Ryan S. Bishop, Tam T. Doan, Claudia Lara, Lindsay F. Eilers, Hari P. Tunuguntla, Joseph A. Spinner, Ricardo H. Pignatelli, Anitha Parthiban, James C. Wilkinson
Texas Children’s Hospital and Baylor College of Medicine.
United States
American Society for Artificial Internal Organs
ASAIO 2025;
DOI: 10.1097/MAT.0000000000002489
Abstract
Identifying pulmonary hypertension in pediatric patients with continuous-flow ventricular assist device (cf-VAD) remains challenging, often relying on invasive hemodynamic assessment. We hypothesized that echocardiography-derived right ventricular global longitudinal strain (RV-GLS) may correlate with invasive pulmonary pressures, potentially guiding the timing of cardiac catheterization. We retrospectively reviewed pediatric cf-VAD patients (<21 years) implanted at our institution from 2011 to 2023 who underwent cardiac catheterization with concurrent echocardiography, excluding those with congenital heart disease. Uniplanar RV-GLS was measured from RV-focused views and compared with invasive hemodynamics, including mean pulmonary artery pressure (mPAP) and pulmonary vascular resistance (PVRi). Associations were evaluated by Spearman correlation and binomial logistic regression. Twenty-five patients were included (median age 14.8 years, weight 68 kg, VAD support duration 5 months). Right ventricular global longitudinal strain was measurable in 23 studies (median -13.3, interquartile range [IQR] [-14.3, -9.3]). Worse RV-GLS correlated with higher mPAP (p = 0.001) and higher PVRi (p = 0.014). Right ventricular global longitudinal strain was also associated with mPAP >20 mm Hg (odds ratio [OR] = 1.79, 95% confidence interval [CI] = 1.10-2.90). An RV-GLS cutoff of -10.6% identified pulmonary hypertension (mPAP >20 mm Hg) with 88% sensitivity and 80% specificity. Right ventricular global longitudinal strain may be useful in noninvasively identifying residual pulmonary hypertension and optimal catheterization timing for pediatric cf-VAD patients. Prospective studies are needed to validate these findings.
Category
Heart Dysfunction Associated with Pulmonary Vascular Disease (Right)
Surgical and Catheter-mediated Interventions for Pulmonary Vascular Disease
Diagnostic Testing for Pulmonary Vascular Disease. Invasive Testing
Diagnostic Testing for Pulmonary Vascular Disease. Non-invasive Testing
Age Focus: Pediatric Pulmonary Vascular Disease
Fresh or Filed Publication: Fresh (PHresh). Less than 1-2 years since publication
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