Right Ventricular Diastolic Performance in Children with Pulmonary Arterial Hypertension Associated with Congenital Heart Disease: Correlation of Echocardiographic Parameters with Invasive Reference Standards by High-fidelity Micro-manometer Catheter
Background—Right ventricular (RV) diastolic dysfunction influences outcomes in pulmonary arterial hypertension (PAH); but echocardiographic parameters have not been investigated in relation to invasive reference standards in pediatric PAH. We investigated echocardiographic parameters of RV diastolic function in children with PAH in relation to simultaneously measured invasive reference measures.
Methods and Results—We prospectively recruited children undergoing a clinically indicated cardiac catheterization for evaluation of PAH and/ or pulmonary vasoreactivity testing. Echocardiography was performed simultaneously with invasive reference measurements by high-fidelity micro-manometer catheter. For analysis, patients were divided into shunt and non-shunt groups. 16 children were studied. In the group as a whole, significant correlations were found between tau and tricuspid deceleration time, E', E/E', TimeE-E', A-wave velocity and global early and late diastolic strain rate. dp/dt minimum correlated significantly with late diastolic tricuspid annular velocity (A'), TDI derived S:D ratio and global late diastolic strain rate. EDP correlated significantly with TDI derived S:D ratio. On multivariate analysis, tricuspid deceleration time, TimeE-E' and global early diastolic strain rate were independent predictors of tau, while TDI derived S:D ratio was an independent predictor of dp/dt minimum. In general, correlations between echocardiographic and invasive parameters were better in the shunt group than in the non-shunt group.
Conclusions—Echocardiography correlates with invasive reference measures of RV diastolic function in children with PAH, although does not differentiate between early versus late diastolic abnormalities. Newer echocardiographic techniques may have added value to assess RV diastolic dysfunction in this population.
- pulmonary arterial hypertension
- systolic: diastolic duration ratio
- right ventricular function
- diastolic function
- Received August 16, 2013.
- Accepted February 21, 2014.