Pediatr Cardiol DOI 10.1007/s00246-014-0871-0
LETTER TO THE EDITOR
Abnormalities in Echocardiographic Indices of Right- and LeftVentricular Systolic Function in Pediatric Pulmonary Artery Hypertension Jasmin Pansy • Martin Koestenberger
Received: 2 January 2014 / Accepted: 22 January 2014 Ó Springer Science+Business Media New York 2014
To the Editor, We read with great interest the article entitled ‘‘Echocardiographic Evaluation of Ventricular Function in Children with Pulmonary Hypertension’’ by Vorhies et al. [5]. This interesting article describes right- (RV) and left-ventricular (LV) dysfunction in children with pulmonary artery hypertension (PAH). The authors highlight the need for a reliable noninvasive measure of biventricular function using tissue Doppler imaging (TDI), e.g. tricuspid annular peak systolic velocity (S‘), and mitral valve annular systolic velocity (Sm) in the serial assessment of pediatric PAH. The authors found that S‘ decreased significantly in PAH patients C1 year of age consistent with RV systolic dysfunction [5]. We want to emphasize their findings that RV systolic dysfunction occurs with increasing age because changes in RV function have been described to occur over time [2]. Impaired RV function in pediatric PAH patients has been reported in previous studies of pediatric PAH [1, 2, 4]. Vorhies et al. [1] showed that the Sm, a TDI marker of systolic LV function, was also decreased in their PAH cases. Measurement of RV–LV interaction is increasingly important in the follow-up of children with PAH. We This comment refers to the article available at doi:10.1007/s00246013-0849-3. J. Pansy Division of Neonatology, Department of Pediatrics, Medical University Graz, 8036 Graz, Austria M. Koestenberger (&) Division of Pediatric Cardiology, Department of Pediatrics, Medical University Graz, Auenbruggerplatz 34/2, 8036 Graz, Austria e-mail: [email protected]; [email protected]
support the authors’ idea of an age-stratified analysis of RV and LV function considering age-specific changes [1]. For the convenience of the readership of Pediatric Cardiology, we mention that a comparison of the authors’ S‘ data with available S‘ normal values and z scores [3] would have improved the statistical power of their analysis. A decrease of S‘ lower than -2 SD of age-related normal values determines decreased systolic RV function in children with PAH [2]. Recently reported studies on pediatric idiopathic PAH, PAH associated with lung or autoimmune disease [4], and PAH associated with congenital heart disease [1, 2] suggest that systolic RV function progressively deteriorates over time. The results of Vorhies et al. [5] nicely supported the notion that the right ventricle is highly susceptible to pulmonary vascular resistance and PAH. We thank the authors for addressing the need for careful and systematic evaluation of the right ventricle in PAH patients. We hope that with more interesting studies like this from Vorhies et al. [5], quantification of systolic biventricular function will become a routine measurement in the follow-up of pediatric PAH patients.
References 1. Kassem E, Humpl T, Friedberg MK (2013) Prognostic significance of 2-dimensional, M-mode, and Doppler echo indices of right ventricular function in children with pulmonary arterial hypertension. Am Heart J 165:1024–1031 2. Koestenberger M, Nagel B, Ravekes W, Avian A, Heinzl B, Fandl A et al (2012) Tricuspid annular peak systolic velocity (S’) in children and young adults with pulmonary artery hypertension secondary to congenital heart diseases and in those with repaired tetralogy of Fallot: echocardiography and MRI data. J Am Soc Echocardiogr 25:1041–1049
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Pediatr Cardiol 3. Koestenberger M, Nagel B, Ravekes W, Avian A, Heinzl B, Cvirn G et al (2012) Reference values of tricuspid annular peak systolic velocity in healthy pediatric patients, calculation of z score, and comparison to tricuspid annular plane systolic excursion. Am J Cardiol 109:116–121 4. Lammers AE, Haworth SG, Riley G, Malsin K, Diller GP, Marek J (2012) Value of tissue Doppler echocardiography in children with pulmonary hypertension. J Am Soc Echocardiogr 25:504–510
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5. Vorhies EE, Gajarski RJ, Yu S, Donohue JE, Fifer CG (2013) Echocardiographic evaluation of ventricular function in children with pulmonary hypertension. Pediatr Cardiol. doi:10.1176/appi. ps.201200536
