Skip to main content
Log in

Echocardiographic Evaluation of Ventricular Function in Children With Pulmonary Hypertension

  • Original Article
  • Published:
Pediatric Cardiology Aims and scope Submit manuscript

A Letter to the Editor to this article was published on 09 February 2014

Abstract

Although described in adults, it remains unclear whether ventricular dysfunction exists in pediatric patients with pulmonary hypertension (PHN). The goal of this study was to identify differences in echocardiographic indices of ventricular function among pediatric PHN patients. From 2009 to 2011, pediatric PHN patients with normal intracardiac anatomy and age-matched controls (1:3 ratio) were enrolled in this retrospective case–control study. Diagnosis of PHN was based on tricuspid regurgitation velocity or septal position estimating right-ventricular (RV) pressure >50 % systemic. Measures of RV and left ventricular systolic and diastolic function, including tissue Doppler imaging (TDI) of the mitral annulus (MA) and tricuspid annulus (TA), were compared. Enrollees included 25 PHN patients and 75 age-matched controls (mean age 7.5 years [range 1 day to 19 years]). Parameters of RV systolic and diastolic function were worse in PHN patients. Compared with controls, PHN patients had significantly decreased tricuspid valve inflow ratio, decreased TA TDI early diastolic velocities, decreased systolic velocities, increased tricuspid E/E’ ratio (all p < 0.01) and increased myocardial performance index. In an age-stratified analysis, TDI measures in PHN patients <1 year of age were similar to controls, whereas differences in TA TDI velocities and MA TDI velocities were noted in patients ≥1 year of age. Abnormalities in Doppler echocardiographic indices of ventricular systolic and diastolic function were identified in pediatric PHN patients and were more prominent with older age. These indices are promising for serial noninvasive monitoring of disease severity, but further correlation with catheterization-derived measures is needed.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Barst RJ, Ertel SI, Beghetti M, Ivy DD (2011) Pulmonary arterial hypertension: a comparison between children and adults. Eur Respir J 37:665–677

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  2. Barst RJ, Maislin G, Fishman AP (1999) Vasodilator therapy for primary pulmonary hypertension in children. Circulation 99:1197–1208

    Article  CAS  PubMed  Google Scholar 

  3. Humbert M, Sitbon O, Simonneau G (2004) Treatment of pulmonary arterial hypertension. N Engl J Med 351:1425–1436

    Article  CAS  PubMed  Google Scholar 

  4. Chin KM, Kim NH, Rubin LJ (2005) The right ventricle in pulmonary hypertension. Coron Artery Dis 16:13–18

    Article  PubMed  Google Scholar 

  5. Lopez-Candales A, Edelman K, Gulyasy B (2011) The effect of chronic pulmonary hypertension on diastolic annular tissue velocities: a pilot study. Am J Med Sci 341:344–349

    Article  PubMed  Google Scholar 

  6. Rajagopalan N, Saxena N, Simon MA, Edelman K, Mathier MA, Lopez-Candales A (2007) Correlation of tricuspid annular velocities with invasive hemodynamics in pulmonary hypertension. Congest Heart Fail 13:200–204

    Article  PubMed  Google Scholar 

  7. Ruan Q, Nagueh SF (2007) Clinical application of tissue Doppler imaging in patients with idiopathic pulmonary hypertension. Chest 131:395–401

    Article  PubMed  Google Scholar 

  8. Lammers AE, Haworth SG, Riley G, Maslin K, Diller GP, Marek J (2012) Value of tissue Doppler echocardiography in children with pulmonary hypertension. J Am Soc Echocardiogr 25:504–510

    Article  PubMed  Google Scholar 

  9. Takatsuki S, Nakayama T, Jone PN, Wagner BD, Noai K, Ivy DD et al (2012) Tissue Doppler imaging predicts adverse outcome in children with idiopathic pulmonary arterial hypertension. J Pediatr 161:1126–1131

    Article  PubMed Central  PubMed  Google Scholar 

  10. Lai WW, Geva T, Shirali GS, Frommelt PC, Humes RA, Brook MM et al (2006) Guidelines and standards for performance of a pediatric echocardiogram: a report from the Task Force of the Pediatric Council of the American Society of Echocardiography. J Am Soc Echocardiogr 19:1413–1430

    Article  PubMed  Google Scholar 

  11. Puwanant S, Park M, Popovic ZB, Tang WHW, Farha S, George D et al (2010) Ventricular geometry, strain, and rotational mechanics in pulmonary hypertension. Circulation 121:259–266

    Article  PubMed Central  PubMed  Google Scholar 

  12. Mori K, Nakagawa R, Nii M, Edagawa T, Takehara Y, Inoue M et al (2004) Pulsed wave Doppler tissue echocardiography assessment of the long axis function of the right and left ventricles during the early neonatal period. Heart 90:175–180

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  13. Rudski LG, Lai WW, Afilalo J, Hua L, Handschumacher MD, Chandrasekaran K et al (2010) Guidelines for the echocardiographic assessment of the right heart in adults: a report from the American Society of Echocardiography endorsed by the European Association of Echocardiography, a registered branch of the European Society of Cardiology, and the Canadian Society of Echocardiography. J Am Soc Echocardiogr 23:685–713

    Article  PubMed  Google Scholar 

  14. Patel N, Mills JF, Cheung MM (2009) Assessment of right ventricular function using tissue Doppler imaging in infants with pulmonary hypertension. Neonatology 96:193–199 discussion 200–192

    Article  PubMed  Google Scholar 

  15. Bristow MR, Zisman LS, Lowes BD, Abraham WT, Badesch DB, Groves BM et al (1998) The pressure-overloaded right ventricle in pulmonary hypertension. Chest 114:101S–106S

    Article  CAS  PubMed  Google Scholar 

  16. Zervan K, Male C, Benesch T, Salzer-Muhar U (2009) Ventricular interaction in children after repair of tetralogy of Fallot: a longitudinal echocardiographic study. Eur J Echocardiogr 10:641–646

    Article  PubMed  Google Scholar 

  17. Gurudevan SV, Malouf PJ, Auger WR, Waltman TJ, Madani M, Raisinghani AB et al (2007) Abnormal left ventricular diastolic filling in chronic thromboembolic pulmonary hypertension: true diastolic dysfunction or left ventricular underfilling? J Am Coll Cardiol 49:1334–1339

    Article  PubMed  Google Scholar 

  18. Lumens J, Blanchard DG, Arts T, Mahmud E, Delhaas T (2010) Left ventricular underfilling and not septal bulging dominates abnormal left ventricular filling hemodynamics in chronic thromboembolic pulmonary hypertension. Am J Physiol Heart Circ Physiol 299:H1083–H1091

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Erika E. Vorhies.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Vorhies, E.E., Gajarski, R.J., Yu, S. et al. Echocardiographic Evaluation of Ventricular Function in Children With Pulmonary Hypertension. Pediatr Cardiol 35, 759–766 (2014). https://doi.org/10.1007/s00246-013-0849-3

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00246-013-0849-3

Keywords

Navigation