Department of Anesthesiology, Critical Care, and Pain Medicine, Boston Children's Hospital, Boston, MA; Department of Anaesthesia, Harvard Medical School, Boston, MA.
Department of Anesthesiology, Critical Care, and Pain Medicine, Boston Children's Hospital, Boston, MA; Department of Anaesthesia, Harvard Medical School, Boston, MA.
J Cardiothorac Vasc Anesth. 2024 Dec;38(12):3101-3108. doi: 10.1053/j.jvca.2024.09.016. Epub 2024 Sep 19.
Evaluate the correlation of non-invasive echocardiographic estimates of right ventricular systolic pressure with measurements on cardiac catheterization in children with pulmonary hypertension.
Retrospective chart review.
Quaternary academic children's hospital.
Patients younger than 18 years with a diagnosis of pulmonary hypertension and confirmatory cardiac catheterization from 2015 to 2018.
We analyzed the correlation between measures of right ventricular systolic pressure using nonparametric Spearman rho (ρ) with statistical significance set at p < 0.05.
Children (N = 111) with biventricular circulation, strictly defined pulmonary hypertension, and adequate tricuspid regurgitation on echocardiogram to estimate right ventricular systolic pressure using the modified Bernoulli equation. Median age and weight were 4.3 years and 14.4 kg. Median right ventricular systolic pressure estimated by tricuspid regurgitant velocity on echocardiography was 55 mmHg (IQR 45-75 mmHg) plus right atrial pressure. On cardiac catheterization, median right ventricular systolic pressure was 57 mmHg (IQR 46-75 mmHg). Echocardiographic estimates of right ventricular systolic pressure were moderately well correlated with right ventricular systolic pressure directly measured on catheterization (ρ = 0.44, 95% CI 0.27-0.6, p < 0.001) with a median difference of 4 mmHg (IQR -10 to 17). Subgroup analysis revealed that echocardiography and catheterization measurements correlated well in children with suprasystemic right ventricular pressure on cardiac catheterization (ρ = 0.75, 95% CI 0.51-0.99, p < 0.001) although catheterization measurements were a median of 26 mmHg (IQR 12-31) higher than echocardiographic estimates in this subgroup.
In children with pulmonary hypertension, echocardiographic estimates of right ventricular pressure correlated moderately well with gold standard measurements by cardiac catheterization with stronger correlation in children with suprasystemic right ventricular pressures. This is reassuring for clinicians who must rely on echocardiography for risk stratification before anesthetizing children with pulmonary hypertension.
评估超声心动图估测右心室收缩压与肺动脉高压患儿心导管检查测量值的相关性。
回顾性图表审查。
四级学术儿童医院。
2015 年至 2018 年间，年龄小于 18 岁且经心导管检查确诊为肺动脉高压并经证实的患儿。
我们使用非参数 Spearman rho (ρ) 分析了使用右心室收缩压的各种测量方法之间的相关性，统计学意义设定为 p < 0.05。
共有 111 名患儿纳入研究，其双心室循环、严格定义的肺动脉高压以及超声心动图上有足够三尖瓣反流来使用改良伯努利方程估测右心室收缩压。中位年龄和体重分别为 4.3 岁和 14.4kg。超声心动图估测的三尖瓣反流速度的右心室收缩压为 55mmHg（四分位距 45-75mmHg），加上右心房压。在心导管检查中，右心室收缩压的中位数为 57mmHg（四分位距 46-75mmHg）。超声心动图估测的右心室收缩压与心导管检查直接测量的右心室收缩压中度相关（ρ=0.44，95%可信区间 0.27-0.6，p < 0.001），中位数差异为 4mmHg（四分位距-10 至 17）。亚组分析显示，在心导管检查中右心室压力高于体循环的患儿中，超声心动图和心导管检查测量值相关性良好（ρ=0.75，95%可信区间 0.51-0.99，p < 0.001），尽管在该亚组中，心导管检查测量值比超声心动图估测值中位数高 26mmHg（四分位距 12-31）。
在肺动脉高压患儿中，超声心动图估测右心室压力与金标准心导管检查测量值中度相关，在右心室压力高于体循环的患儿中相关性更强。这对于必须依靠超声心动图对接受麻醉的肺动脉高压患儿进行风险分层的临床医生来说是令人安心的。
