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Invasive haemodynamics predict outcomes in paediatric pulmonary artery hypertension

Published online by Cambridge University Press:  04 April 2024

Rupesh Kumar Natarajan Open the ORCID record for Rupesh Kumar Natarajan [Opens in a new window] ,
Nathan Rodgers ,
Shanti Narasimhan ,
Matthew Ambrose ,
Abraham Rothman ,
Michael Shyne ,
Michael Evans  and
Varun Aggarwal
Rupesh Kumar Natarajan
Affiliation:
Division of Pediatric Cardiology, University of Minnesota, Minneapolis, MN, USA
Nathan Rodgers
Affiliation:
Division of Pediatric Cardiology, University of Minnesota, Minneapolis, MN, USA
Shanti Narasimhan
Affiliation:
Division of Pediatric Cardiology, University of Minnesota, Minneapolis, MN, USA
Matthew Ambrose
Affiliation:
Division of Pediatric Cardiology, University of Minnesota, Minneapolis, MN, USA
Abraham Rothman
Affiliation:
Children’s Heart Center of Nevada, UNLV School of Medicine, Las Vegas, NV, USA
Michael Shyne
Affiliation:
Clinical and Translational Science Institute, University of Minnesota, Minneapolis, MN, USA
Michael Evans
Affiliation:
Clinical and Translational Science Institute, University of Minnesota, Minneapolis, MN, USA
Varun Aggarwal*
Affiliation:
Division of Pediatric Cardiology, University of Minnesota, Minneapolis, MN, USA
*
Corresponding author: Varun Aggarwal; Email: aggar134@umn.edu
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Abstract

Background:

Invasive haemodynamics are often performed for initiating and guiding pulmonary artery hypertension therapy. Little is known about the predictive value of invasive haemodynamic indices for long-term outcomes in children with pulmonary artery hypertension. We aimed to evaluate invasive haemodynamic data to help predict outcomes in paediatric pulmonary artery hypertension.

Methods:

Patients with pulmonary artery hypertension who underwent cardiac catheterisation (2006–2019) at a single centre were included. Invasive haemodynamic data from the first cardiac catheterisation and clinical outcomes were reviewed. The combined adverse outcome was defined as pericardial effusion (due to right ventricle failure), creation of a shunt for pulmonary artery hypertension (atrial septal defect or reverse Pott’s shunt), lung transplant, or death.

Results:

Among 46 patients with a median [interquartile range (IQR)] age of 13.2 [4.1–44.7] months, 76% had CHD. Median mean pulmonary artery pressure was 37 [28–52] mmHg and indexed pulmonary vascular resistance was 6.2 [3.6–10] Woods units × m2. Median pulmonary artery pulsatility index was 4.0 [3.0–4.7] and right ventricular stroke work index was 915 [715–1734] mmHg mL/m2. After a median follow-up of 2.4 years, nine patients had a combined adverse outcome (two had a pericardial effusion, one underwent atrial level shunt, one underwent reverse Pott’s shunt, and six died). Patients with an adverse outcome had higher systolic and mean pulmonary artery pressures, higher diastolic and transpulmonary pressure gradients, higher indexed pulmonary vascular resistance, higher pulmonary artery elastance, and higher right ventricular stroke work index (p < 0.05 each).

Conclusion:

Invasive haemodynamics (especially mean pulmonary artery pressure and diastolic pressure gradient) obtained at first cardiac catheterisation in children with pulmonary artery hypertension predicts outcomes.

Keywords

Invasive haemodynamicspaediatric pulmonary artery hypertensionoutcomes
Type
Original Article
Information
Cardiology in the Young , First View , pp. 1 - 8
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Copyright
© The Author(s), 2024. Published by Cambridge University Press

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