
- Department of Echocardiography, Heart Center, Beijing Chao Yang Hospital, Capital Medical University, Beijing 100020, China
| | - Yi-dan Wang
- Department of Echocardiography, Heart Center, Beijing Chao Yang Hospital, Capital Medical University, Beijing 100020, China
| | - Zhen-guo Zhai
- Department of Respiratory Medicine, Beijing Chao Yang Hospital, Capital Medical University, Beijing 100020, China; Beijing Key Laboratory of Respiratory and Pulmonary Circulation, Beijing Institute of Respiratory Medicine, Capital Medical University, Beijing, China
| | - Xiao-juan Guo
- Department of Radiology, Beijing Chao Yang Hospital, Capital Medical University, Beijing 100020, China
| | - Ya-feng Wu
- Department of Echocardiography, Heart Center, Beijing Chao Yang Hospital, Capital Medical University, Beijing 100020, China
| | - Yuan-hua Yang
- Department of Respiratory Medicine, Beijing Chao Yang Hospital, Capital Medical University, Beijing 100020, China; Beijing Key Laboratory of Respiratory and Pulmonary Circulation, Beijing Institute of Respiratory Medicine, Capital Medical University, Beijing, China
| | - Xiu-zhang Lu
- Department of Echocardiography, Heart Center, Beijing Chao Yang Hospital, Capital Medical University, Beijing 100020, China.
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23
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Ploegstra MJ, Roofthooft MT, Douwes JM, Bartelds B, Elzenga NJ, van de Weerd D, Hillege HL, Berger RM. Echocardiography in Pediatric Pulmonary Arterial Hypertension. Circ Cardiovasc Imaging 2015; 8:CIRCIMAGING.113.000878. [DOI: 10.1161/circimaging.113.000878] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Background—
The value of echocardiography in assessing disease severity and predicting outcome in pediatric pulmonary arterial hypertension (PAH) is insufficiently defined. The aim of this study was to describe correlations between echocardiography and disease severity and outcome in pediatric PAH.
Methods and Results—
Forty-three consecutive children (median age, 8.0 years; range, 0.4–21.5) with idiopathic/hereditary PAH (n=25) or PAH associated with congenital heart disease (n=18) were enrolled in a prospective single-center observational study. Anatomic and right ventricular-functional variables were obtained by two-dimensional echocardiography and Doppler-echocardiography at presentation and at standardized follow-up and were correlated with measures of disease severity (World Health Organization functional class [WHO-FC], N-terminal-pro-B-type natriuretic peptide, hemodynamics) and lung-transplantation–free survival. Right atrial and right ventricular dimensions correlated with WHO-FC and hemodynamics (
P
<0.05), whereas left ventricular dimensions correlated with hemodynamics and survival (
P
<0.05). Right-to-left ventricular dimension ratiocorrelated with WHO-FC, hemodynamics and survival (
P
<0.05). Right ventricular ejection time correlated with hemodynamics and survival (
P
<0.05) and tended to correlate with WHO-FC (
P
=0.071). Tricuspid annular plane systolic excursion correlated with WHO-FC, mean right atrial pressure and survival (
P
<0.05).
Conclusions—
This early descriptive study shows that echocardiographic chararacteristics of both the right and the left heart correlate with disease severity and outcome in pediatric PAH, both at presentation and during the course of the disease. The preliminary data from this study support the potential value of echocardiography as a tool in guiding management in children with PAH.
