Pulmonary Artery Acceleration Time Provides a Reliable Estimate of Invasive Pulmonary Hemodynamics in Children

• Published in: Journal of the American Society of Echocardiography Vol. 29; no. 11; pp. 1056 - 1065
• Main Authors: Levy, Philip T., MD, Patel, Meghna D., MD, Groh, Georgeann, MD, Choudhry, Swati, MD, Murphy, Joshua, MD, Holland, Mark R., PhD, Hamvas, Aaron, MD, Grady, Mark R., MD, Singh, Gautam K., MD
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01-11-2016
• Subjects: Acceleration; Blood Flow Velocity - physiology; Blood Pressure Determination - methods; Cardiovascular; Child; Child, Preschool; Echocardiography; Echocardiography, Doppler - methods; Female; Humans; Image Interpretation, Computer-Assisted - methods; Infant; Male; Pediatrics; Pulmonary Artery - diagnostic imaging; Pulmonary Artery - physiology; Pulmonary artery acceleration time; Pulmonary Circulation - physiology; Pulmonary hypertension; Pulmonary Wedge Pressure - physiology; Reproducibility of Results; Sensitivity and Specificity; Vascular Resistance - physiology; mPAP; Pediatrics; DE; PAAT; RV; Pulmonary artery pressure; Right heart catheterization; RHC; PVR; Pulmonary artery acceleration time; AUC; Mean pulmonary artery pressure; Doppler echocardiography; Pulmonary vascular resistance index; RVET; sPAP; Pulmonary vascular resistance; Systolic pulmonary artery pressure; WU; Echocardiography; ROC; Pulmonary hypertension; Wood units; Area under the receiver operating characteristic curve; Receiver operating characteristic; PVRi; Right ventricular; PAP; Right ventricular ejection time
• ISSN: 0894-7317; 1097-6795
• DOI: 10.1016/j.echo.2016.08.013

Background Pulmonary artery acceleration time (PAAT) is a noninvasive method to assess pulmonary hemodynamics, but it lacks validity in children. The aim of this study was to evaluate the accuracy of Doppler echocardiography–derived PAAT in predicting right heart catheterization (RHC)–derived pulmonary artery pressure (PAP), pulmonary vascular resistance (PVR), and compliance in children. Methods Prospectively acquired and retrospectively measured Doppler echocardiography–derived PAAT and RHC-derived systolic PAP, mean PAP (mPAP), indexed PVR (PVRi), and compliance were compared using regression analysis in a derivation cohort of 75 children (median age, 5.3 years; interquartile range, 1.3–12.6 years) with wide ranges of pulmonary hemodynamics. To account for heart rate variability, PAAT was adjusted for right ventricular ejection time and corrected by the RR interval. Regression equations incorporating PAAT and PAAT/right ventricular ejection time from the derivation cohort were then evaluated for the accuracy of their predictive values for invasive pulmonary hemodynamics in a validation cohort of 50 age- and weight-matched children with elevated PAP and PVR. Results There were significant inverse correlations between PAAT and RHC-derived mPAP ( r  = −0.82) and PVRi ( r  = −0.78) and a direct correlation ( r  = 0.78) between PAAT and pulmonary compliance in the derivation cohort. For detection of pulmonary hypertension (PRVi > 3 Wood units · m2 and mPAP > 25 mm Hg), PAAT < 90 msec and PAAT/right ventricular ejection time < 0.31 resulted in sensitivity of 97% and specificity of 95%. In the derivation cohort, the regression equations relating PAAT with mPAP and PVRi were mPAP = 48 − 0.28 × PAAT and PVRi = 9 − 0.07 × PAAT. These PAAT-integrated equations predicted RHC-measured pulmonary hemodynamics in the validation cohort with good correlations ( r  = 0.88 and r  = 0.83, respectively), small biases (<10%), and minimal coefficients of variation (<8%). Conclusions PAAT inversely correlates with RHC-measured pulmonary hemodynamics and directly correlates with pulmonary arterial compliance in children. The study established PAAT-based regression equations in children to accurately predict RHC-derived PAP and PVR.