Koestenberger Martin, Grangl Gernot, Avian Alexander, Gamillscheg Andreas, Grillitsch Marlene, Cvirn Gerhard, Burmas Ante, Hansmann Georg
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.).
Circ Cardiovasc Imaging. 2017 Jan;10(1). doi: 10.1161/CIRCIMAGING.116.005336.
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.
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.
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.
迄今为止，仅在成人中进行的研究发现，通过脉冲波多普勒测定肺动脉加速时间（PAAT）作为肺动脉压力的替代指标，对评估肺动脉高压（PH）具有临床价值。本研究旨在提供各年龄段儿童PAAT的代表性正常参考值。此外，我们对54例PH患儿的异常PAAT值进行了验证。
我们对756例健康儿童（年龄1天至18岁）和54例PH患儿进行了前瞻性超声心动图研究。研究了年龄、身长、体重、体表面积和心率与PAAT之间可能存在的关联。PAAT与年龄（r = 0.848）、身长（r = 0.871）、体表面积（r = 0.856）和体重（r = 0.825）呈正相关，与心率（r = -0.906）呈负相关。PAAT随年龄增长而增加（新生儿：中位数：81毫秒，范围：53 - 104；18岁：中位数：151毫秒，范围：107 - 187）。使用年龄特异性z评分检测PH患者的受试者工作特征分析显示，PAAT具有出色的性能（P < 0.001；曲线下面积，0.98；95%置信区间，0.97 - 0.99），根据约登指数，最佳截断分数为 -1.565（敏感性：92%，特异性：96%）。PH患者的PAAT值与肺血管阻力呈负相关（ρ = -0.497）。
我们在此提供的PAAT正常参考值和z评分将有助于识别PAAT缩短的儿童。评分 < -2的异常PAAT值可预测PH。
