A Novel Method To Evaluate Pulmonary Arterial Hypertension In Congenital Ventricular Septal Defect Patients By Transthoracic Doppler Echocardiography

Background:Transthoracic Doppler echocardiography is recommended to evaluate the presence of pulmonary arterial hypertension (PAH). However, some recent studies have revealed that Doppler echocardiographic for pulmonary artery pressure estimatias may frequently be inaccurate. Objectives:The aim of this study was to determine the prognostic value of some quantitative echocardiographic criterion for PAH in patients with congenital ventricular septal defect, including left to right shunt pressure gradient (LRPG), the thickness ratio of the right ventricle end-diastolic anterior wall to the left ventricle end-diastolic posterior wall (RVAW/LVPW ratio) and the ratio of main pulmonary artery diameter to ascended aorta diameter (PA/AO ratio).Methods:A total of 202 patients with isolated congenital ventricular septal defect (VSD) were enrolled in this study and classified into 4 groups according to their mean pulmonary artery pressure (PAMP) by right-heart catheterization:A group without-PAH,with PAMP< 25 mmHg A group of mild-PAH, with PAMP≥25 mmHg and< 40 mmHg; A group of moderate-PAH, with PAMP≥40 mmHg and<60 mmHg; A group of severe-PAH, with PAMP≥60 mmHg. Bivariate correlations were evaluated using Pearson's correlation coefficient. Univariate correlations were evaluated using Pearson's correlation coefficient. The discriminatory ability of LRPG, PA/AO ratio and RVAW/LVPW ratio for PAH was assessed using the receiver operating characteristic curve (ROC). Results:The RVAW/LVPW ratio, PA/AO ratio and LRPG were correlated well with mean pulmonary artery pressure (PAMP) measured by right-heart catheterization (r= 0.732, r= 0.556; r=-0.647; P＜0.0001; resprctively). The sensitivity and specificity of RVAW/LVPW ratio≥0.6 for predicting PAH defined as PMAP≥25 mm Hg were 80% and 69%, with a high area under the ROC (AUC,0.80; 95% CI,0.76-0.86). The sensitivity and specificity of RVAW/LVPW ratio≥0.9 for diagnosing severe PAH (PAMP≥60 mmHg) were 93% and 94%, with a high AUC, (0.97;95%CI,0.94-0.99). The sensitivity and specificity of PA/AO ratio≥1.2, and LRPG≤49 mmHg for predicting PAH defined as PMAP> 25 mm Hg were 72% and 70%,76% and 92%, respectively The sensitivity and specificity of PA/AO ratio≥1.45, and LRPG≤25 mmHg for diagnosing severe PAH (PAMP>60 mmHg) were 61% and 80%,89% and 80%, respectivelyConclusion:These variables, including RVAW/LVPW ratio, PA/AO ratio and LRPG derived from echocardiography, have a good prognostic value regarding the severity of PAH in patients with VSD, especially RVAW/LVPW ratio and LRPG...