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Cardiomyopathy in children: Can we rely on echocardiographic tricuspid regurgitation gradient estimates of right ventricular and pulmonary arterial pressure?

Published online by Cambridge University Press:  04 March 2016

Simon Lee ,
Irene D. Lytrivi ,
Zhanna Roytman ,
Hyun-Sook Helen Ko ,
Cheryl Vinograd  and
Shubhika Srivastava
Simon Lee*
Affiliation:
Department of Pediatrics, Icahn School of Medicine at Mount Sinai, Division of Cardiology, Kravis Children’s Hospital, New York, New York
Irene D. Lytrivi
Affiliation:
Department of Pediatrics, Icahn School of Medicine at Mount Sinai, Division of Cardiology, Kravis Children’s Hospital, New York, New York
Zhanna Roytman
Affiliation:
Department of Pediatrics, Icahn School of Medicine at Mount Sinai, Division of Cardiology, Kravis Children’s Hospital, New York, New York
Hyun-Sook Helen Ko
Affiliation:
Department of Pediatrics, Icahn School of Medicine at Mount Sinai, Division of Cardiology, Kravis Children’s Hospital, New York, New York
Cheryl Vinograd
Affiliation:
Department of Pediatrics, Kravis Children’s Hospital, New York, New York
Shubhika Srivastava
Affiliation:
Department of Pediatrics, Icahn School of Medicine at Mount Sinai, Division of Cardiology, Kravis Children’s Hospital, New York, New York
*
Correspondence to: S. Lee, MD, Department of Pediatrics, Icahn School of Medicine at Mount Sinai, Division of Cardiology, Kravis Children’s Hospital, 1468 Madison Avenue, Annenberg Building, Suite 3-50, New York, NY 10029, United States of America. Tel: +212 241 8662; Fax: +888 367 1977; E-mail: [email protected]
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Abstract

Introduction

Agreement between echocardiography and right heart catheterisation-derived right ventricular systolic pressure is modest in the adult heart failure population, but is unknown in the paediatric cardiomyopathy population.

Methods

All patients at a single centre from 2001 to 2012 with a diagnosis of cardiomyopathy who underwent echocardiography and catheterisation within 30 days were included in this study. The correlation between tricuspid regurgitation gradient and catheterisation-derived right ventricular systolic pressure and mean pulmonary artery pressure was determined. Agreement between echocardiography and catheterisation-derived right ventricular systolic pressure was assessed using Bland–Altman plots. Analysis was repeated for patients who underwent both procedures within 7 days. Haemodynamic data from those with poor agreement and good agreement between echocardiography and catheterisation were compared.

Results

A total of 37 patients who underwent 48 catheterisation procedures were included in our study. The median age was 11.8 (0.1–20.6 years) with 22 males (58% total). There was a modest correlation (r=0.65) between echocardiography and catheterisation-derived right ventricular systolic pressure, but agreement was poor. Agreement between tricuspid regurgitation gradient and right ventricular systolic pressure showed wide 95% limits of agreement. There was a modest correlation between the tricuspid regurgitation gradient and mean pulmonary artery pressure (r=0.6). Shorter time interval between the two studies did not improve agreement. Those with poor agreement between echocardiography and catheterisation had higher right heart pressures, but this difference became insignificant after accounting for right atrial pressure.

Conclusion

Transthoracic echocardiography estimation of right ventricular systolic pressure shows modest correlation with right heart pressures, but has limited agreement and may underestimate the degree of pulmonary hypertension in paediatric cardiomyopathy patients.

Keywords

Cardiomyopathytricuspid regurgitationpulmonary hypertension
Type
Original Articles
Information
Cardiology in the Young , Volume 26 , Issue 7 , October 2016 , pp. 1406 - 1413
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Copyright
© Cambridge University Press 2016 

