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Koestenberger M, Grangl G, Avian A, Gamillscheg A, Grillitsch M, Cvirn G, Burmas A, Hansmann G. Normal Reference Values and z Scores of the Pulmonary Artery Acceleration Time in Children and Its Importance for the Assessment of Pulmonary Hypertension. Circ Cardiovasc Imaging 2017; 10:CIRCIMAGING.116.005336. [PMID: 28003222 DOI: 10.1161/circimaging.116.005336] [Citation(s) in RCA: 54] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2016] [Accepted: 11/28/2016] [Indexed: 11/16/2022]
Abstract
BACKGROUND Pulsed-wave Doppler determination of the pulmonary artery acceleration time (PAAT) as a surrogate for pulmonary artery pressure was found to be of clinical value for assessment of pulmonary hypertension (PH) with studies to date exclusively performed in adults. This study aims to provide representative, normal reference values for PAAT in children of all ages. Moreover, we validated abnormal PAAT values in 54 children with PH. METHODS AND RESULTS We conducted a prospective echocardiographic study in 756 healthy children (aged 1 day to 18 years) and in 54 children with PH. Possible associations of age, body length, body weight, body surface area, and heart rate on PAAT were investigated. The PAAT correlated positively with age (r=0.848), body length (r=0.871), body surface area (r=0.856), and body weight (r=0.825) and negatively with heart rate (r=-0.906). PAAT increased with age (neonates: median: 81 ms, range: 53-104; 18th year of life: median: 151 ms, range: 107-187). Receiver operating characteristic analysis for detecting PH patients using age-specific z scores showed an excellent performance of PAAT (P<0.001; area under the curve, 0.98; 95% confidence interval, 0.97-0.99) with a best cutoff score according to Youden index of -1.565 (sensitivity: 92%, specificity: 96%). PAAT values of PH patients negatively correlated (ρ=-0.497) with pulmonary vascular resistance. CONCLUSIONS The PAAT normal reference values and z scores we provide here will be useful to identify children with a shortened PAAT. Abnormal PAAT values with scores <-2 were predictive of PH.
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Affiliation(s)
- Martin Koestenberger
- From the Division of Pediatric Cardiology, Department of Pediatrics (M.K., G.G., A.G., M.G., A.B.), Institute for Medical Informatics, Statistics and Documentation (A.A.), and Centre of Physiological Medicine (G.C.), Medical University Graz, Austria; and Department of Pediatric Cardiology and Critical Care, Hannover Medical School, Hannover, Germany (G.H.).
| | - Gernot Grangl
- From the Division of Pediatric Cardiology, Department of Pediatrics (M.K., G.G., A.G., M.G., A.B.), Institute for Medical Informatics, Statistics and Documentation (A.A.), and Centre of Physiological Medicine (G.C.), Medical University Graz, Austria; and Department of Pediatric Cardiology and Critical Care, Hannover Medical School, Hannover, Germany (G.H.)
| | - Alexander Avian
- From the Division of Pediatric Cardiology, Department of Pediatrics (M.K., G.G., A.G., M.G., A.B.), Institute for Medical Informatics, Statistics and Documentation (A.A.), and Centre of Physiological Medicine (G.C.), Medical University Graz, Austria; and Department of Pediatric Cardiology and Critical Care, Hannover Medical School, Hannover, Germany (G.H.)
| | - Andreas Gamillscheg
- From the Division of Pediatric Cardiology, Department of Pediatrics (M.K., G.G., A.G., M.G., A.B.), Institute for Medical Informatics, Statistics and Documentation (A.A.), and Centre of Physiological Medicine (G.C.), Medical University Graz, Austria; and Department of Pediatric Cardiology and Critical Care, Hannover Medical School, Hannover, Germany (G.H.)
| | - Marlene Grillitsch
- From the Division of Pediatric Cardiology, Department of Pediatrics (M.K., G.G., A.G., M.G., A.B.), Institute for Medical Informatics, Statistics and Documentation (A.A.), and Centre of Physiological Medicine (G.C.), Medical University Graz, Austria; and Department of Pediatric Cardiology and Critical Care, Hannover Medical School, Hannover, Germany (G.H.)
| | - Gerhard Cvirn
- From the Division of Pediatric Cardiology, Department of Pediatrics (M.K., G.G., A.G., M.G., A.B.), Institute for Medical Informatics, Statistics and Documentation (A.A.), and Centre of Physiological Medicine (G.C.), Medical University Graz, Austria; and Department of Pediatric Cardiology and Critical Care, Hannover Medical School, Hannover, Germany (G.H.)
