Echocardiographic Reference Values for Right Atrial Size in Children with and without Atrial Septal Defects or Pulmonary Hypertension
Echocardiographic Reference Values for Right Atrial Size in Children with and without Atrial Septal Defects or Pulmonary Hypertension
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DOI：
10.1007/s00246-015-1332-0
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发表时间：
2016-04-01
影响因子：
1.6
通讯作者：
Hansmann, Georg
中科院分区：
文献类型：
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作者：
Koestenberger, Martin;Burmas, Ante;Hansmann, Georg
右心房（RA）大小可能成为先天性心脏病（CHD）伴右心功能障碍患者非常有用且容易获得的超声心动图变量；然而，缺乏针对儿童的相关研究。我们研究了健康儿童RA尺寸的生长相关变化。此外，我们确定了RA变量在继发性房间隔缺损（ASD）儿童和继发性肺动脉高压（PH）儿童（PH-CHD）中的预测价值。这是一项前瞻性研究，包括516名健康儿童、80名继发性ASD儿童（bbb70mm上下尺寸）和42名PH-CHD儿童。我们确定了三个RA变量，即收缩期终长轴长度、收缩期终小轴长度和收缩期终面积，并按年龄、体重、长度和表面积分层。与健康对照人群相比，ASD和PH-CHD患儿RA收缩期终末长度和面积z评分均有所增加。使用约登指数来确定性别和年龄特异性RA维度的最佳截止分数，我们观察到ASD儿童的敏感性和特异性分别为94%和91%，PH-CHD儿童的敏感性和特异性分别为98%和94%。我们在一个具有代表性的大型儿科队列中提供了RA大小和面积的正常值（z评分-2到+2）。RA变量增大，评分>+2可预测继发性ASD和PH-CHD。在高容量负荷（ASD）或压力负荷（PH-CHD）情况下，二维测定RA大小可以识别出RA的增大。
Right atrial (RA) size may become a very useful, easily obtainable, echocardiographic variable in patients with congenital heart disease (CHD) with right-heart dysfunction; however, according studies in children are lacking. We investigated growth-related changes of RA dimensions in healthy children. Moreover, we determined the predictive value of RA variables in both children with secundum atrial septal defect (ASD) and children with pulmonary hypertension (PH) secondary to CHD (PH-CHD). This is a prospective study in 516 healthy children, in 80 children with a secundum ASD (> 7 mm superior-inferior dimension), and in 42 children with PH-CHD. We determined three RA variables, i.e., end-systolic major-axis length, end-systolic minor-axis length, and end-systolic area, stratified by age, body weight, length, and surface area. RA end-systolic length and area z scores were increased in children with ASD and PH-CHD when compared to those variables in the healthy control population. Using the Youden Index to determine the best cutoff scores in sex- and age-specific RA dimensions, we observed a sensitivity and specificity up to 94 and 91 %, respectively, in ASD children and 98 and 94 %, respectively, in PH-CHD children. We provide normal values (z scores -2 to +2) for RA size and area in a representative, large pediatric cohort. Enlarged RA variables with scores >+2 were predictive of secundum ASD and PH-CHD. Two-dimensional determination of RA size can identify enlarged RAs in the setting of high volume load (ASD) or pressure load (PH-CHD).