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Affiliation(s)
- Mark-Jan Ploegstra
- From the Center for Congenital Heart Diseases, Dutch National Referral Center for Children with Pulmonary Hypertension, Beatrix Children’s Hospital (M.-J.P., M.T.R.R., J.M.D., B.B., N.J.E., D.v.d.W., R.M.F.B) and Department of Epidemiology (H.L.H), University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Marcus T.R. Roofthooft
- From the Center for Congenital Heart Diseases, Dutch National Referral Center for Children with Pulmonary Hypertension, Beatrix Children’s Hospital (M.-J.P., M.T.R.R., J.M.D., B.B., N.J.E., D.v.d.W., R.M.F.B) and Department of Epidemiology (H.L.H), University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Johannes M. Douwes
- From the Center for Congenital Heart Diseases, Dutch National Referral Center for Children with Pulmonary Hypertension, Beatrix Children’s Hospital (M.-J.P., M.T.R.R., J.M.D., B.B., N.J.E., D.v.d.W., R.M.F.B) and Department of Epidemiology (H.L.H), University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Beatrijs Bartelds
- From the Center for Congenital Heart Diseases, Dutch National Referral Center for Children with Pulmonary Hypertension, Beatrix Children’s Hospital (M.-J.P., M.T.R.R., J.M.D., B.B., N.J.E., D.v.d.W., R.M.F.B) and Department of Epidemiology (H.L.H), University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Nynke J. Elzenga
- From the Center for Congenital Heart Diseases, Dutch National Referral Center for Children with Pulmonary Hypertension, Beatrix Children’s Hospital (M.-J.P., M.T.R.R., J.M.D., B.B., N.J.E., D.v.d.W., R.M.F.B) and Department of Epidemiology (H.L.H), University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Dick van de Weerd
- From the Center for Congenital Heart Diseases, Dutch National Referral Center for Children with Pulmonary Hypertension, Beatrix Children’s Hospital (M.-J.P., M.T.R.R., J.M.D., B.B., N.J.E., D.v.d.W., R.M.F.B) and Department of Epidemiology (H.L.H), University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Hans L. Hillege
- From the Center for Congenital Heart Diseases, Dutch National Referral Center for Children with Pulmonary Hypertension, Beatrix Children’s Hospital (M.-J.P., M.T.R.R., J.M.D., B.B., N.J.E., D.v.d.W., R.M.F.B) and Department of Epidemiology (H.L.H), University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Rolf M.F. Berger
- From the Center for Congenital Heart Diseases, Dutch National Referral Center for Children with Pulmonary Hypertension, Beatrix Children’s Hospital (M.-J.P., M.T.R.R., J.M.D., B.B., N.J.E., D.v.d.W., R.M.F.B) and Department of Epidemiology (H.L.H), University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
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24
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Ji Q, Mei Y, Wang X, Feng J, Ding W. Risk Factors for Late Right Ventricular Systolic Dysfunction in Pediatric Patients With Repaired Tetralogy of Fallot. Int Heart J 2015; 56:80-5. [DOI: 10.1536/ihj.14-154] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Qiang Ji
- Department of Thoracic Cardiovascular Surgery of Tongji Hospital of Tongji University
| | - Yunqing Mei
- Department of Thoracic Cardiovascular Surgery of Tongji Hospital of Tongji University
| | - Xisheng Wang
- Department of Thoracic Cardiovascular Surgery of Tongji Hospital of Tongji University
| | - Jing Feng
- Department of Thoracic Cardiovascular Surgery of Tongji Hospital of Tongji University
| | - Wenjun Ding
- Department of Cardiovascular Surgery of Zhongshan Hospital of Fudan University
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25
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Zakaria D, Sachdeva R, Gossett JM, Tang X, O'Connor MJ. Tricuspid Annular Plane Systolic Excursion Is Reduced in Infants with Pulmonary Hypertension. Echocardiography 2014; 32:834-8. [DOI: 10.1111/echo.12797] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Affiliation(s)
- Dala Zakaria
- Division of Pediatric Cardiology; University of Arkansas for Medical Sciences, Arkansas Children's Hospital; Little Rock Arkansas
| | - Ritu Sachdeva
- Division of Pediatric Cardiology; University of Arkansas for Medical Sciences, Arkansas Children's Hospital; Little Rock Arkansas
| | - Jeffrey M. Gossett
- Biostatistics Program; Department of Pediatrics; University of Arkansas for Medical Sciences; Little Rock Arkansas
| | - Xinyu Tang
- Biostatistics Program; Department of Pediatrics; University of Arkansas for Medical Sciences; Little Rock Arkansas
| | - Matthew J. O'Connor
- Division of Pediatric Cardiology; University of Arkansas for Medical Sciences, Arkansas Children's Hospital; Little Rock Arkansas
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Pansy J, Koestenberger M, Ravekes W. Value of Tricuspid Annular Peak Systolic Velocity (s′) Measurement in Scleroderma-Associated Pulmonary Arterial Hypertension: Comment on the Article by Gopal et al. Arthritis Care Res (Hoboken) 2014; 66:1591. [DOI: 10.1002/acr.22338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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27
