Department of Pediatrics, University of California, San Francisco, California, USA.
Echocardiography. 2022 Jul;39(7):895-905. doi: 10.1111/echo.15397. Epub 2022 Jun 12.
Pulmonary artery acceleration time (PAAT) is considered useful for the non-invasive evaluation of pulmonary artery pressure (PAP) and pulmonary vascular resistance (PVR). PAAT is dependent on PAP, PVR, pulmonary artery compliance, stroke volume, and heart rate. Its relative dependency on these determinants may differ between young and older children, raising uncertainty regarding its utility in young children. We aim to identify the primary determinants of the PAAT in children less than 36 months undergoing cardiac catheterization and its utility for the diagnosis of elevated PVR.
We prospectively studied 42 children undergoing cardiac catheterization and simultaneous echocardiography. We determined the correlations of PAAT to the above-mentioned determinants and evaluated receiver operator characteristic (ROC) curves for diagnosis of PVR indexed to body surface area (PVRi) ≥3 Wu*m .
Median age was 11.5 (IQR 5.2, 21.2) months. Moderate correlations were found between PAAT and mean PAP (R = -.66, p < .001), PVRi (R = -.54, p = .004), pulmonary artery compliance (R = .65, p < .001), transpulmonary gradient (R = -.67, p < .001), stroke volume (R = .61, p = .002), and heart rate (R = -.63, p < .001). In multivariate regression modeling, only transpulmonary gradient and heart rate were independent determinants of PAAT. PAAT ≤77 msec had acceptable utility for diagnosing PVRi ≥ 3 Wu*m (AUC .8 [.64, .95], n = 36), low sensitivity (59%), and excellent specificity (94%).
Transpulmonary gradient and heart rate, but not pulmonary blood flow, are important determinants of PAAT in children <36 months undergoing cardiac catheterization. PAAT has low sensitivity for diagnosing elevated PVRi, therefore, should not be solely relied upon in screening for elevated PVRi in young children.
肺动脉加速时间（PAAT）被认为是一种有用的非侵入性评估肺动脉压（PAP）和肺血管阻力（PVR）的方法。PAAT 取决于 PAP、PVR、肺动脉顺应性、每搏量和心率。它对这些决定因素的相对依赖性在儿童和老年人之间可能不同，这使得其在儿童中的应用存在不确定性。我们的目的是确定在接受心脏导管检查的小于 36 个月的儿童中 PAAT 的主要决定因素及其在诊断升高的 PVR 中的应用。
我们前瞻性地研究了 42 名接受心脏导管检查和同时进行超声心动图检查的儿童。我们确定了 PAAT 与上述决定因素的相关性，并评估了诊断体表面积指数（PVRi）≥3 Wu*m 的 PVR 时 PAAT 的接收者操作特征（ROC）曲线。
中位年龄为 11.5（IQR 5.2，21.2）个月。PAAT 与平均 PAP（R = -.66，p <.001）、PVRi（R = -.54，p =.004）、肺动脉顺应性（R =.65，p <.001）、跨肺梯度（R = -.67，p <.001）、每搏量（R =.61，p =.002）和心率（R = -.63，p <.001）之间存在中度相关性。在多元回归模型中，只有跨肺梯度和心率是 PAAT 的独立决定因素。PAAT ≤77 msec 对诊断 PVRi ≥ 3 Wu*m （AUC.8 [.64，.95]，n = 36）具有可接受的效用，敏感性低（59%），特异性高（94%）。
在接受心脏导管检查的小于 36 个月的儿童中，跨肺梯度和心率而不是肺血流量是 PAAT 的重要决定因素。PAAT 对诊断升高的 PVRi 的敏感性较低，因此，不应单独用于筛查幼儿中的升高的 PVRi。
