Right ventricular base/apex ratio in the assessment of pediatric pulmonary arterial hypertension: Results from the European Pediatric Pulmonary Vascular Disease Network

Abstract

The RVES b/a ratio decreased in children with PAH compared with age- and sex-matched healthy subjects. The RVES b/a ratio inversely correlated with both echocardiographic and hemodynamic indicators of increased RV pressure afterload and with NYHA class, suggesting that RVES b/a ratio reflects disease severity in PAH children.

Reply to “Diagnostic and prognostic value of echocardiography in pulmonary arterial hypertension”

“…In agreement with our recent findings and recommendations, [2][3][4] Dandel and Hetzer suggest to use the RVES b/a ratio in combination with more established measures of RV function, and the authors explain the advantages of a multi-parameter analysis to assess myocardial changes under pathological conditions (as evident in PAH), where parallel measurements of the load-dependency of RV size, geometry, and pump function prove useful for a detailed RV evaluation. 1 Other integrative approaches using different combinations of parameters also included data on RV afterload.…”

“…2 As suggested by Dandel and Hetzer we herein assessed the correlation between RVES b/a ratio and the indexed PVR (PVRi), which was found to be significant (ρ = −0.571, P < 0.001). Furthermore, S 0 showed a significant negative correlation with mPAP (ρ = −0.428, P = 0.009) and PVRi (ρ = −0.451, P = 0.003), TAPSE had a negative correlation only with PVRi (ρ = −0.439, P = 0.004), while TAPSE and mPAP only showed a trend toward a negative correlation (ρ = −0.291, P = 0.085), suggesting that single systolic RV function parameters such as the TAPSE or S`cannot provide a detailed information on RV function and hemodynamics of the patient.In agreement with our recent findings and recommendations, [2][3][4] Dandel and Hetzer suggest to use the RVES b/a ratio in combination with more established measures of RV function, and the authors explain the advantages of a multi-parameter analysis to assess myocardial changes under pathological conditions (as evident in PAH), where parallel measurements of the load-dependency of RV size, geometry, and pump function prove useful for a detailed RV evaluation. 1 Other integrative approaches using different combinations of parameters also included data on RV afterload.…”

“…1 The newly developed RV end-systolic base/apex (RVES b/a) ratio inversely correlated with echocardiographic RV/LV endsystolic diameter ratio (ρ = −0.450, P = 0.001) and invasive mPAP (ρ = −0.415, P = 0.012), but did not correlate with the RV systolic function parameters TAPSE and S 0 in our study. 2 As suggested by Dandel and Hetzer we herein assessed the correlation between RVES b/a ratio and the indexed PVR (PVRi), which was found to be significant (ρ = −0.571, P < 0.001). Furthermore, S 0 showed a significant negative correlation with mPAP (ρ = −0.428, P = 0.009) and PVRi (ρ = −0.451, P = 0.003), TAPSE had a negative correlation only with PVRi (ρ = −0.439, P = 0.004), while TAPSE and mPAP only showed a trend toward a negative correlation (ρ = −0.291, P = 0.085), suggesting that single systolic RV function parameters such as the TAPSE or S`cannot provide a detailed information on RV function and hemodynamics of the patient.…”

Diagnostic and prognostic value of echocardiography in pulmonary arterial hypertension

“…1 In that study, the RVES b/a ratio revealed a high ability to distinguish children with PAH from healthy children and might therefore be useful for initial detection of children with previously unknown PAH. As expected, the RVES b/a ratio inversely correlated with both echocardiographic and hemodynamic indicators of increased overload.…”

“…We read with great interest the study by Koestenberger et al, which was recently published in Clinical Cardiology, aiming to assess the usefulness of the right ventricle end-systolic basal-apical diameter ratio (RVES b/a) for initial diagnosis and follow-up of pediatric patients with pulmonary arterial hypertension (PAH). 1 In that study, the RVES b/a ratio revealed a high ability to distinguish children with PAH from healthy children and might therefore be useful for initial detection of children with previously unknown PAH. As expected, the RVES b/a ratio inversely correlated with both echocardiographic and hemodynamic indicators of increased overload.…”