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References

1. Murali, S, Kormos, RL, Uretsky, BF, et al. Preoperative pulmonary hemodynamics and early mortality after orthotopic cardiac transplantation: the Pittsburgh experience. Am Heart J 1993; 126: 896–904.Google Scholar
2. Jeewa, A, Manlhiot, C, Kantor, PF, Mital, S, McCrindle, BW, Dipchand, AI. Risk factors for mortality or delisting of patients from the pediatric heart transplant waiting list. J Thorac Cardiovasc Surg 2014; 147: 462–468.Google Scholar
3. Currie, PJ, Seward, JB, Chan, KL, et al. Continuous wave Doppler determination of right ventricular pressure: a simultaneous Doppler-catheterization study in 127 patients. J Am Coll Cardiol 1985; 6: 750–756.Google Scholar
4. Berger, M, Haimowitz, A, Van Tosh, A, Berdoff, RL, Goldberg, E. Quantitative assessment of pulmonary hypertension in patients with tricuspid regurgitation using continuous wave Doppler ultrasound. J Am Coll Cardiol 1985; 6: 359–365.Google Scholar
5. Kirkpatrick, EC. Echocardiography in pediatric pulmonary hypertension. Paediatr Respir Rev 2013; 14: 157–164.Google Scholar
6. Slaughter, JL, Pakrashi, T, Jones, DE, South, AP, Shah, TA. Echocardiographic detection of pulmonary hypertension in extremely low birth weight infants with bronchopulmonary dysplasia requiring prolonged positive pressure ventilation. J Perinatol 2011; 31: 1–6.Google Scholar
7. Groh, GK, Levy, PT, Holland, MR, et al. Doppler echocardiography inaccurately estimates right ventricular pressure in children with elevated right heart pressure. J Am Soc Echocardiogr 2014; 27: 163–171.CrossRefGoogle ScholarPubMed
8. Friedberg, MK, Feinstein, JA, Rosenthal, DN. A novel echocardiographic Doppler method for estimation of pulmonary arterial pressures. J Am Soc Echocardiogr 2006; 19: 559–562.Google Scholar
9. Attaran, RR, Ramaraj, R, Sorrell, VL, Movahed, MR. Poor correlation of estimated pulmonary artery systolic pressure between echocardiography and right heart catheterization in patients awaiting cardiac transplantation: results from the clinical arena. Transplant Proc 2009; 41: 3827–3830.Google Scholar
10. Kouzu, H, Nakatani, S, Kyotani, S, Kanzaki, H, Nakanishi, N, Kitakaze, M. Noninvasive estimation of pulmonary vascular resistance by Doppler echocardiography in patients with pulmonary arterial hypertension. Am J Cardiol 2009; 103: 872–876.Google Scholar
11. Bland, JM, Altman, DG. Measuring agreement in method comparison studies. Stat Methods Med Res 1999; 8: 135–160.CrossRefGoogle ScholarPubMed
12. Bossone, E, Bodini, BD, Mazza, A, Allegra, L. Pulmonary arterial hypertension: the key role of echocardiography. Chest 2005; 127: 1836–1843.Google Scholar
13. Abbas, AE, Fortuin, FD, Schiller, NB, Appleton, CP, Moreno, CA, Lester, SJ. A simple method for noninvasive estimation of pulmonary vascular resistance. J Am Coll Cardiol 2003; 41: 1021–1027.Google Scholar
14. Nakahata, Y, Hiraishi, S, Oowada, N, et al. 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 2008; 30: 232–239.Google Scholar
15. Kalogeropoulos, AP, Georgiopoulou, VV, Borlaug, BA, Gheorghiade, M, Butler, J. Left ventricular dysfunction with pulmonary hypertension: part 2: prognosis, noninvasive evaluation, treatment, and future research. Circ Heart Fail 2013; 6: 584–593.Google Scholar
16. Kutty, S, Li, L, Hasan, R, Peng, Q, Rangamani, S, Danford, DA. Systemic venous diameters, collapsibility indices, and right atrial measurements in normal pediatric subjects. J Am Soc Echocardiogr 2014; 27: 155–162.Google Scholar
17. Bach, DS. Echo/Doppler evaluation of hemodynamics after aortic valve replacement: principles of interrogation and evaluation of high gradients. JACC Cardiovasc Imaging 2010; 3: 296–304.CrossRefGoogle ScholarPubMed
18. Giardini, A, Tacy, TA. Non-invasive estimation of pressure gradients in regurgitant jets: an overdue consideration. Eur J Echocardiogr 2008; 9: 578–584.CrossRefGoogle ScholarPubMed