Quantitative Measures of Right Ventricular Size and Function by Echocardiogram Correlate with Cardiac Catheterization Hemodynamics in Congenital Diaphragmatic Hernia.
Quantitative Measures of Right Ventricular Size and Function by Echocardiogram Correlate with Cardiac Catheterization Hemodynamics in Congenital Diaphragmatic Hernia.
复制标题
超声心动图对右心室大小和功能的定量测量与先天性膈疝的心导管插入血流动力学相关。
DOI：
10.1016/j.jpeds.2023.113564
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发表时间：
2023
期刊：
影响因子：
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通讯作者：
Hedrick,HollyL
中科院分区：
文献类型：
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作者：
Avitabile,CatherineM;Flohr,Sabrina;Mathew,Leny;Wang,Yan;Ash,Devon;Frank,DavidB;Tingo,JenniferE;Rintoul,NatalieE;Hedrick,HollyL
目的评价心脏导管插入术（cath）血流动力学、超声心动图右心室（RV）功能定量测量与先天性膈疝（CDH）患者生存率之间的相关性。研究设计本单中心回顾性队列研究纳入了2003年至2022年接受索引导管插入术的CDH患者。通过术前超声心动图测量三尖瓣环平面收缩压差评分、RV面积变化分数、RV游离壁和整体纵向应变、左心室（LV）偏心指数、RV/LV比值和肺动脉加速时间。之间的血液动力学值，超声心动图的措施，和生存的关联进行了评估斯皮尔曼相关性和Wilcoxon秩和检验，分别。Results 53例（68%左侧，74%肝疝，57%体外膜肺氧合，93%的生存率）进行导管（39指数住院期间，14后），包括装置关闭动脉导管未闭5。大多数患者（n = 31，58%）在导管插入术时接受肺动脉高压治疗，最常见的是西地那非（n = 24，45%）和/或静脉注射曲前列尼尔（n = 16，30%）。总体而言，血流动力学与毛细血管前肺动脉高压一致。肺毛细血管楔压>15 mm Hg者2例（4%）。较低的面积变化分数和更差的心室应变与更高的肺动脉压相关，而更高的LV偏心指数和更高的RV/LV比值与更高的肺动脉压和更高的肺血管阻力相关。血流动力学没有不同的生存状态。ConclusionsWorse RV扩张和功能障碍的超声心动图与较高的肺动脉压和肺血管阻力导管在这个CDH队列。这些措施可能代表了该人群中新的非侵入性临床试验目标。
ObjectiveTo evaluate associations between cardiac catheterization (cath) hemodynamics, quantitative measures of right ventricular (RV) function by echocardiogram, and survival in patients with congenital diaphragmatic hernia (CDH).Study designThis single-center retrospective cohort study enrolled patients with CDH who underwent index cath from 2003 to 2022. Tricuspid annular plane systolic excursionzscore, RV fractional area change, RV free wall and global longitudinal strain, left ventricular (LV) eccentricity index, RV/LV ratio, and pulmonary artery acceleration time were measured from preprocedure echocardiograms. Associations between hemodynamic values, echocardiographic measures, and survival were evaluated by Spearman correlation and Wilcoxon rank sum test, respectively.ResultsFifty-three patients (68% left-sided, 74% liver herniation, 57% extracorporeal membrane oxygenation, 93% survival) underwent cath (39 during index hospitalization, 14 later) including device closure of a patent ductus arteriosus in 5. Most patients (n = 31, 58%) were on pulmonary hypertension treatment at cath, most commonly sildenafil (n = 24, 45%) and/or intravenous treprostinil (n = 16, 30%). Overall, hemodynamics were consistent with precapillary pulmonary hypertension. Pulmonary capillary wedge pressure was >15 mm Hg in 2 patients (4%). Lower fractional area change and worse ventricular strain were associated with higher pulmonary artery pressure while higher LV eccentricity index and higher RV/LV ratio were associated with both higher pulmonary artery pressure and higher pulmonary vascular resistance. Hemodynamics did not differ based on survival status.ConclusionsWorse RV dilation and dysfunction by echocardiogram correlate with higher pulmonary artery pressure and pulmonary vascular resistance on cath in this CDH cohort. These measures may represent novel, noninvasive clinical trial targets in this population.