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Right Ventricular Tissue Doppler Myocardial Performance Index in Children with Pulmonary Hypertension: Relation to Invasive Hemodynamics

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Abstract

Right ventricular (RV) failure is a significant cause of morbidity and mortality in patients with pulmonary hypertension (PH). Myocardial performance index measured by tissue Doppler imaging (TDI-MPI) has been useful in assessing RV dysfunction in adults with PH. However, TDI-MPI as a marker for RV dysfunction or disease severity has not been evaluated in pediatric PH. The aim of this study was to investigate TDI-MPI and correlate with invasive hemodynamics in pediatric PH patients. Eighty pediatric PH patients undergoing cardiac catheterization and simultaneous transthoracic echocardiography were analyzed. RV TDI-MPI was averaged over three cardiac cycles and measured under each condition of vasodilatory testing during the catheterization. TDI-MPI was compared between PH patients and age-matched controls and correlated to invasive hemodynamics. RV TDI-MPI was increased in PH patients compared to controls (0.49 vs. 0.35, p < 0.0001). Significant associations (beta ± SE) are seen between RV TDI-MPI and baseline mean pulmonary arterial pressures (0.0002 ± 0.001, p < 0.05), indexed pulmonary vascular resistance (0.007 ± 0.002, p < 0.002), and pulmonary-to-systemic arterial pressure ratio (0.146 ± 0.063, p < 0.05). No statistically significant associations were seen with vasodilatory testing. RV TDI-MPI is elevated in children with PH, suggestive of RV dysfunction. RV TDI-MPI shows correlation with severity of PH at baseline but lacks sensitivity to evaluate the RV response to acute changes in afterload in children with PH. Therefore, while RV TDI-MPI can help identify RV dysfunction in children with PH, its utility as a non-invasive surrogate marker for acute changes in hemodynamics is limited.

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Funding

This study was supported by the Frederick and Margaret L. Weyerhaeuser Foundation, the Jayden de Luca Foundation, NIH Grants R01HL114753, U01HL121518, and by NIH/NCATS Colorado CTSA Grant Number UL1 TR001082.

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Authors and Affiliations

  1. Division of Cardiology, Heart Institute, Children’s Hospital Colorado, University of Colorado Denver | Anschutz Medical Campus, Aurora, CO, USA

    Richard M. Friesen, Michal Schäfer, Dale A. Burkett, Courtney J. Cassidy, D. Dunbar Ivy & Pei-Ni Jone

  2. Department of Bioengineering, College of Engineering and Applied Sciences, University of Colorado Denver | Anschutz Medical Campus, Aurora, CO, USA

    Michal Schäfer

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  1. Richard M. Friesen
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  2. Michal Schäfer
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  3. Dale A. Burkett
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  5. D. Dunbar Ivy
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  6. Pei-Ni Jone
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Correspondence to Richard M. Friesen.

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All authors declare they have no conflicts of interest to disclose.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Informed consent was obtained from all individual participants included in the study.

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Friesen, R.M., Schäfer, M., Burkett, D.A. et al. Right Ventricular Tissue Doppler Myocardial Performance Index in Children with Pulmonary Hypertension: Relation to Invasive Hemodynamics. Pediatr Cardiol 39, 98–104 (2018). https://doi.org/10.1007/s00246-017-1733-3

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  • DOI: https://doi.org/10.1007/s00246-017-1733-3

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