Right Ventricular Wall Tension in the Assessment of Pediatric Pulmonary Arterial Hypertension

Background: Echocardiographic determination of right ventricular wall tension (RVWT) is a novel parameter for the assessment of pulmonary hypertension (PH) in adults. We aimed to investigate RVWT in pediatric PH patients and to correlate RVWT data with invasively obtained hemodynamics, echocardiographic variables, NT-proBNP, and NYHA functional class (FC).

Method: Prospective echocardiographic study in two independent cohorts of children with PH and age- and gender-matched control patients (pediatric PH patients: n = 49).

Results: RVWT was increased in children with PH as compared with healthy controls (p < 0.01). Higher RVWT values were associated with less favorable invasive hemodynamics, that is, increased mean pulmonary artery pressure (mPAP) and pulmonary to systemic vascular resistance ratio (PVR/SVR). RVWT values also increased with worsening NYHA-FC and increasing plasma NT-pro-BNP levels. In addition, RVWT values correlated with other echocardiographic variables, such as pulmonary artery acceleration time (PAAT), tricuspid annular peak systolic excursion (TAPSE), RV/LV dimension ratio, and left ventricular eccentricity index (LVEI).

Conclusion: RVWT is a novel and easily obtained bedside indicator of RV remodeling and dilatation. Higher RVWT values were associated with lower FC and worse hemodynamics, demonstrating that this index provides additional information on right ventricular performance in the setting of pressure-loaded RVs in pediatric PH.

Publication History

Article published online:
12 February 2022