LETTER TO THE EDITOR
Abnormalities in Echocardiographic Indices of Right- and LeftVentricular Systolic Function in Pediatric Pulmonary Artery Hypertension Jasmin Pansy • Martin Koestenberger
Received: 2 January 2014 / Accepted: 22 January 2014 Ó Springer Science+Business Media New York 2014
To the Editor, We read with great interest the article entitled ‘‘Echocardiographic Evaluation of Ventricular Function in Children with Pulmonary Hypertension’’ by Vorhies et al. [5]. This interesting article describes right- (RV) and left-ventricular (LV) dysfunction in children with pulmonary artery hypertension (PAH). The authors highlight the need for a reliable noninvasive measure of biventricular function using tissue Doppler imaging (TDI), e.g. tricuspid annular peak systolic velocity (S‘), and mitral valve annular systolic velocity (Sm) in the serial assessment of pediatric PAH. The authors found that S‘ decreased significantly in PAH patients C1 year of age consistent with RV systolic dysfunction [5]. We want to emphasize their findings that RV systolic dysfunction occurs with increasing age because changes in RV function have been described to occur over time [2]. Impaired RV function in pediatric PAH patients has been reported in previous studies of pediatric PAH [1, 2, 4]. Vorhies et al. [1] showed that the Sm, a TDI marker of systolic LV function, was also decreased in their PAH cases. Measurement of RV–LV interaction is increasingly important in the follow-up of children with PAH. We This comment refers to the article available at doi:10.1007/s00246013-0849-3. J. Pansy Division of Neonatology, Department of Pediatrics, Medical University Graz, 8036 Graz, Austria M. Koestenberger (&) Division of Pediatric Cardiology, Department of Pediatrics, Medical University Graz, Auenbruggerplatz 34/2, 8036 Graz, Austria e-mail: [email protected]; [email protected]
support the authors’ idea of an age-stratified analysis of RV and LV function considering age-specific changes [1]. For the convenience of the readership of Pediatric Cardiology, we mention that a comparison of the authors’ S‘ data with available S‘ normal values and z scores [3] would have improved the statistical power of their analysis. A decrease of S‘ lower than -2 SD of age-related normal values determines decreased systolic RV function in children with PAH [2]. Recently reported studies on pediatric idiopathic PAH, PAH associated with lung or autoimmune disease [4], and PAH associated with congenital heart disease [1, 2] suggest that systolic RV function progressively deteriorates over time. The results of Vorhies et al. [5] nicely supported the notion that the right ventricle is highly susceptible to pulmonary vascular resistance and PAH. We thank the authors for addressing the need for careful and systematic evaluation of the right ventricle in PAH patients. We hope that with more interesting studies like this from Vorhies et al. [5], quantification of systolic biventricular function will become a routine measurement in the follow-up of pediatric PAH patients.
References 1. Kassem E, Humpl T, Friedberg MK (2013) Prognostic significance of 2-dimensional, M-mode, and Doppler echo indices of right ventricular function in children with pulmonary arterial hypertension. Am Heart J 165:1024–1031 2. Koestenberger M, Nagel B, Ravekes W, Avian A, Heinzl B, Fandl A et al (2012) Tricuspid annular peak systolic velocity (S’) in children and young adults with pulmonary artery hypertension secondary to congenital heart diseases and in those with repaired tetralogy of Fallot: echocardiography and MRI data. J Am Soc Echocardiogr 25:1041–1049
123
Pediatr Cardiol 3. Koestenberger M, Nagel B, Ravekes W, Avian A, Heinzl B, Cvirn G et al (2012) Reference values of tricuspid annular peak systolic velocity in healthy pediatric patients, calculation of z score, and comparison to tricuspid annular plane systolic excursion. Am J Cardiol 109:116–121 4. Lammers AE, Haworth SG, Riley G, Malsin K, Diller GP, Marek J (2012) Value of tissue Doppler echocardiography in children with pulmonary hypertension. J Am Soc Echocardiogr 25:504–510
123
5. Vorhies EE, Gajarski RJ, Yu S, Donohue JE, Fifer CG (2013) Echocardiographic evaluation of ventricular function in children with pulmonary hypertension. Pediatr Cardiol. doi:10.1176/appi. ps.201200536
