Abstract 17576: Right Atrial and Right Ventricular Deformation Are Reflections of Right Ventricular Afterload in Predicting Outcomes in Pediatric Pulmonary Hypertension
Background: Pulmonary hypertension (PH) results in right ventricular (RV) dysfunction. Elevated right atrial (RA) pressure is prognostic of adverse outcomes in PH. Strain imaging provides quantitative assessment of cardiac deformation and our previous study demonstrated that RA reservoir and conduit functions are decreased in pediatric PH compared to controls. In this study, we compared RA and RV deformation to invasive hemodynamics and assessed outcomes in pediatric PH.
Methods: Sixty-six PH patients (mean age 8.9 ±5.6 years) with 146 echocardiograms and 105 catheterizations were retrospectively evaluated. RA and RV deformation indices were obtained in the apical 4 chamber view using 2D speckle tracking (2DCPA, TomTec). RA strain, strain rates, emptying fraction, and RV global longitudinal strain (GLS) were measured. Tricuspid regurgitation (TR) velocity, end-systolic RV/LV ratio, TAPSE, and fractional area change (FAC) were measured. Systolic and mean pulmonary artery pressure (sPAP, mPAP), mean RA pressure (mRAP), pulmonary vascular resistance index (PVRi), and cardiac index were obtained. PH patients with and without clinical events were compared. Logistic regression was used to test the association of invasive indices and with adverse events defined as: initiation of intravenous prostacyclin, atrial septostomy, death, or transplant.
Results: PH patient with 22 adverse events had worse TR velocity, FAC, peak RA strain (ɛS), higher RV/LV ratio, sPAP, mPAP, and PVRi compared to patients with no clinical events (all p<0.01). There was significant association between early strain (ɛE), atrial EDV, and ESV with mRAP (estimate -o.o6, p<0.02; 2.13, p<0.001; 1.59, p<0.004 respectively). RVGLS was significantly associated with mPAP (estimate 0.08, p<0.004). ɛS, ɛE, early negative SR, RVGLS, and RV/LV ratio were found to be predictors of survival (HR 0.95, p<0.01; 0.95, p<0.04; 2.03, p<0.001; 1.18, p<0.001; 14.27, p<0.001).
Conclusions: High afterload results in RV dysfunction which results in impaired RA reservoir and conduit functions in pediatric PH patients. RA pump function remains preserved in pediatric PH. Reservoir, conduit function, RV strain, and RV/LV ratio (reflection of RV afterload) emerged as outcome predictors in pediatric PH.
Author Disclosures: P. Jone: None. L. Li: None. M.J. Mulvahill: None. M. Craft: None. D. Ivy: None. S. Kutty: None.
- © 2016 by American Heart Association, Inc.