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Echocardiographic Markers of Mild Pulmonary Hypertension are not Correlated with Worse Respiratory Outcomes in Infants with Bronchiolitis

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Abstract

Pulmonary hypertension has been reported as a crucial factor in the pathophysiology of severe bronchiolitis. The aim of this study was to evaluate pulmonary artery pressure (PAP) in patients with bronchiolitis and to analyze their correlation with clinical outcomes. This prospective cohort study examined children admitted for bronchiolitis. PAP was assessed by right ventricle (RV) acceleration/ejection time ratio (AT/ET), isovolumic relaxation time, eccentricity index, and the presence of a pulmonary systolic notch. Pulmonary hypertension (PH) was considered if at least two altered parameters were present. Severity of clinical course was established by higher N-terminal (NT)-prohormone BNP (NT-proBNP) values, the need for positive pressure respiratory support (PPRS), and the duration of hospital admission. One hundred sixty-nine children were included in analysis. Sixty-eight patients (40%) required PPRS, and those patients had increased NT-proBNP values and worse tricuspid annular systolic excursion (TAPSE) compared to mild cases (p < 0.001and p < 0.001, respectively). Twenty-two (13%) cases had at least two altered parameters of PAP and met criteria for presumed PH, with no differences in NT-proBNP values, TAPSE, need for PPRS or hospital length of stay compared to normal PAP group (p = 0.98, p = 0.07, p = 0.94 and p = 0.64, respectively). We found no correlation between altered RV AT/ET and worse cardiac function, NT-proBNP values or hospital length of stay. In our cohort, the presence of echocardiographic findings of PH were not associated with worse clinical outcomes. Patients with severe bronchiolitis had higher values ​​of NT-proBNP but, interestingly, no clear association with PH.

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Abbreviations

AT:

Acceleration time

BiPAP:

Bi‐level positive airway pressure

BROSJOD:

Bronchiolitis Score of San Joan de Deu

CPAP:

Continuous positive airway pressure

EI:

Eccentricity index

ET:

Ejection time

HFNC:

High-flow nasal cannula

IVRT:

Isovolumic relaxation time

LOS:

Length of stay

LV:

Left ventricle

MAPSE:

Mitral annular systolic excursion

MV:

Mechanical ventilation

NC:

Nasal cannula

NIV:

Non-invasive ventilation

NT-proBNP:

N-terminal fraction of pro-B-type natriuretic peptide

PICU:

Pediatric intensive care unit

PPRS:

Positive pressure respiratory support

PH:

Pulmonary hypertension

PAP:

Pulmonary Artery pressure

RSV:

Respiratory syncytial virus

RV:

Right ventricle

RVOT:

Right ventricle outflow tract

TAPSE:

Tricuspid annular systolic excursion

TDI:

Tissue Doppler imaging

TVRJ:

Tricuspid valve regurgitation jet

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Acknowledgements

To Marta Camprubi Camprubi MD, PhD, who supervised the statistical analysis.

Funding

The article was done with no funding or support.

Author information

Author notes

  1. Joan Sanchez-de-Toledo and Iolanda Jordan have contributed equally as co-senior authors.

Authors and Affiliations

  1. Department of Pediatric Cardiology, Sant Joan de Deu Hospital, Passeig de Sant Joan de Déu, 2, Esplugues de Llobregat, 08950, Barcelona, Spain

    Maria Lucia Rossi, Maria Clara Escobar-Diaz, Paula Cecilia Randanne & Joan Sanchez-de-Toledo

  2. Cardiovascular Research Group, Sant Joan de Déu Research Institute, Barcelona, Spain

    Maria Lucia Rossi, Maria Clara Escobar-Diaz & Joan Sanchez-de-Toledo

  3. Department of Pediatrics, Boston Children’s Hospital, Boston, MA, USA

    Stephanie Marie Hadley

  4. Department of Critical Care Medicine, University of Pittsburgh, Pittsburgh, PA, USA

    Joan Sanchez-de-Toledo

  5. Pediatric Intensive Care Unit. Hospital Sant Joan de Déu, Barcelona, Spain

    Iolanda Jordan

  6. Institut de Recerca Sant Joan de Déu, University of Barcelona, Barcelona, Spain

    Iolanda Jordan

  7. Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain

    Iolanda Jordan

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  1. Maria Lucia Rossi
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Contributions

Dr. Rossi conceptualized and designed the study, collected data, analyzed echocardiograms, performed the statistical analyses, and drafted the manuscript. Dr. Escobar-Díaz drafted and critically reviewed the manuscript for important intellectual content. Dr. Hadley designed the data collection instruments, and reviewed and revised the manuscript. Dr. Randanne participated in collecting data and analyzed echocardiograms. Drs. Jordan and Sanchez de Toledo conceptualized and designed the study, coordinated and supervised data collection, and critically reviewed the manuscript for important intellectual content.

Corresponding author

Correspondence to Maria Lucia Rossi.

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The authors have no conflicts of interest relevant to this article to disclose.

Ethical Approval

Patients were included after obtaining consent from their parents or legal guardians. The study was approved by the local Institutional Review Board and followed the recommendations of the Helsinki declaration (CEIC PIC-143–18).

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Rossi, M.L., Escobar-Diaz, M.C., Hadley, S.M. et al. Echocardiographic Markers of Mild Pulmonary Hypertension are not Correlated with Worse Respiratory Outcomes in Infants with Bronchiolitis. Pediatr Cardiol 44, 237–244 (2023). https://doi.org/10.1007/s00246-022-03043-3

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