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COMPARISON OF INVASIVELY AND NONINVASIVELY MEASURED RIGHT VENTRICULAR-VASCULAR COUPLING RATIO IN PEDIATRIC PULMONARY ARTERIAL HYPERTENSION: A MULTI-CENTER STUDY

(2016) Breeman, K. (Karel)

Introduction: In pediatric pulmonary arterial hypertension (PAH), RV failure is the main cause of death. Right ventricular-vascular coupling ratio (VVCR) is gaining interest as it encloses both contractility and afterload. Conventional determination of VVCR by catheterization (VVCRs) is invasive and frequently requires anesthesia. Therefore, the goal of this study was to compare the usefulness of noninvasively determined VVCR by cardiac magnetic resonance (CMR) (VVCRm) to VVCRs in pediatric PAH.
Hypothesis: We assessed two hypotheses: 1) VVCRm is a good estimate of VVCRs; and 2) both serve as good measures of disease severity and outcome.
Methods: Retrospectively, PAH patients who had catheterization and CMR within 90 days were included from two specialized PH centers. VVCR was defined as the end-systolic elastance/effective arterial elastance ratio. VVCRm as stroke volume/end-systolic volume ratio and VVCRs by single-beat method were compared using regression analysis and Bland-Altman plots. Both were correlated to disease severity (PVRi, mRAP, CI) and adverse outcome (death, lung transplantation, atrial septostomy and intravenous medication). The area under the receiver operating characteristic curve (AU-ROC), Kaplan-Meier curves and hazard ratios (HR) from Cox regression determined their value in predicting adverse outcome.
Results: In the 31 patients included (17 from CHC and 14 from UMCG), median age was 14 years (0.3 – 23) and median PVRi was 7.6 WU × m2 (2.1 – 32). VVCRm and VVCRs were strongly correlated (r = 0.78, p < 0.001) with a mean difference of 0.2 and 95% of the differences between -0.3 and 0.7. Both had comparable significant correlations with disease severity and adverse outcome. Also, both VVCRm and VVCRs were shown to be of good prognostic value with AU-ROCs of respectively 0.84 and 0.90 and HRs (95%-CI) of 0.82 (0.70 – 0.96) and 0.69 (0.53 – 0.90).
Conclusion: In line with previous research, the results of this study indicate that VVCRm and VVCRs are comparable in pediatric PAH and are both good predictors of outcome. The characteristic disease progression is clearly seen in VVCRm, but its clinical use has to be defined by further research.





