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DOI: 10.1055/s-0037-1599020
Echocardiographic Reference Values of the Pulmonary Artery Acceleration Time in 756 Healthy Children and Impact on Pediatric Pulmonary Hypertension
Publication History
Publication Date:
02 February 2017 (online)
Objectives: The unique features of pulmonary hypertension (PH) in children and young adults have led to the development of specific recommendations for the early diagnosis and treatment in this age group. Echocardiographic estimates of right ventricular systolic pressure are calculated from the maximal velocity of the tricuspid regurgitation (TR) jet. Unfortunately, there often is insufficient TR to reliably quantify the CW-Doppler envelope. Recently, PW-Doppler determination of the pulmonary artery acceleration time (PAAT) as a surrogate for PA pressure has gained more interest; however, studies have been performed exclusively in adults. In previous, small studies, significant differences in PAAT values had been found in children with PH versus those without PH; however, both groups were not matched by age. This study aims to provide representative, normal PAAT values for children with variable heart rates (HR).
Methods: We conducted a prospective echocardiographic study in 756 healthy children (age: day 1 to 18 years) and in 54 children with PH. Possible associations of age, body length (BL), body weight (BW), body surface area (BSA), and HR on PAAT were investigated.
Results: The PAAT correlated positively with age (r = 0.848), BL (r = 0.871), BSA (r = 0.856), and BW (r = 0.825) and negatively with HR (r = −0.906). PAAT increased in a nonlinear fashion with age (neonates: 80 ± 11 ms, 18th year of life: 151 ± 19 ms). ROC analysis for detecting PH patients using age specific z-scores showed an excellent performance of the variable PAAT (p < 0.001, AUC: 0.98, 95% CI: 0.97–0.99) with a best cut of score according to the Youden Index of −1.565 (sensitivity: 92%, specificity: 96%). PAAT values of PH patients positively correlated with systolic RV function, and negatively correlated with pulmonary vascular resistance.
Conclusion: The PAAT normal reference values and z-scores we provide here will be useful to identify children with a shortened PAAT. Abnormal PAAT values with scores < −2 were predictive of PH.