Prognostic Value of Change in Cardiac Index After Prostacyclin Initiation in Pediatric Pulmonary Hypertension

Evers, Patrick D.; Critser, Paul J.; Cash, Michelle; Magness, Melissa; Hirsch, Russel

doi:10.1007/s00246-020-02460-6

Cited by 2 publications

(9 citation statements)

References 21 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Timing of referral, however, is challenging as patients with significant RV dysfunction have been shown to tolerate the Potts shunt poorly 43,44 . Our findings lend support to the concept that early hemodynamic changes (such as SV augmentation and SVR reduction) may be useful indicators of positive (or negative) responders to therapy 12,15,35 . This may help with the timing of surgical intervention or lung transplant evaluation.…”

Section: Discussionsupporting

confidence: 63%

“…The development of a high cardiac output state (CI > 4 L/min/m 2 ) after starting PPT has been previously noted in adult and pediatric PH studies, 3,[14][15][16] but this is the first study specifically describing the incidence and time course of SCI in the PPH population. In this cohort, SCI occurred in ~75% of patients by 12 months of therapy, consistent with prior reports observing maximal hemodynamic effects of PPT by 12-18 months of therapy.…”

Section: Discussionmentioning

confidence: 76%

“…Stroke work represents a ventricle's ability to generate a SV in the setting of afterload and thus can serve as an additional marker of RV performance. Increased RVSW after 3 months of PPT has been strongly correlated with change in CI and inversely associated with adverse outcomes 15 . However, RVSW must be interpreted with careful consideration of the patient's ventriculo‐vascular coupling condition 26 .…”

Section: Discussionmentioning

confidence: 99%

“…Further, this study found that combination therapy with rapid titration of therapy and initiation early after PPH diagnosis was associated with better outcomes. In these and prior studies, SCI has been frequently noted in PPH patients on PPT 3,14–16,18,19 . However, the incidence and associations with outcomes have not been investigated in the pediatric population.…”

Section: Introductionmentioning

confidence: 93%

“…Long‐term outcome studies have demonstrated that increased cardiac output after starting PPT is associated with improved clinical outcomes and survival 12,15 . However, a proportion of patients treated with PPT can develop a supranormal cardiac index (SCI) of >4 L/min/m 2 3,14,16–18 .…”

Section: Introductionmentioning

confidence: 99%

See 4 more Smart Citations

Factors leading to supranormal cardiac index in pediatric pulmonary hypertension patients treated with parenteral prostanoid therapy

et al. 2023

Self Cite

View full text Add to dashboard Cite

Parenteral prostanoid therapy (PPT) can result in supranormal cardiac index (SCI; >4 L/min/m2) in pediatric pulmonary hypertension (PPH) patients. We evaluated the incidence, hemodynamic factors, and outcomes associated with SCI in PPH. This retrospective cohort study included 22 PPH patients on PPT from 2005 to 2020. Hemodynamic profiles were compared between the baseline and 3–6 month follow‐up catheterization in the SCI and non‐SCI cohorts. Cox regression analysis examined time to composite adverse outcome (CAO; Potts shunt, lung transplant, or death) controlling for initial disease severity. SCI developed in 17 (77%) patients, of whom 11 (65%) developed SCI within 6 months. The SCI cohort was characterized by significant augmentation of cardiac index (CI) and stroke volume (SV) as well as reductions in systemic vascular resistance (SVR) and pulmonary vascular resistance (PVR). Conversely, the non‐SCI cohort had unchanged SV despite a modest rise in CI as well as persistent vasoconstriction. After median follow‐up of 4.3 years (range 0.2–13 years), non‐SCI patients were at significantly increased risk for the CAO (5/5: three deaths, two Potts shunts) compared with SCI patients (5/17: two deaths, three lung transplants; adjusted hazard ratio 14.0 [95% confidence interval: 2.1–91.3], p < 0.001). A majority of PPH patients developed SCI within 6–12 months of starting PPT and demonstrated lower risk of adverse outcomes compared with non‐SCI patients. These data suggest that change in SVR and SV after 3–6 months of PPT may be early markers of therapeutic response and prognosis.

show abstract

Section: Discussionsupporting

confidence: 63%