ID 3350
Moeder ID 3084
Volgorde Breeman, K.
Naam BreemanK
Publiceren yes
OAI-naam Student_thesis
Path root/geneeskunde/2016/BreemanK/
Gemaakt op: 2017-03-06 10:02:10
Gemodificeerd op: 2017-03-06 10:02:10
Digitaal ID 58bd33a1aa8a7
Afstudeerrichting opleiding/afstudeerrichting 1
Studierichting Studierichting 1
Titel COMPARISON OF INVASIVELY AND NONINVASIVELY MEASURED RIGHT VENTRICULAR-VASCULAR COUPLING RATIO IN PEDIATRIC PULMONARY ARTERIAL HYPERTENSION: A MULTI-CENTER STUDY
Ruilverkeer mogelijk no
Printen in opdracht no
Aantal pagina's 25
Publicatiejaar 2016
Taal en
Engelse samenvatting Introduction: In pediatric pulmonary arterial hypertension (PAH), RV failure is the main cause of death. Right ventricular-vascular coupling ratio (VVCR) is gaining interest as it encloses both contractility and afterload. Conventional determination of VVCR by catheterization (VVCRs) is invasive and frequently requires anesthesia. Therefore, the goal of this study was to compare the usefulness of noninvasively determined VVCR by cardiac magnetic resonance (CMR) (VVCRm) to VVCRs in pediatric PAH.
Hypothesis: We assessed two hypotheses: 1) VVCRm is a good estimate of VVCRs; and 2) both serve as good measures of disease severity and outcome.
Methods: Retrospectively, PAH patients who had catheterization and CMR within 90 days were included from two specialized PH centers. VVCR was defined as the end-systolic elastance/effective arterial elastance ratio. VVCRm as stroke volume/end-systolic volume ratio and VVCRs by single-beat method were compared using regression analysis and Bland-Altman plots. Both were correlated to disease severity (PVRi, mRAP, CI) and adverse outcome (death, lung transplantation, atrial septostomy and intravenous medication). The area under the receiver operating characteristic curve (AU-ROC), Kaplan-Meier curves and hazard ratios (HR) from Cox regression determined their value in predicting adverse outcome.
Results: In the 31 patients included (17 from CHC and 14 from UMCG), median age was 14 years (0.3 – 23) and median PVRi was 7.6 WU × m2 (2.1 – 32). VVCRm and VVCRs were strongly correlated (r = 0.78, p < 0.001) with a mean difference of 0.2 and 95% of the differences between -0.3 and 0.7. Both had comparable significant correlations with disease severity and adverse outcome. Also, both VVCRm and VVCRs were shown to be of good prognostic value with AU-ROCs of respectively 0.84 and 0.90 and HRs (95%-CI) of 0.82 (0.70 – 0.96) and 0.69 (0.53 – 0.90).
Conclusion: In line with previous research, the results of this study indicate that VVCRm and VVCRs are comparable in pediatric PAH and are both good predictors of outcome. The characteristic disease progression is clearly seen in VVCRm, but its clinical use has to be defined by further research.
Nederlandse samenvatting 2
SUMMARY
Introduction: In pediatric pulmonary arterial hypertension (PAH), RV failure is the main cause of death. Right ventricular-vascular coupling ratio (VVCR) is gaining interest as it encloses both contractility and afterload. Conventional determination of VVCR by catheterization (VVCRs) is invasive and frequently requires anesthesia. Therefore, the goal of this study was to compare the usefulness of noninvasively determined VVCR by cardiac magnetic resonance (CMR) (VVCRm) to VVCRs in pediatric PAH.
Hypothesis: We assessed two hypotheses: 1) VVCRm is a good estimate of VVCRs; and 2) both serve as good measures of disease severity and outcome.
Methods: Retrospectively, PAH patients who had catheterization and CMR within 90 days were included from two specialized PH centers. VVCR was defined as the end-systolic elastance/effective arterial elastance ratio. VVCRm as stroke volume/end-systolic volume ratio and VVCRs by single-beat method were compared using regression analysis and Bland-Altman plots. Both were correlated to disease severity (PVRi, mRAP, CI) and adverse outcome (death, lung transplantation, atrial septostomy and intravenous medication). The area under the receiver operating characteristic curve (AU-ROC), Kaplan-Meier curves and hazard ratios (HR) from Cox regression determined their value in predicting adverse outcome.
Results: In the 31 patients included (17 from CHC and 14 from UMCG), median age was 14 years (0.3 – 23) and median PVRi was 7.6 WU × m2 (2.1 – 32). VVCRm and VVCRs were strongly correlated (r = 0.78, p < 0.001) with a mean difference of 0.2 and 95% of the differences between -0.3 and 0.7. Both had comparable significant correlations with disease severity and adverse outcome. Also, both VVCRm and VVCRs were shown to be of good prognostic value with AU-ROCs of respectively 0.84 and 0.90 and HRs (95%-CI) of 0.82 (0.70 – 0.96) and 0.69 (0.53 – 0.90).
Conclusion: In line with previous research, the results of this study indicate that VVCRm and VVCRs are comparable in pediatric PAH and are both good predictors of outcome. The characteristic disease progression is clearly seen in VVCRm, but its clinical use has to be defined by further research.
SAMENVATTING (DUTCH)
Introductie: Rechterkamerfalen is de hoofdoorzaak van overlijden in pediatrische pulmonale arteriële hypertensie (PAH). Er is groeiende interesse in de koppelingsratio tussen het rechterventrikel en de pulmonale vasculatuur (VVCR), omdat deze zowel contractiliteit als afterload omvat. De conventionele manier om VVCR te bepalen door catheterizatie (VVCRs) is invasief en vaak is anesthesie noodzakelijk. Daarom was het doel van deze studie om het nut van noninvasief bepaalde VVCR door middel van CMR (VVCRm) te vergelijken met VVCRs in kinder-PAH.
Hypothese: We toetsten twee hypothesen: 1) VVCRm is een goede schatting van VVCRs; en 2) beide zijn goede voorspellers van ziekte-ernst en ongunstige uitkomsten.
Methode: PAH patiënten die catheterizatie en CMR binnen 90 dagen hadden gehad, werden retrospectief geincludeerd. VVCR werd gedefinieerd als de ratio van eindsystolische elasticiteit/effectieve arteriële elasticiteit. VVCRm als de ratio van slagvolume/eindsystolisch volume en VVCRs door de een-slagmethode werden vergeleken met regressie-analyse en Bland-Altman plots. Beide werden gecorreleerd aan ernst van de ziekte (PVRi, mRAP, CI) en ongunstige uitkomst (overlijden, longtransplantatie, atriale septostomie en intraveneuze medicatie). Het gebied onder de receiver operating characteristic curve (AU-ROC), Kaplan-Meier curves en hazard ratios (HR) van de Cox regressie bepaalden de waarde van VVCRm en VVCRs in het voorspellen van uitkomst.
Resultaten: In de 31 geincludeerde patienten (17 uit het CHC en 14 uit het UMCG) was de mediane leeftijd 14 jaar (0.3 – 23) en mediane PVRi 7.6 WU × m2 (2.1 – 32). VVCRm en VVCRs waren sterk gcorreleerd (r = 0.78, p < 0.001) met een gemiddeld verschil van 0.2 en 95% van de verschillen tussen -0.3 en 0.7. Beiden hadden vergelijkbare significante correlaties met ziekte-ernst en ongunstige uitkomst. Ook bleken zowel VVCRm als VVCRs van goede prognostische waarde met AU-ROCs van respectievelijk 0.84 en 0.90 en HRs (95%-BI) van 0.82 (0.70 – 0.96) en 0.69 (0.53 – 0.90).
Conclusie: In lijn met eerder onderzoek laat dit onderzoek zien dat VVCRm en VVCRs vergelijkbaar zijn in kinder-PAH en goede voorspellers van uitkomst zijn. De karakteristieke ziekteprogressie is duidelijk zichtbaar in VVCRm, maar het klinisch nut hiervan moet nog verder onderzocht worden.
Onderwijsinstelling Medical Sciences
Type embargo abstract openbaar, scriptie op aanvraag
Auteur(s) Breeman, K. (Karel)
UMCG begeleider(s) Faculty supervisor:; Berger, prof. dr. (University Medical Center Groningen)
Begeleider(s) opleidingsinstelling Second supervisor:; Ivy, prof. dr. (Children’s Hospital Colorado); Location: Division of Pediatric Cardiology, Children’s Hospi
Auteur(s) Breeman, K. (Karel)
UMCG begeleider(s) Faculty supervisor:; Berger, prof. dr. (University Medical Center Groningen)


 
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