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Echocardiography-derived septal curvature correlated with invasive hemodynamics in pediatric pulmonary hypertension

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Abstract

Background

Right ventricular function and afterload are associated with clinical outcomes in pulmonary hypertension (PH). MRI-derived interventricular septal curvature has been associated with invasive hemodynamics in PH patients. This study sought to determine the relationship of echocardiography derived septal curvature with invasive hemodynamics in pediatric PH patients.

Methods

A single center chart review identified 56 pediatric patients with PH and 50 control patients with adequate echocardiography to assess septal curvature within one month of initial cardiac catheterization. Echocardiographic indices of septal flattening including end-systolic eccentricity index (EIs), maximum EI (EImax), minimum septal curvature (SCmin), and average SC (SCavg) were determined.

Results

PH patients had a median right ventricular systolic pressure of 64 mmHg (interquartile range (IQR) 48–81), mean pulmonary artery pressure of 44 mmHg (IQR 32–57), pulmonary vascular resistance of 7.9 iWU (IQR 4.8–12.9), and pulmonary capillary wedge pressure of 10 mmHg (IQR 8–12). Patients with PH had higher EIs and EImax and lower SCmin and SCavg compared to control patients. SCavg demonstrated the strongest association with right ventricular systolic pressure (R2 0.73, p < 0.0001), mean pulmonary artery pressure (R2 0.63, p < 0.0001), and pulmonary vascular resistance (R2 0.47, p < 0.0001). All septal curvature indices were associated with the composite adverse outcome, including Potts shunt, lung transplantation, and death. SCmin (HR 0.29; 95%CI 0.07–0.97) and SCavg (HR 0.15; 95%CI 0.03–0.72) were the only septal flattening indices associated with death.

Conclusions

Echocardiography derived septal curvature is a non-invasive marker of ventricular afterload and adverse outcomes.

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Abbreviations

ALCAPA:

Anomalous left coronary artery arising from the pulmonary artery

ASD:

Atrial septal defect

CAO:

Composite adverse event

CI:

Confidence interval

EIs :

Eccentricity index at end systole

EImax :

Maximum eccentricity index

EIsc :

Eccentricity index at minimum septal curvature

HR:

Hazard ratio

IQR:

Interquartile range

IVC:

Inferior vena cava

mPAP:

Mean pulmonary artery pressure

PAPVR:

Partial anomalous pulmonary venous return

PAWP:

Pulmonary artery wedge pressure

PH:

Pulmonary hypertension

Qp:

Pulmonary blood flow

Qp: Qs:

Ratio of pulmonary blood flow to cardiac index

Qs:

Cardiac index

ROC:

Receiver-operating characteristic

Rp:

Pulmonary vascular resistance

RVEDP:

Right ventricular end diastolic pressure

RVSP:

Right ventricular systolic pressure

SBP:

Systemic blood pressure

SCavg :

Average septal curvature

SCes :

Septal curvature at end systole

SCmin :

Minimum septal curvature

WHO:

World Health Organization

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Acknowledgements

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Authors and Affiliations

  1. Heart Institute, Cincinnati Children’s Hospital Medical Center, 3333 Burnet Avenue, ML 5033, Cincinnati, OH, 45229, USA

    P. J. Critser, K. Schneider, R. Hirsch, M. D. Taylor & S. M. Lang

  2. Center for Pulmonary Imaging Research, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, 45229, USA

    P. J. Critser & J. C. Woods

  3. Division of Pediatric Cardiology, Oregon Health and Science University, Portland, OR, 97239, USA

    P. D. Evers

  4. Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, 45229, USA

    P. J. Critser, K. Schneider, R. Hirsch, M. D. Taylor, J. C. Woods & S. M. Lang

  5. Department of Radiology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, 45229, USA

    J. C. Woods

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  1. P. J. Critser
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  7. S. M. Lang
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Contributions

All authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by Paul Critser, Patrick Evers, and Kristin Schneider. The first draft of the manuscript was written by Paul Critser and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to P. J. Critser.

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Conflict of interest

Paul Critser, Patrick Evers, Kristin Schneider, Russel Hirsch, Michael Taylor, Jason Woods, and Sean Lang declare that they have no conflict of interest.

Human right statement and informed consent

All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation and with the Helsinki Declaration of 1964 and later versions. The Institutional Review Board approved this study and waived the requirement for informed consent of this retrospective cohort study (study ID 2020-0391).

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Critser, P.J., Evers, P.D., Schneider, K. et al. Echocardiography-derived septal curvature correlated with invasive hemodynamics in pediatric pulmonary hypertension. J Echocardiogr 20, 24–32 (2022). https://doi.org/10.1007/s12574-021-00545-6

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  • DOI: https://doi.org/10.1007/s12574-021-00545-6

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