| | - Ante Burmas
- From the Division of Pediatric Cardiology, Department of Pediatrics (M.K., G.G., A.G., M.G., A.B.), Institute for Medical Informatics, Statistics and Documentation (A.A.), and Centre of Physiological Medicine (G.C.), Medical University Graz, Austria; and Department of Pediatric Cardiology and Critical Care, Hannover Medical School, Hannover, Germany (G.H.)
| | - Georg Hansmann
- From the Division of Pediatric Cardiology, Department of Pediatrics (M.K., G.G., A.G., M.G., A.B.), Institute for Medical Informatics, Statistics and Documentation (A.A.), and Centre of Physiological Medicine (G.C.), Medical University Graz, Austria; and Department of Pediatric Cardiology and Critical Care, Hannover Medical School, Hannover, Germany (G.H.)
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Schwarz CE, Preusche A, Baden W, Poets CF, Franz AR. Repeatability of echocardiographic parameters to evaluate the hemodynamic relevance of patent ductus arteriosus in preterm infants: a prospective observational study. BMC Pediatr 2016; 16:18. [PMID: 26810942 PMCID: PMC4727343 DOI: 10.1186/s12887-016-0552-7] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2015] [Accepted: 01/19/2016] [Indexed: 11/22/2022] Open
Abstract
Background The hemodynamically relevant patent ductus arteriosus in preterm infants is not well defined. Different clinical and echocardiographic parameters are used and the diagnostic accuracy is unknown because of the lack of a gold standard definition. Our study evaluates the inter-observer repeatability of echocardiographic and Doppler-ultrasound parameters. Methods This prospective observational study included 19 very low birth weight preterm infants (median [interquartile range]: gestational age 28.0 (28.0–29.0) weeks, birth weight 1130 (905–1321) g, postnatal age at measurement 8.7 (4.8–23.5) d) with a clinical suspicion of ductal patency in whom 27 repeated echocardiographic and Doppler-ultrasound examinations were performed within 30 min by 2 of 3 independent observers (54 measurements overall). The repeatability index (=2 times the standard deviation of the differences/mean of all measurements) according to Bland and Altman was used to assess repeatability of different parameters. Results The repeatability indices of the echocardiographic parameters (left Atrium-to-Aortic root-ratio, diameter of the patent ductus arteriosus at its narrowest part, the left-ventricular-preejection-period-to-ejection-time-ratio and the ratio of the velocity time integrals in the large vessels were 16, 21, 23 and 26 % respectively. The repeatability indices of Doppler-ultrasound measurements (resistance index in celiac artery and anterior cerebral artery) were 11 and 14 %, respectively. Conclusions The inter-observer repeatability of all echocardiographic parameters was poor compared to that of resistance indices in peripheral vessels. Therefore, interventions for ductal patency should be indicated based on averaged repeated rather than single measurements, especially when measured values are close to their cut-off value - both in clinical routine and for study purposes.
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Affiliation(s)
- Christoph E Schwarz
- Department of Neonatology, University Children's Hospital of Tuebingen, University of Tuebingen, Calwerstr. 7, 72076, Tuebingen, Germany.
| | - Antonio Preusche
- Department of Neonatology, University Children's Hospital of Tuebingen, University of Tuebingen, Calwerstr. 7, 72076, Tuebingen, Germany.
| | - Winfried Baden
- Department of Pediatric Cardiology, University Children's Hospital of Tuebingen, University of Tuebingen, Tuebingen, Germany.
| | - Christian F Poets
- Department of Neonatology, University Children's Hospital of Tuebingen, University of Tuebingen, Calwerstr. 7, 72076, Tuebingen, Germany.
| | - Axel R Franz
- Department of Neonatology, University Children's Hospital of Tuebingen, University of Tuebingen, Calwerstr. 7, 72076, Tuebingen, Germany. .,Center for Pediatric Clinical Studies, University Children's Hospital of Tuebingen, University of Tuebingen, Tuebingen, Germany.
