Malakan Rad Elaheh, Elhamian Reza, Zanjani Keyhan Sayadpour, Shabanian Reza, Moghadam Ehsan Aghaei, Majnoon Mohamad Taghi, Zeinaloo Aliakbar
Department of Pediatric Cardiology, Children's Medical Center (Pediatric Center of Excellence), Tehran University of Medical Sciences, Tehran, Iran.
Fetal and Pediatric Cardiovascular Research Center, Children's Medical Center (Pediatric Center of Excellence), Tehran University of Medical Sciences, Tehran, Iran.
J Cardiovasc Imaging. 2024 Aug 8;32(1):23. doi: 10.1186/s44348-024-00023-4.
Pediatric pulmonary hypertension (PH) is characterized by a mean pulmonary arterial pressure exceeding 20 mmHg. There is limited research on the suitability of adult-based methods for estimating PH in pediatric populations. Using established formulas for adults, this study aimed to evaluate the correlation between echocardiographic estimates of systolic, diastolic, and mean pulmonary arterial pressures, and mean right atrial pressures in children with congenital heart disease (CHD).
A prospective study was conducted involving children with CHD undergoing cardiac catheterization without prior cardiac surgery. We used echocardiography to estimate pulmonary and right atrial pressures and compared these with invasively measured values. Four reliable regression equations were developed to estimate systolic, diastolic, and mean pulmonary arterial pressures, and mean right atrial pressures. Cutoff values were determined to predict the occurrence of PH. Linear regression, Bland-Altman analysis, and receiver operating characteristic curve analysis were performed to assess the accuracy of echocardiography and establish diagnostic thresholds for PH.
The study involved 55 children (23 with normal pulmonary arterial pressure and 32 with PH) with acyanotic CHD aged 1 to 192 months. Four equations were developed to detect high pulmonary arterial pressures, with cutoff values of 32.9 for systolic pulmonary arterial pressure, 14.95 for diastolic pulmonary arterial pressure, and 20.7 for mean pulmonary arterial pressure. The results showed high sensitivity and moderate specificity but a tendency to underestimate systolic and mean pulmonary arterial pressures at higher pressures.
The study provides valuable insights into the use of adult-based echocardiographic formulas for estimating PH in pediatric patients with acyanotic CHD.
小儿肺动脉高压（PH）的特征是平均肺动脉压超过20mmHg。关于基于成人的方法在小儿群体中评估PH适用性的研究有限。本研究使用成人的既定公式，旨在评估先天性心脏病（CHD）患儿的收缩期、舒张期和平均肺动脉压以及平均右心房压的超声心动图估计值之间的相关性。
对未经心脏手术且接受心导管检查的CHD患儿进行了一项前瞻性研究。我们使用超声心动图估计肺动脉和右心房压力，并将这些值与有创测量值进行比较。开发了四个可靠的回归方程来估计收缩期、舒张期和平均肺动脉压以及平均右心房压。确定了预测PH发生的临界值。进行线性回归、Bland-Altman分析和受试者操作特征曲线分析，以评估超声心动图的准确性并建立PH的诊断阈值。
该研究纳入了55名年龄在1至192个月之间的无青紫型CHD患儿（23名肺动脉压正常，32名患有PH）。开发了四个方程来检测高肺动脉压，收缩期肺动脉压的临界值为32.9，舒张期肺动脉压的临界值为14.95，平均肺动脉压的临界值为20.7。结果显示敏感性高、特异性中等，但在较高压力下有低估收缩期和平均肺动脉压的趋势。
该研究为在无青紫型CHD小儿患者中使用基于成人的超声心动图公式评估PH提供了有价值的见解。
