Relationship between pulmonary artery acceleration time and pulmonary artery pressures in infants

Abstract

Background Pulmonary artery acceleration time measured by echocardiography inversely correlates with pulmonary artery pressures in adults and children older than 1 year of age. There is a paucity of data investigating this relationship in young children, particularly among preterm infants. Objective To characterize the relationship between pulmonary artery acceleration time (PAAT) and pulmonary artery pressures in infants. Design/Methods Patients ≤ 1 year of age at Children's Hospital of Philadelphia between 2011 and 2017 were reviewed. Infants with congenital heart disease were excluded, except those with a patent ductus arteriosus (PDA), atrial septal defect (ASD), or ventricular septal defect (VSD). Linear regression analysis was used to assess the correlation between PAAT measured by echocardiography and systolic pulmonary artery pressure, mean pulmonary artery pressure, and indexed pulmonary vascular resistance from cardiac catheterization. Results Fifty‐seven infants were included, of which 61% were preterm and 49% had a diagnosis of bronchopulmonary dysplasia. The median postmenstrual age and weight at catheterization were 51.1 weeks (IQR 35.8–67.9 weeks) and 4400 g (IQR 3100–6500 g), respectively. Forty‐four infants (77%) had a patent ductus arteriosus (PDA). There was a weak inverse correlation between PAAT with mPAP (r = −0.35, P = 0.01), sPAP (r = −0.29, P = 0.03), and PVRi (r = −0.29, P = 0.03). Conclusion There is a weak inverse relationship between PAAT and pulmonary artery pressures. This relationship is less robust in our population of infants with a high incidence of PDAs compared to previous studies in older children. Thus, PAAT may be less clinically meaningful for diagnosing pulmonary arterial hypertension in infants, particularly those with PDAs.

Using pulmonary artery acceleration time to evaluate pulmonary hemodynamic changes on preterm infants with respiratory distress syndrome

“…We found that PAAT/RVET did not increase after PS treatment, and speculated that while PS treatment improved early postnatal dyspnea symptoms and reduced respiratory support requirements, it was not helpful in preliminary measurements of PAAT. Notably, previous studies have found that PAAT/RVET is inversely correlated with mean PAP (27), which may mean that the rapid decline in pulmonary vascular resistance in the first 1-2 days after birth is delayed for RDS preterm infants, especially those who need PS treatment (25).…”

“…Thus, it is our view that preterm birth-associated cardiopulmonary conditions may affect the maturational patterns of PAAT, and RDS exacerbates this effect. Due to the well-established inverse relationship between PAAT and HR (27), we simultaneously measured RVET to account for potential effects of HR variability, as the use of PAAT/RVET negates the need to correct for HR. We found that PAAT/RVET did not increase after PS treatment, and speculated that while PS treatment improved early postnatal dyspnea symptoms and reduced respiratory support requirements, it was not helpful in preliminary measurements of PAAT.…”

A guide to echocardiographic assessment in children and adolescents with pulmonary hypertension

“…Expressing both values as ratio, PAAT/RVET is less dependent on variables like age, heart rate and body surface area (21). Therefore, it has also been found to be useful in children (21,22).…”

Update on noninvasive imaging of right ventricle dysfunction in pulmonary hypertension

“…A ratio of PAAT/RVET is less dependent on age, body surface area (BSA) and heart rate. Therefore, PAAT/RVET is suggested to be meaningful in pediatric patients (50,51). Furthermore, bronchopulmonary dysplasia and PH were described to have negative impact on PAAT measures, suggesting that PAAT and PAAT/RVET ratio can be used as complementary modalities to assess pulmonary hemodynamics in neonates (52).…”