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Damy T, Burgel PR, Pepin JL, Boelle PY, Cracowski C, Murris-Espin M, Nove-Josserand R, Stremler N, Simon T, Adnot S, Fauroux B. Pulmonary acceleration time to optimize the timing of lung transplant in cystic fibrosis. Pulm Circ 2012; 2:75-83. [PMID: 22558523 PMCID: PMC3342752 DOI: 10.4103/2045-8932.94838] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Pulmonary hypertension (PH) may affect survival in cystic fibrosis (CF) and can be assessed on echocardiographic measurement of the pulmonary acceleration time (PAT). The study aimed at evaluating PAT as a tool to optimize timing of lung transplant in CF patients. Prospective multicenter longitudinal study of patients with forced expiratory volume in 1 second (FEV1) ≤60% predicted. Echocardiography, spirometry and nocturnal oximetry were obtained as part of the routine evaluation. We included 67 patients (mean FEV1 42±12% predicted), among whom 8 underwent lung transplantation during the mean follow-up of 19±6 months. No patients died. PAT was determined in all patients and correlated negatively with systolic pulmonary artery pressure (sPAP, r=-0.36, P=0.01). Patients in the lowest PAT tertile (<101 ms) had lower FEV1 and worse nocturnal oxygen saturation, and they were more often on the lung transplant waiting list compared to patients in the other tertiles. Kaplan-Meier curves showed a shorter time to lung transplantation in the lowest PAT tertile (P<0.001) but not in patients with sPAP>35 mmHg. By multivariate analysis, FEV(1)and nocturnal desaturation were the main determinants of reduced PAT. A PAT<101 ms reduction is a promising tool for timing of lung transplantation in CF.
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Affiliation(s)
- Thibaud Damy
- Department of Cardiology, AP-HP, Henri Mondor Hospital, Créteil, France
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Nakahata Y, Hiraishi S, Oowada N, Ando H, Kimura S, Furukawa S, Ogata S, Ishii M. Quantitative assessment of pulmonary vascular resistance and reactivity in children with pulmonary hypertension due to congenital heart disease using a noninvasive method: new Doppler-derived indexes. Pediatr Cardiol 2009; 30:232-9. [PMID: 18956135 DOI: 10.1007/s00246-008-9316-y] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2007] [Revised: 08/18/2008] [Accepted: 09/15/2008] [Indexed: 11/26/2022]
Abstract
We assessed the usefulness of transthoracic Doppler-derived indexes obtained in the proximal pulmonary artery (PA) branch for estimating pulmonary vascular resistance (PVR) in 45 children with congenital heart disease (CHD) and 23 normal control subjects. The acceleration time, inflection time (InT), deceleration index, and peak velocity, which were measured from the systolic PA flow velocity curve obtained at the sites of the main PA, and right and left PA, were compared with the PVR in patients with CHD. In addition, changes in either Doppler-derived indexes or PVR during 100% oxygen administration were compared in 22 patients showing a baseline PVR >or=4.6 U/m(2) (high PVR). The heart-rate-corrected InT (InTc) values obtained in the left PA in the high PVR group were significantly lower than those in the main PA (4.7 +/- 1.5 vs. 7.5 +/- 3.0; p < 0.001). The InTc obtained from the left PA separated patients with high and low PVR (4.7 +/- 1.4 vs. 9.9 +/- 2.4; p < 0.001) and no significant differences in InTc were found between the low PVR and the control groups. An increase in InTc to >6 during 100% oxygen administration for the high PVR group indicated good PA reactivity with a sensitivity of 93%, specificity of 100%, and agreement of 95% (kappa = 0.83). Moreover, this InTc index correlated inversely with PVR (r = -0.80). In conclusion, our method can noninvasively separate high and low PVR and assess the PA reactivity for high PVR in children with CHD.
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Affiliation(s)
- Yayaoi Nakahata
- Department of Pediatrics, Kitasato University School of Medicine, Sagamihara, Kanagawa, Japan.
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McGoon M, Gutterman D, Steen V, Barst R, McCrory DC, Fortin TA, Loyd JE. Screening, early detection, and diagnosis of pulmonary arterial hypertension: ACCP evidence-based clinical practice guidelines. Chest 2004; 126:14S-34S. [PMID: 15249493 DOI: 10.1378/chest.126.1_suppl.14s] [Citation(s) in RCA: 520] [Impact Index Per Article: 26.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Pulmonary arterial hypertension (PAH) occurs as an idiopathic process or as a component of a variety of disease processes, including chronic thromboembolic disease, connective tissue diseases, congenital heart disease, and exposure to exogenous factors including appetite suppressants or infectious agents such as HIV. This article reviews evidence for screening in susceptible patient groups and the approach to diagnosing PAH when it is suspected, and provides specific recommendations for applying this evidence to clinical practice.
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