Koestenberger Martin, Avian Alexander, Gamillscheg Andreas, Sallmon Hannes, Grangl Gernot, Burmas Ante, Schweintzger Sabrina, Kurath-Koller Stefan, Cvirn Gerhard, Hansmann Georg
Division of Pediatric Cardiology, Department of Pediatrics, Medical University Graz, Graz, Austria.
Institute for Medical Informatics, Statistics and Documentation, Medical University Graz, Graz, Austria.
Clin Cardiol. 2018 Sep;41(9):1144-1149. doi: 10.1002/clc.22994. Epub 2018 Aug 18.
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.
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.
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).
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).
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.
超声心动图测定右心室收缩末期基底部/心尖部（RVES b/a）比值被认为对评估成人肺动脉高压（PAH）具有临床价值。
我们推测PAH患儿的RVES b/a比值会受到影响，旨在将RVES b/a比值与传统使用的超声心动图和血流动力学变量以及纽约心脏协会（NYHA）功能分级相关联。
首先我们确定了157名健康儿童（68名男性；年龄范围0.5 - 17.7岁）的RVES b/a比值的正常儿科值。然后我们对51名PAH患儿（29名男性；年龄范围0.3 - 17.8岁）进行了超声心动图研究。
与年龄和性别匹配的健康对照组相比，RVES b/a比值较低（P < 0.001）。在PAH患儿中，RVES b/a比值随NYHA分级恶化而降低。RVES b/a比值与右心室/左心室收缩末期直径比值呈负相关（ρ = -0.450，P = 0.001），但与右心室收缩功能参数（如三尖瓣环平面收缩期位移）无关，且与心导管检查测定的肺血管阻力指数相关（ρ = -0.571，P < 0.001）。ROC分析表明RVES b/a比值在检测儿童PAH方面表现出色（AUC：0.95，95%CI：0.89 - 1.00，P < 0.001）。
与年龄和性别匹配的健康受试者相比，PAH患儿的RVES b/a比值降低。RVES b/a比值与右心室压力后负荷增加的超声心动图和血流动力学指标以及NYHA分级呈负相关，表明RVES b/a比值反映了PAH患儿的疾病严重程度。
