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Right Atrial Strain in Pediatric Pulmonary Hypertension-A Prospective Observational Study

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Abstract

Right ventricular (RV) afterload due to elevated pulmonary arterial (PA) pressure in pulmonary hypertension (PH) causes long-term right atrial (RA) remodeling and dysfunction. RA function has been shown to correlate with PA pressures and outcome in both adult and pediatric patients with PH. We studied the role of RA strain in estimating PA pressures in congenital heart disease (CHD)-associated PH. Children below 12 years undergoing elective repair of CHD with left-to-right shunts and echocardiographic evidence of PH were included. RA reservoir, conduit and contractile strain along with conventional measures of RV function and PA pressure were measured using transthoracic echocardiography after induction of anaesthesia. Pre-and post-repair invasive PA pressures were measured after surgical exposure. 51 children with a median age of 24 months (range 4–144 months) were included, most of whom were undergoing VSD closure. Contractile RA strain showed good correlation with pre-repair systolic PA pressure in mmHg (r = 0.59, 95%CI 0.37–0.75) or expressed as a percentage of SBP (r = 0.67, 95%CI 0.49–0.80). It also predicted persistent postoperative PH as well as pre-repair pulmonary artery acceleration time and right ventricular systolic pressure measured from tricuspid regurgitation jet. The trends of correlation observed suggest a possible prognostic role of RA strain in ACHD with PH and potential utility in its echocardiographic assessment. The observed findings merit deeper evaluation in larger cohorts.

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Data Availability

The data underlying this article will be shared on reasonable request to the corresponding author.

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Funding

No funding was received for conducting this study.

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Authors and Affiliations

  1. Department of Anaesthesia, All India Institute of Medical Sciences, Kalyani, West Bengal, India

    Subhrashis Guha Niyogi

  2. Department of Anaesthesia and Intensive Care, Government Medical College and Hospital, Chandigarh, India

    Avneet Singh

  3. Department of Anaesthesia and Intensive Care, Post Graduate Institute of Medical Education and Research, Sector 12, Chandigarh, 160012, India

    Bhupesh Kumar & Goverdhan Dutt Puri

  4. Department of Cardiothoracic and Vascular Surgery, Post Graduate Institute of Medical Education and Research, Chandigarh, India

    Anand Kumar Mishra

Authors
  1. Subhrashis Guha Niyogi
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  2. Avneet Singh
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  5. Goverdhan Dutt Puri
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Contributions

This study was jointly conceptualized by S.G.N., B.K. and G.D.P. Investigations were done by S.G.N., A.S., B.K. and A.K.M. The manuscript was prepared by SGN and BK and reviewed by all the authors.

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Correspondence to Bhupesh Kumar.

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None of the authors have any conflicts of interest to disclose.

Ethical Approval

The study was registered (NCT05699681 at clinicaltrials.gov) after Institutional Ethical Committee approval, and conducted in accordance with the ethical standards as laid down in the 1964 Declaration of Helsinki.

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Niyogi, S.G., Singh, A., Kumar, B. et al. Right Atrial Strain in Pediatric Pulmonary Hypertension-A Prospective Observational Study. Pediatr Cardiol (2024). https://doi.org/10.1007/s00246-024-03523-8

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