Clinical InvestigationEchocardiography in ChildrenRight Ventricular to Left Ventricular Diameter Ratio at End-Systole in Evaluating Outcomes in Children with Pulmonary Hypertension
Section snippets
Normal Controls
The University of Colorado Children's Hospital Colorado pediatric normal echocardiographic database (per an institutional review board–approved protocol) was used to retrospectively identify 80 normal controls with similar age and gender distributions as the PH cohort. All 80 normal children were evaluated for heart murmurs and had normal results on echocardiography. RV/LV ratios were obtained in normal controls and compared with RV/LV ratios in patients with PH.
Patients with PH
The University of Colorado
Results
The data consist of 80 echocardiograms in 80 normal controls and 194 echocardiographic measurements in 84 patients with PH, with a median of two observations per patient with PH (range, 1–6). Clinical diagnoses and medications in patients with PH are shown in Table 1.
Discussion
In this study, RV/LV ratio measured in the standard parasternal short-axis view was easily obtained in all subjects and feasible in 99% of all echocardiographic studies. RV/LV ratio was significantly higher in patients with PH compared with normal controls. RV/LV ratios correlated well with invasive hemodynamic measures, and increased RV/LV ratio was associated with adverse clinical events, making this new index a potentially clinical relevant parameter in patients with PH.
Because of the
Conclusions
The RV/LV end-systolic diameter ratio incorporates both pathologic septal shift and RV dilation in PH and correlates with invasive hemodynamic measures of PH. The RV/LV ratio can easily be obtained in the clinical setting and appears to be a strong predictor of outcome. The RV/LV ratio may be a valuable additional echocardiographic measure in the quest to find a surrogate technology for cardiac catheterization in children with PH.
Acknowledgments
We would like to acknowledge the contributions of Courtney Cassidy and Allison Sterk in data collection.
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This study was supported by the Frederick and Margaret L Weyerhaeuser Foundation, the Jayden DeLuca Foundation, the Leah Bult Foundation, Colorado Clinical Translational Science Institute (UL1 TR000154), National Center for Research Resources, and National Institutes of Health, P50 HL084923, and RO1 HL114753.