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Pansy J, Koestenberger M. Right ventricular stroke work in children with pulmonary arterial hypertension: a promising approach. BRITISH HEART JOURNAL 2014; 100:1396. [DOI: 10.1136/heartjnl-2014-306421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Pansy J, Koestenberger M. Abnormalities in echocardiographic indices of right- and left-ventricular systolic function in pediatric pulmonary artery hypertension. Pediatr Cardiol 2014; 35:741-2. [PMID: 24509634 DOI: 10.1007/s00246-014-0871-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2014] [Accepted: 01/22/2014] [Indexed: 11/28/2022]
Affiliation(s)
- Jasmin Pansy
- Division of Neonatology, Department of Pediatrics, Medical University Graz, 8036, Graz, Austria
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Koestenberger M, Ravekes W, Nagel B, Avian A, Heinzl B, Cvirn G, Fritsch P, Fandl A, Rehak T, Gamillscheg A. Reference values of the right ventricular outflow tract systolic excursion in 711 healthy children and calculation of z-score values. Eur Heart J Cardiovasc Imaging 2014; 15:980-6. [DOI: 10.1093/ehjci/jeu041] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
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Pansy J, Grangl G, Koestenberger M. Impairment of tricuspid annular plane systolic excursion and tricuspid annular peak systolic velocity after arterial switch operation. J Thorac Cardiovasc Surg 2014; 147:1435-6. [PMID: 24630225 DOI: 10.1016/j.jtcvs.2013.11.058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2013] [Accepted: 11/05/2013] [Indexed: 11/26/2022]
Affiliation(s)
- Jasmin Pansy
- Division of Pediatric Cardiology, Department of Pediatrics, Medical University Graz, Graz, Austria
| | - Gernot Grangl
- Division of Pediatric Cardiology, Department of Pediatrics, Medical University Graz, Graz, Austria
| | - Martin Koestenberger
- Division of Pediatric Cardiology, Department of Pediatrics, Medical University Graz, Graz, Austria
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Gores G, Grangl G, Weitzer C, Koestenberger M. Cardiac Magnetic Resonance Imaging and Echocardiography in Pediatric Pulmonary Arterial Hypertension. Pulm Circ 2014; 4:148. [DOI: 10.1086/674877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Affiliation(s)
- Gunther Gores
- Division of Pediatric CardiologyDepartment of PediatricsMedical University of GrazGrazAustria
| | - Gernot Grangl
- Division of Pediatric CardiologyDepartment of PediatricsMedical University of GrazGrazAustria
| | - Claus Weitzer
- Division of Pediatric CardiologyDepartment of PediatricsMedical University of GrazGrazAustria
| | - Martin Koestenberger
- Division of Pediatric CardiologyDepartment of PediatricsMedical University of GrazGrazAustria
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Pansy J, Grangl G, Koestenberger M. Right Ventricular Function Impairment in Children After Tetralogy of Fallot Repair. Artif Organs 2014; 38:268. [DOI: 10.1111/aor.12272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Jasmin Pansy
- Division of Pediatric Cardiology; Department of Pediatrics; Medical University of Graz; Graz Austria
| | - Gernot Grangl
- Division of Pediatric Cardiology; Department of Pediatrics; Medical University of Graz; Graz Austria
| | - Martin Koestenberger
- Division of Pediatric Cardiology; Department of Pediatrics; Medical University of Graz; Graz Austria
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Villafañe J, Feinstein JA, Jenkins KJ, Vincent RN, Walsh EP, Dubin AM, Geva T, Towbin JA, Cohen MS, Fraser C, Dearani J, Rosenthal D, Kaufman B, Graham TP. Hot Topics in Tetralogy of Fallot. J Am Coll Cardiol 2013; 62:2155-66. [DOI: 10.1016/j.jacc.2013.07.100] [Citation(s) in RCA: 89] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2013] [Revised: 06/26/2013] [Accepted: 07/01/2013] [Indexed: 12/13/2022]
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Koestenberger M, Ravekes W. Value of the tricuspid annular plane systolic excursion as a follow-up parameter in patients with hypoplastic left heart syndrome. J Thorac Cardiovasc Surg 2013; 145:1682-3. [PMID: 23679972 DOI: 10.1016/j.jtcvs.2013.01.048] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2013] [Accepted: 01/17/2013] [Indexed: 11/30/2022]
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35
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Subclinical deterioration of systolic right ventricular function parameters in adolescents with mild cystic fibrosis. J Cyst Fibros 2013; 12:417. [DOI: 10.1016/j.jcf.2012.10.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2012] [Accepted: 10/22/2012] [Indexed: 11/13/2022]
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36
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Ability of the tricuspid annular peak systolic velocity (S') to detect systolic right ventricular impairment after congenital heart defect surgery in pediatric patients. Pediatr Cardiol 2013; 34:1292. [PMID: 23430322 DOI: 10.1007/s00246-013-0661-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2013] [Accepted: 02/06/2013] [Indexed: 10/27/2022]
