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Normal values of the pulmonary artery acceleration time (PAAT) and the right ventricular ejection time (RVET) in children and adolescents and the impact of the PAAT/RVET-index in the assessment of pulmonary hypertension

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Abstract

New echocardiographic modalities including pulmonary artery acceleration time (PAAT) and right ventricular ejection time (RVET) are evolving to facilitate an early non-invasive diagnosis for pulmonary hypertension (PH) in adults. In children, PAAT depends on age, body surface area (BSA) and heart rate (HR) and is used to predict PH. Normal values of RVET and their role to predict PH in children are still missing. PAAT/RVET-index correlates negatively with PH. We hypothesized that this index is a good predictor for PH in children and adolescents independent of age, BSA and HR and RVET is significantly reduced in PH. PAAT and RVET of 401 healthy children and 30 PH-patients were measured using pulsed-wave-Doppler. PH was diagnosed in PH-group invasively. PAAT/RVET-index for both groups was calculated. Sensitivity and specificity in prediction of PH of PAAT, PAAT z-score and PAAT/RVET-index were compared. We demonstrated normal values of RVET in children. In the healthy group, PAAT and RVET correlated significant positive to age (p < 0.001), and BSA (p < 0.001) and negative to HR (p < 0.001). PAAT/RVET-index correlated weakly to age, BSA and HR (p < 0.001). Mean pulmonary artery pressure (PAPM) ranged in the PH-group from 27 to 82 mmHg (mean 44 mmHg). In predicting PH, RVET is significantly reduced (p < 0.001). Comparing area under the curve (AUC), the difference between sensitivity and specificity of PAAT/RVET-index < 0.29 and calculated PAAT cut-off-point (87 ms) was significant (p < 0.001). Equally, AUC comparison between PAAT/RVET-index < 0.29 and PAAT z-score of − 1.33 was significant (p = 0.008). PAAT/RVET-index < 0.29 represents a good predictor of PH with a 100% sensitivity and a 95.8% specificity. PAAT/RVET-index is a simple tool and facilitates prediction of PH independent from z-scores.

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Acknowledgements

The present work was performed in fulfillment of the requirements for obtaining the degree “Dr. med” at “Friedrich-Alexander-Universität, Erlangen-Nürnberg (FAU)” for Sheeraz Habash.

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Authors and Affiliations

  1. Department of Pediatric Cardiology, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nuernberg, Erlangen, Germany

    Sheeraz Habash, Julia Moosmann, Martin Glöckler & Sven Dittrich

  2. Department for Congenital Heart Defects, Heart and Diabetes Centre North Rhine Westphalia, Ruhr University Bochum, Bad Oeynhausen, Germany

    Sheeraz Habash, Kai Thorsten Laser & Deniz Kececioglu

  3. Pediatric Cardiologic Practice, Nuernberg, Germany

    Roland Reif

  4. Department of Medical Informatics, Biometry and Epidemiology, Friedrich-Alexander-University Erlangen-Nuernberg, Erlangen, Germany

    Werner Adler

  5. Kiefernweg 7, 91088, Bubenreuth, Germany

    Sheeraz Habash

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Correspondence to Sheeraz Habash.

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The study was approved by the ethics committee of the University of Erlangen-Nurnberg and University of Bochum. All procedures were based on standard of care, and established clinical guidelines were followed. The study was conducted in accordance with the Declaration of Helsinki.

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Habash, S., Laser, K.T., Moosmann, J. et al. Normal values of the pulmonary artery acceleration time (PAAT) and the right ventricular ejection time (RVET) in children and adolescents and the impact of the PAAT/RVET-index in the assessment of pulmonary hypertension. Int J Cardiovasc Imaging 35, 295–306 (2019). https://doi.org/10.1007/s10554-019-01540-w

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