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Cardiomyopathy in children: Can we rely on echocardiographic tricuspid regurgitation gradient estimates of right ventricular and pulmonary arterial pressure?

Published online by Cambridge University Press:  04 March 2016

Simon Lee ,
Irene D. Lytrivi ,
Zhanna Roytman ,
Hyun-Sook Helen Ko ,
Cheryl Vinograd  and
Shubhika Srivastava
Simon Lee*
Affiliation:
Department of Pediatrics, Icahn School of Medicine at Mount Sinai, Division of Cardiology, Kravis Children’s Hospital, New York, New York
Irene D. Lytrivi
Affiliation:
Department of Pediatrics, Icahn School of Medicine at Mount Sinai, Division of Cardiology, Kravis Children’s Hospital, New York, New York
Zhanna Roytman
Affiliation:
Department of Pediatrics, Icahn School of Medicine at Mount Sinai, Division of Cardiology, Kravis Children’s Hospital, New York, New York
Hyun-Sook Helen Ko
Affiliation:
Department of Pediatrics, Icahn School of Medicine at Mount Sinai, Division of Cardiology, Kravis Children’s Hospital, New York, New York
Cheryl Vinograd
Affiliation:
Department of Pediatrics, Kravis Children’s Hospital, New York, New York
Shubhika Srivastava
Affiliation:
Department of Pediatrics, Icahn School of Medicine at Mount Sinai, Division of Cardiology, Kravis Children’s Hospital, New York, New York
*
Correspondence to: S. Lee, MD, Department of Pediatrics, Icahn School of Medicine at Mount Sinai, Division of Cardiology, Kravis Children’s Hospital, 1468 Madison Avenue, Annenberg Building, Suite 3-50, New York, NY 10029, United States of America. Tel: +212 241 8662; Fax: +888 367 1977; E-mail: simon.lee@mssm.edu
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Abstract

Introduction

Agreement between echocardiography and right heart catheterisation-derived right ventricular systolic pressure is modest in the adult heart failure population, but is unknown in the paediatric cardiomyopathy population.

Methods

All patients at a single centre from 2001 to 2012 with a diagnosis of cardiomyopathy who underwent echocardiography and catheterisation within 30 days were included in this study. The correlation between tricuspid regurgitation gradient and catheterisation-derived right ventricular systolic pressure and mean pulmonary artery pressure was determined. Agreement between echocardiography and catheterisation-derived right ventricular systolic pressure was assessed using Bland–Altman plots. Analysis was repeated for patients who underwent both procedures within 7 days. Haemodynamic data from those with poor agreement and good agreement between echocardiography and catheterisation were compared.

Results

A total of 37 patients who underwent 48 catheterisation procedures were included in our study. The median age was 11.8 (0.1–20.6 years) with 22 males (58% total). There was a modest correlation (r=0.65) between echocardiography and catheterisation-derived right ventricular systolic pressure, but agreement was poor. Agreement between tricuspid regurgitation gradient and right ventricular systolic pressure showed wide 95% limits of agreement. There was a modest correlation between the tricuspid regurgitation gradient and mean pulmonary artery pressure (r=0.6). Shorter time interval between the two studies did not improve agreement. Those with poor agreement between echocardiography and catheterisation had higher right heart pressures, but this difference became insignificant after accounting for right atrial pressure.

Conclusion

Transthoracic echocardiography estimation of right ventricular systolic pressure shows modest correlation with right heart pressures, but has limited agreement and may underestimate the degree of pulmonary hypertension in paediatric cardiomyopathy patients.

Keywords

Cardiomyopathytricuspid regurgitationpulmonary hypertension
Type
Original Articles
Information
Cardiology in the Young , Volume 26 , Issue 7 , October 2016 , pp. 1406 - 1413
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Copyright
© Cambridge University Press 2016 

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