Echocardiographic estimation of pulmonary arterial and right atrial pressures in children with congenital heart disease: a comprehensive prospective study and introduction of novel equations

Elaheh Malakan Rad; Reza Elhamian; Keyhan Sayadpour Zanjani; Reza Shabanian; Ehsan Aghaei Moghadam; Mohamad Taghi Majnoon; Aliakbar Zeinaloo

doi:10.1186/s44348-024-00023-4

Echocardiographic estimation of pulmonary arterial and right atrial pressures in children with congenital heart disease: a comprehensive prospective study and introduction of novel equations

J Cardiovasc Imaging. 2024 Aug 8;32(1):23. doi: 10.1186/s44348-024-00023-4.

Authors

Elaheh Malakan Rad^#^{1

2}, Reza Elhamian^#³, Keyhan Sayadpour Zanjani^{4

3}, Reza Shabanian⁵, Ehsan Aghaei Moghadam^{4

3}, Mohamad Taghi Majnoon^{4

3}, Aliakbar Zeinaloo^{4

3}

Affiliations

¹ Department of Pediatric Cardiology, Children's Medical Center (Pediatric Center of Excellence), Tehran University of Medical Sciences, Tehran, Iran. [email protected].
² Fetal and Pediatric Cardiovascular Research Center, Children's Medical Center (Pediatric Center of Excellence), Tehran University of Medical Sciences, Tehran, Iran. [email protected].
³ Fetal and Pediatric Cardiovascular Research Center, Children's Medical Center (Pediatric Center of Excellence), Tehran University of Medical Sciences, Tehran, Iran.
⁴ Department of Pediatric Cardiology, Children's Medical Center (Pediatric Center of Excellence), Tehran University of Medical Sciences, Tehran, Iran.
⁵ Hakim Children's Hospital, Tehran University of Medical Sciences, Tehran, Iran.

^# Contributed equally.

Abstract

Background: Pediatric pulmonary hypertension (PH) is characterized by a mean pulmonary arterial pressure exceeding 20 mmHg. There is limited research on the suitability of adult-based methods for estimating PH in pediatric populations. Using established formulas for adults, this study aimed to evaluate the correlation between echocardiographic estimates of systolic, diastolic, and mean pulmonary arterial pressures, and mean right atrial pressures in children with congenital heart disease (CHD).

Methods: A prospective study was conducted involving children with CHD undergoing cardiac catheterization without prior cardiac surgery. We used echocardiography to estimate pulmonary and right atrial pressures and compared these with invasively measured values. Four reliable regression equations were developed to estimate systolic, diastolic, and mean pulmonary arterial pressures, and mean right atrial pressures. Cutoff values were determined to predict the occurrence of PH. Linear regression, Bland-Altman analysis, and receiver operating characteristic curve analysis were performed to assess the accuracy of echocardiography and establish diagnostic thresholds for PH.

Results: The study involved 55 children (23 with normal pulmonary arterial pressure and 32 with PH) with acyanotic CHD aged 1 to 192 months. Four equations were developed to detect high pulmonary arterial pressures, with cutoff values of 32.9 for systolic pulmonary arterial pressure, 14.95 for diastolic pulmonary arterial pressure, and 20.7 for mean pulmonary arterial pressure. The results showed high sensitivity and moderate specificity but a tendency to underestimate systolic and mean pulmonary arterial pressures at higher pressures.

Conclusions: The study provides valuable insights into the use of adult-based echocardiographic formulas for estimating PH in pediatric patients with acyanotic CHD.

Keywords: Bland–Altman analysis; Children; Congenital heart disease; Echocardiography; Pulmonary arterial pressure; Receiver operating characteristic curve; Right atrial pressure.