Active right atrial emptying fraction predicts reduced survival and increased adverse events in childhood pulmonary arterial hypertension.
Int J Cardiol
; 271: 306-311, 2018 Nov 15.
Article
em En
| MEDLINE
| ID: mdl-30223361
ABSTRACT
BACKGROUND:
Right atrial (RA) function has been studied rarely in childhood pulmonary arterial hypertension (PAH). We sought to determine if RA and right ventricular (RV) area changes measured by echocardiography predicted outcomes.METHODS:
We reviewed data from children with PAH undergoing cardiac catheterization and echocardiography. RA and RV areas were obtained from the apical 4-chamber view. Clinical worsening indicated initiation of parenteral prostanoid therapy, heart and/or lung transplantation, Potts shunt surgery or death.RESULTS:
We studied 57 children (27 females), median age 3â¯years (range 0.30-17â¯years), body surface area 0.56â¯m2 (0.2-1.8), follow up 3â¯years (0.21-8.35), time to clinical worsening was 1.14â¯years (0.03-6.14) and mortality was 1.55â¯years (range 0.88-4.95). We determined from receiver operator curves that RA active emptying fraction (RA EaF) ≥60% predicted clinical worsening (sensitivity 78%, specificity 69%, AUC 0.7) and mortality (sensitivity 100%, specificity 65%, AUC 0.82). RV fractional area change (RVFAC) <25% predicted clinical worsening (sensitivity 72%, specificity 79%, AUC 0.85) and death (sensitivity 67%, specificity 69%, AUC 0.77). The combination of RA EaF ≥60% and RVFAC <33% were best predictors of clinical worsening (sensitivity 72%, specificity 82%, partial AUC 0.65) and mortality (sensitivity 100%, specificity 77%, partial AUC 0.75).CONCLUSION:
In childhood PAH, RA EaFâ¯≥â¯60% and RVFAC <25% were associated with poor outcomes. RA EaF ≥60% and RVFAC <33% were best predictors of clinical worsening and may be useful markers in children with PAH who require closer observation and more intensive therapy.Palavras-chave
Texto completo:
1
Coleções:
01-internacional
Base de dados:
MEDLINE
Assunto principal:
Função do Átrio Direito
/
Hipertensão Pulmonar
Tipo de estudo:
Observational_studies
/
Prognostic_studies
/
Risk_factors_studies
Limite:
Adolescent
/
Child
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Child, preschool
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Female
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Humans
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Infant
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Male
Idioma:
En
Revista:
Int J Cardiol
Ano de publicação:
2018
Tipo de documento:
Article
País de afiliação:
Canadá