Pulmonary Artery Acceleration Time Provides a Reliable Estimate of Invasive Pulmonary Hemodynamics in Children

Philip T. Levy*, Meghna D. Patel, Georgeann Groh, Swati Choudhry, Joshua Murphy, Mark R. Holland, Aaron Hamvas, Mark R. Grady, Gautam K. Singh

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

77 Scopus citations

Abstract

Background Pulmonary artery acceleration time (PAAT) is a noninvasive method to assess pulmonary hemodynamics, but it lacks validity in children. The aim of this study was to evaluate the accuracy of Doppler echocardiography–derived PAAT in predicting right heart catheterization (RHC)–derived pulmonary artery pressure (PAP), pulmonary vascular resistance (PVR), and compliance in children. Methods Prospectively acquired and retrospectively measured Doppler echocardiography–derived PAAT and RHC-derived systolic PAP, mean PAP (mPAP), indexed PVR (PVRi), and compliance were compared using regression analysis in a derivation cohort of 75 children (median age, 5.3 years; interquartile range, 1.3–12.6 years) with wide ranges of pulmonary hemodynamics. To account for heart rate variability, PAAT was adjusted for right ventricular ejection time and corrected by the RR interval. Regression equations incorporating PAAT and PAAT/right ventricular ejection time from the derivation cohort were then evaluated for the accuracy of their predictive values for invasive pulmonary hemodynamics in a validation cohort of 50 age- and weight-matched children with elevated PAP and PVR. Results There were significant inverse correlations between PAAT and RHC-derived mPAP (r = −0.82) and PVRi (r = −0.78) and a direct correlation (r = 0.78) between PAAT and pulmonary compliance in the derivation cohort. For detection of pulmonary hypertension (PRVi > 3 Wood units · m2 and mPAP > 25 mm Hg), PAAT < 90 msec and PAAT/right ventricular ejection time < 0.31 resulted in sensitivity of 97% and specificity of 95%. In the derivation cohort, the regression equations relating PAAT with mPAP and PVRi were mPAP = 48 − 0.28 × PAAT and PVRi = 9 − 0.07 × PAAT. These PAAT-integrated equations predicted RHC-measured pulmonary hemodynamics in the validation cohort with good correlations (r = 0.88 and r = 0.83, respectively), small biases (<10%), and minimal coefficients of variation (<8%). Conclusions PAAT inversely correlates with RHC-measured pulmonary hemodynamics and directly correlates with pulmonary arterial compliance in children. The study established PAAT-based regression equations in children to accurately predict RHC-derived PAP and PVR.

Original languageEnglish (US)
Pages (from-to)1056-1065
Number of pages10
JournalJournal of the American Society of Echocardiography
Volume29
Issue number11
DOIs
StatePublished - Nov 1 2016

Keywords

  • Echocardiography
  • Pediatrics
  • Pulmonary artery acceleration time
  • Pulmonary hypertension

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine

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