We read with great interest the article by Di Maria et al. [1],
describing the importance of right ventricular (RV) performance,
especially RV stroke work (RVSW) in children with pulmonary arterial
hypertension (PAH). The authors investigated the relation between
echocardiographic measurements of RV function and the "gold standard" of
right heart catheterization in children and found that the RVSW strongly
correlates with non-invasive data of RV function [1]. The authors
concluded that RVSW correlates with outcome parameters, e.g. abnormal WHO
class, and mortality, in children with PAH. We completely agree with the
findings of Di Maria et al. [1] and want to emphasize the importance of
echocardiographic evaluation, e.g. tricuspid annular peak systolic
excursion (TAPSE) for longitudinal management of pediatric patients with
PAH. Di Maria et al. compared data of patients with adverse outcomes to
patients with WHO class I-III, of different age groups: median 16.9 versus
11.8 years (table 1) and found no statistically significant difference of
TAPSE (mean values 1.3 versus 1.5 cm, respectively) between those groups
[1]. In our opinion their data would have been more promising and
statistically significant, if the authors would have compared their TAPSE
data with already existing normative data of TAPSE [2] (comparing 1.5 to
2.14 cm for 12 years of age, and 1.3 cm to 2.45 cm for 17 years of age).
This might highlight the importance of their data for future pediatric PAH
follow ups. We want to encourage the prospective use of echocardiography
for routine assessment of RV systolic function in pediatric PAH patients.
References
1.) Di Maria MV, Younoszai AK, Mertens L, Landeck BF 2nd, Ivy DD, Hunter
KS, Friedberg MK. RV stroke work in children with pulmonary arterial
hypertension: estimation based on invasive haemodynamic assessment and
correlation with outcomes. Heart 2014 Apr 29. doi: 10.1136/heartjnl-2013-
305298 [Epub ahead of print].
2.) Koestenberger M, Nagel B, Ravekes W, Avian A, Heinzl B, Fandl A,
et al. Tricuspid annular peak systolic velocity (S') in children and young
adults with pulmonary artery hypertension secondary to congenital heart
diseases, and in those with repaired tetralogy of Fallot: echocardiography
and MRI data. J Am Soc Echocardiogr 2012; 25: 1041-9.
Conflict of Interest:
None declared
We read with great interest the article by Di Maria et al. [1], describing the importance of right ventricular (RV) performance, especially RV stroke work (RVSW) in children with pulmonary arterial hypertension (PAH). The authors investigated the relation between echocardiographic measurements of RV function and the "gold standard" of right heart catheterization in children and found that the RVSW strongly correlates with non-invasive data of RV function [1]. The authors concluded that RVSW correlates with outcome parameters, e.g. abnormal WHO class, and mortality, in children with PAH. We completely agree with the findings of Di Maria et al. [1] and want to emphasize the importance of echocardiographic evaluation, e.g. tricuspid annular peak systolic excursion (TAPSE) for longitudinal management of pediatric patients with PAH. Di Maria et al. compared data of patients with adverse outcomes to patients with WHO class I-III, of different age groups: median 16.9 versus 11.8 years (table 1) and found no statistically significant difference of TAPSE (mean values 1.3 versus 1.5 cm, respectively) between those groups [1]. In our opinion their data would have been more promising and statistically significant, if the authors would have compared their TAPSE data with already existing normative data of TAPSE [2] (comparing 1.5 to 2.14 cm for 12 years of age, and 1.3 cm to 2.45 cm for 17 years of age). This might highlight the importance of their data for future pediatric PAH follow ups. We want to encourage the prospective use of echocardiography for routine assessment of RV systolic function in pediatric PAH patients.
References 1.) Di Maria MV, Younoszai AK, Mertens L, Landeck BF 2nd, Ivy DD, Hunter KS, Friedberg MK. RV stroke work in children with pulmonary arterial hypertension: estimation based on invasive haemodynamic assessment and correlation with outcomes. Heart 2014 Apr 29. doi: 10.1136/heartjnl-2013- 305298 [Epub ahead of print].
2.) Koestenberger M, Nagel B, Ravekes W, Avian A, Heinzl B, Fandl A, et al. Tricuspid annular peak systolic velocity (S') in children and young adults with pulmonary artery hypertension secondary to congenital heart diseases, and in those with repaired tetralogy of Fallot: echocardiography and MRI data. J Am Soc Echocardiogr 2012; 25: 1041-9.
Conflict of Interest:
None declared