Author + information
Doppler echocardiography (DE) is widely used as a surrogate for right heart catheterization (RHC), the gold standard, to assess and monitor elevated right heart pressure in children. However, its accuracy has not been validated in children.
Simultaneous pressure gradients between right ventricle and right atrium were prospectively assessed by RHC and DE using tricuspid valve regurgitation in 98 consecutive children (age 0-18 yrs, median 5.8 yrs) with 2 ventricle physiology and a wide range of right heart pressures. Subjects were grouped based on RHC measured right ventricular systolic pressure (RVP): group 1 (n=56) with RVP<1/2 systemic systolic blood pressure (SBP) and group 2 (n=42) with RVP >1/2 SBP. Elevated right heart pressure was defined as RVP>1/2 SBP. Correlation and agreement between the methods were assessed using linear regression and Bland-Altman analysis, respectively. Accuracy was predefined as 95% limits of agreement (LOA) ±10mmHg.
Correlation between DE and RHC measured RVP was strong in both groups (group 1: r=0.8, p<0.001; group 2: r=0.77, p<0.001). Agreement between the two methods was good in group 1 (bias 2.5mmHg, 95% LOA +9.4 to −4.5 mmHg), but poor in group 2 (bias −0.68mmHg, 95% LOA +22.8 to −24.2 mmHg) (Figure 1). DE estimated RVP was inaccurate in 2% of subjects in group 1 vs. 33% in group 2.
DE estimates of RVP may often be inaccurate and should not be solely relied upon in the management of children with elevated right heart pressure.
Poster Sessions, Expo North
Saturday, March 09, 2013, 3:45 p.m.-4:30 p.m.
Session Title: Congenital Cardiology Solutions: Congenital Imaging
Abstract Category: 13. Congenital Cardiology Solutions: Pediatric
Presentation Number: 1160-124
- 2013 American College of Cardiology Foundation