From the Division of Cardiology, The Labatt Family Heart Center, Hospital for Sick Children, University of Toronto, Toronto, Canada.
Circ Cardiovasc Imaging. 2014 May;7(3):491-501. doi: 10.1161/CIRCIMAGING.113.001071. Epub 2014 Feb 27.
Right ventricular diastolic dysfunction influences outcomes in pulmonary arterial hypertension (PAH), but echocardiographic parameters have not been investigated in relation to invasive reference standards in pediatric PAH. We investigated echocardiographic parameters of right ventricular diastolic function in children with PAH in relation to simultaneously measured invasive reference measures.
We prospectively recruited children undergoing a clinically indicated cardiac catheterization for evaluation of PAH and pulmonary vasoreactivity testing. Echocardiography was performed simultaneously with invasive reference measurements by high-fidelity micromanometer catheter. For analysis, patients were divided into shunt and nonshunt groups. Sixteen children were studied. In the group as a whole, significant correlations were found among τ and tricuspid deceleration time, E', E/E', TimeE-E', A wave velocity, and global early and late diastolic strain rate. dp/dt minimum correlated significantly with late diastolic tricuspid annular velocity (A'), tissue Doppler imaging-derived systolic:diastolic duration ratio, and global late diastolic strain rate. End-diastolic pressure correlated significantly with tissue Doppler imaging-derived systolic:diastolic duration ratio. On multivariate analysis, tricuspid deceleration time, TimeE-E', and global early diastolic strain rate were independent predictors of τ, whereas tissue Doppler imaging-derived systolic:diastolic duration ratio was an independent predictor of dp/dt minimum. In general, correlations between echocardiographic and invasive parameters were better in the shunt group than in the nonshunt group.
Echocardiography correlates with invasive reference measures of right ventricular diastolic function in children with PAH, although it does not differentiate between early versus late diastolic abnormalities. Newer echocardiographic techniques may have added value to assess right ventricular diastolic dysfunction in this population.
右心室舒张功能障碍会影响肺动脉高压（PAH）的结局，但在儿科 PAH 中，尚未针对超声心动图参数与侵入性参考标准进行相关研究。我们研究了 PAH 患儿的超声心动图右心室舒张功能参数与同时测量的侵入性参考测量值的关系。
我们前瞻性招募了因 PAH 评估和肺血管反应性测试而接受临床指示性心导管插入术的儿童。超声心动图与使用高保真微压力计导管进行的侵入性参考测量同时进行。为了分析，患者被分为分流组和非分流组。共研究了 16 名儿童。在整个组中，τ与三尖瓣减速时间、E'、E/E'、TimeE-E'、A 波速度以及整体早期和晚期舒张应变率之间存在显著相关性。dp/dt 最小值与晚期舒张三尖瓣环速度（A'）、组织多普勒成像衍生的收缩期：舒张期持续时间比以及整体晚期舒张应变率显著相关。舒张末期压力与组织多普勒成像衍生的收缩期：舒张期持续时间比显著相关。多元分析显示，三尖瓣减速时间、TimeE-E'和整体早期舒张应变率是 τ的独立预测因子，而组织多普勒成像衍生的收缩期：舒张期持续时间比是 dp/dt 最小值的独立预测因子。一般来说，超声心动图和侵入性参数之间的相关性在分流组比非分流组更好。
超声心动图与 PAH 儿童的右心室舒张功能的侵入性参考测量值相关，但不能区分舒张早期与晚期异常。新的超声心动图技术可能对评估该人群的右心室舒张功能具有附加价值。
