Active right atrial emptying fraction predicts reduced survival and increased adverse events in childhood pulmonary arterial hypertension
| Autor: | Shine Kumar, Ian Adatia, Shreepal Jain, Karunakar Vadlamudi, Benjamin H. Goot, Prashant Bobhate, Nee Scze Khoo, Timothy Colen, Tarek Kaddoura, Mohamed Elgendi |
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| Rok vydání: | 2017 |
| Předmět: |
Male
medicine.medical_specialty Cardiac Catheterization Adolescent medicine.medical_treatment Hypertension Pulmonary Atrial Function Right 030204 cardiovascular system & hematology Right atrial 03 medical and health sciences chemistry.chemical_compound 0302 clinical medicine Predictive Value of Tests Internal medicine Medicine Lung transplantation Humans 030212 general & internal medicine Adverse effect Child Cardiac catheterization Retrospective Studies Body surface area Potts shunt business.industry Prostanoid Infant medicine.disease Pulmonary hypertension Survival Rate chemistry Child Preschool Cardiology Female Cardiology and Cardiovascular Medicine business |
| Zdroj: | International journal of cardiology. 271 |
| ISSN: | 1874-1754 |
| Popis: | Right atrial (RA) function has been studied rarely in childhood pulmonary arterial hypertension (PAH). We sought to determine if RA and right ventricular (RV) area changes measured by echocardiography predicted outcomes.We reviewed data from children with PAH undergoing cardiac catheterization and echocardiography. RA and RV areas were obtained from the apical 4-chamber view. Clinical worsening indicated initiation of parenteral prostanoid therapy, heart and/or lung transplantation, Potts shunt surgery or death.We studied 57 children (27 females), median age 3 years (range 0.30-17 years), body surface area 0.56 m2 (0.2-1.8), follow up 3 years (0.21-8.35), time to clinical worsening was 1.14 years (0.03-6.14) and mortality was 1.55 years (range 0.88-4.95). We determined from receiver operator curves that RA active emptying fraction (RA EaF) ≥60% predicted clinical worsening (sensitivity 78%, specificity 69%, AUC 0.7) and mortality (sensitivity 100%, specificity 65%, AUC 0.82). RV fractional area change (RVFAC)25% predicted clinical worsening (sensitivity 72%, specificity 79%, AUC 0.85) and death (sensitivity 67%, specificity 69%, AUC 0.77). The combination of RA EaF ≥60% and RVFAC33% were best predictors of clinical worsening (sensitivity 72%, specificity 82%, partial AUC 0.65) and mortality (sensitivity 100%, specificity 77%, partial AUC 0.75).In childhood PAH, RA EaF ≥ 60% and RVFAC25% were associated with poor outcomes. RA EaF ≥60% and RVFAC33% were best predictors of clinical worsening and may be useful markers in children with PAH who require closer observation and more intensive therapy. |
| Databáze: | OpenAIRE |
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