116 - Novel Echocardiographic Markers for the Assessment of Pulmonary Vascular Disease in Infants

Poster Number: 116
Publication Number: 116.2036

Background: Pulmonary hypertension (PH) carries significant morbidity and mortality in infants. Although cardiac catheterization is the gold standard for diagnosis of PH, it is risky. Thus, echocardiography (ECHO) is used as a surrogate. However, traditional markers, such as septal wall flattening and tricuspid regurgitation (TR) jet, are not always present or reliable. Newer markers, such as pulmonary artery acceleration time (PAAT) and eccentricity index (EI), have been studied in children, but data in infants, particularly catheterization-matched data, is limited.

Objective: To evaluate the ability of PAAT and EI to predict catheterization-derived hemodynamic measurements in infants less than 1 year of age, and to determine if combining these novel markers with traditional markers improves the agreement of diagnosis and categorization of PH with catheterization data.

Design/Methods: This is an eight-year (2017-2023) retrospective review of infants who underwent cardiac catheterization at Arkansas Children’s Hospital. Infants with heart disease apart from patent ductus, atrial, and small ventricular septal defects were excluded. Traditional (TR jet, septal flattening) and novel (PAAT, EI) markers were retrospectively obtained from the ECHO performed within 1 month of catheterization and read by a cardiologist blinded to catheterization data. Demographic, clinical and catheterization data were collected. The ratio of systolic pulmonary artery pressure to systemic pressure determined the PH severity ( < 2/3 systemic pressure=mild, >2/3 systemic to systemic pressure=moderate, >systemic pressure=severe). Multiple linear regression and agreement analysis was conducted between cardiac catheterization and ECHO for the presence and severity of PH.

Results: Included were 28 neonates, of which 53.6% were females with a mean gestational age of 32.8±5 weeks. PAAT was a significant predictor of mean pulmonary artery pressure (R-square=0.21, p=0.014). EI did not reach significance (p=0.59). There was substantial agreement between the presence of PH by ECHO using traditional markers and cardiac catheterization (κ = 0.63, SE = 0.24, p < 0.001). There was almost perfect agreement between the presence of PH by ECHO using the combination of traditional and novel markers and cardiac catheterization (κ = 0.78, SE = 0.21, p < 0.001). There was moderate agreement between the severity of PH by ECHO using the combination of traditional and novel markers and cardiac catheterization (κ = 0.44, SE = 0.17, p = 0.04).

Conclusion(s): When combined with traditional ECHO markers, PAAT and EI may improve the diagnostic ability of ECHOs for PH.