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Koestenberger M, Ravekes W. Impairment of tricuspid annular plane systolic excursion and tricuspid annular peak systolic velocity after ventricular septal defect correction. Eur J Cardiothorac Surg 2013; 44:1158. [PMID: 23671206 DOI: 10.1093/ejcts/ezt270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Martin Koestenberger
- Division of Pediatric Cardiology, Department of Pediatrics, Medical University Graz, Graz, Austria
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38
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Koestenberger M, Nagel B, Ravekes W, Gamillscheg A, Pichler G, Avian A, Heinzl B, Binder C, Cvirn G, Urlesberger B. Right ventricular performance in preterm and term neonates: reference values of the tricuspid annular peak systolic velocity measured by tissue Doppler imaging. Neonatology 2013; 103:281-6. [PMID: 23548493 DOI: 10.1159/000348521] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2012] [Accepted: 01/29/2013] [Indexed: 11/19/2022]
Abstract
BACKGROUND The tricuspid annular peak systolic velocity (S') is an echocardiographic measurement to assess systolic right ventricular function in adults and children. OBJECTIVE We determined growth and birth weight-related changes of S' to establish reference values in preterm and term neonates. METHODS A prospective study was conducted in a group of 290 preterm and term neonates (gestational age 26 + 0 to 40 + 6 weeks of gestation; birth weight 660-4,460 g). A correlation of S' values with established tricuspid annular plane systolic excursion (TAPSE) values was performed. RESULTS The S' ranged from a mean of 4.5 cm/s (Z-score ± 2 SD: 3.6-5.5 cm/s) in preterm neonates in week 26(0-6) of gestation to 7.8 cm/s (Z-score ± 2 SD: 5.5-10.1 cm/s) in term neonates in week 40(0-6) of gestation. The S' values increased from 26 to 40 weeks of gestation. S' and week of gestation are strongly correlated: Pearson's correlation coefficient was 0.66 for week of gestation - S' (p < 0.001). A significant correlation was found between S' and TAPSE values (r = 0.67; p < 0.001). CONCLUSION Z-scores of S' values were calculated and percentile charts were established to serve as reference data for preterm and term neonates with structurally normal hearts.
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Affiliation(s)
- Martin Koestenberger
- Division of Pediatric Cardiology, Department of Pediatrics, Medical University Graz, Graz, Austria.
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Senthilnathan S, Dragulescu A, Mertens L. Pulmonary Regurgitation after Tetralogy of Fallot Repair: A Diagnostic and Therapeutic Challenge. J Cardiovasc Echogr 2013; 23:1-9. [PMID: 28465877 PMCID: PMC5353440 DOI: 10.4103/2211-4122.117975] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Pulmonary regurgitation is the key hemodynamically significant lesion in repaired tetralogy of Fallot contributing to progressive right ventricular (RV) dilatation and biventricular dysfunction. The timing for pulmonary valve replacement remains a controversial topic, and the decision to intervene depends on assessment of RV size and RV function. OBJECTIVES This review aims to discuss the echocardiographic techniques that can be used to assess patients with pulmonary regurgitation after the repair of tetralogy of Fallot defect. While cardiac magnetic resonance (CMR) imaging is the clinical reference method, there is an important role of echocardiography in identifying patients with significant pulmonary regurgitation and assessing the RV size and function. The different echocardiographic techniques that can be used in this context are discussed. Newer techniques for assessing RV size and function include three-dimensional (3D) echocardiography, tissue Doppler and strain imaging. 3D RV volumetric reconstruction based on two-dimensional imaging is a promising new technique that could potentially replace CMR for RV volumetric assessment. CONCLUSIONS Developments in echocardiographic techniques provide new insights into the impact of pulmonary regurgitation on RV structure and function. Echocardiography and CMR are complementary modalities and further research is required to define the optimal use of both techniques for this indication.
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Affiliation(s)
- Selvi Senthilnathan
- The Labatt Family Heart Center, the Hospital for Sick Children, University of Toronto. Toronto, ON, Canada
| | - Andreea Dragulescu
- The Labatt Family Heart Center, the Hospital for Sick Children, University of Toronto. Toronto, ON, Canada
| | - Luc Mertens
- The Labatt Family Heart Center, the Hospital for Sick Children, University of Toronto. Toronto, ON, Canada
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40
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Right ventricular function in Juvenile idiopathic arthritis patients. Pediatr Cardiol 2012; 33:1475. [PMID: 22872021 DOI: 10.1007/s00246-012-0473-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2012] [Accepted: 07/19/2012] [Indexed: 10/28/2022]
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