Pulmonary vascular disease & thromboembolism
Use of Right Ventricular Free-Wall Strain in a Multivariable Estimate of Right Ventricular-Arterial Coupling in Pediatric Pulmonary Arterial Hypertension
Authors' conclusion
In the pediatric population, baseline PVRi and echo-estimated PASP were strongly associated with adverse clinical outcomes, but TAPSE and RVFW-LS were not. Estimates of RVAC utilizing RVFW-LS were superior to those utilizing TAPSE-however, only marginally additive to PASP and PVRi at predicting the adverse clinical outcome in patients without a history of repaired congenital heart disease.
Study context
- Population
- Children with pulmonary arterial hypertension undergoing hemodynamic catheterization with simultaneous echocardiography
- Participants
- 108 children2 institutions
- Exposure
- Right ventricular free-wall longitudinal strain (RVFW-LS)-based vs tricuspid annular plane systolic excursion (TAPSE)-based estimates of RV-arterial coupling (right ventricular-arterial coupling (RVAC)) for predicting transplant or death
- Outcome
- Transplant or death
Methodological details2 institutions
- 2 institutions
Main finding
As reported in the abstract
Prediction of transplant or death
| Group | AUC |
|---|---|
| PVRi | 0.771 [P<0.001] |
| Pulmonary artery systolic pressure (PASP) | 0.729 [P=0.004] |
| RVFW-LS/PVRi | 0.748 [P=0.002] |
| TAPSE/PVRi | 0.732 [P=0.009] |
| RVFW-LS/PASP | 0.714 [P=0.01] |
| TAPSE/PASP | 0.671 |
| RVFW-LS | 0.603 |
| TAPSE | 0.525 |
AUC
PVRi0.771 [P<0.001]
Pulmonary artery systolic pressure (PASP)0.729 [P=0.004]
RVFW-LS/PVRi0.748 [P=0.002]
TAPSE/PVRi0.732 [P=0.009]
RVFW-LS/PASP0.714 [P=0.01]
TAPSE/PASP0.671
RVFW-LS0.603
TAPSE0.525
Observational data: associations, not effects.
Further findings
| Outcome | RVFW-LS/PASP | PVRi | PASP | RVFW-LS/PVRi |
|---|---|---|---|---|
| Transplant or death, patients without repaired congenital heart disease (subgroup) | ||||
| AUC | 0.738 [P=0.002] | 0.729 [P=0.01] | 0.729 [P=0.01] | 0.729 [P=0.015] |
- Transplant or death, patients without repaired congenital heart disease (subgroup): n=88
Correlation with PVRi
- RVFW-LS correlated with PVRi
- r=0.315, P=0.01
- TAPSE did not correlate with PVRi
- r=0.058, P=0.64
WHO Functional Class
- PVRi, PASP and RVAC metrics declined with worse WHO Functional Class; TAPSE and RVFW-LS did not
- n=108
Transplant or death, patients without repaired congenital heart disease (subgroup)
- Only RVFW-LS/PASP, PVRi, PASP and RVFW-LS/PVRi predicted outcomes
Original publication
Use of Right Ventricular Free-Wall Strain in a Multivariable Estimate of Right Ventricular-Arterial Coupling in Pediatric Pulmonary Arterial Hypertension. Circ Cardiovasc Imaging. Published 17 December 2024. doi:10.
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