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Combined CMR and catheterization data in determining right ventricular-arterial coupling in children and adolescents with pulmonary arterial hypertension

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Pulmonary arterial hypertension (PAH) remains a disease with high morbidity/mortality in pediatrics... Ea/Emax (range 0.43-2.82) was highly correlated with PVRi (r = 0.92, 95% CI 0.79-0.97, p < 0.0001)... Non-invasively derived ventricular arterial coupling was found to be significantly correlated with PVRi (r = 0.85, 95% CI 0.62-0.95, p < 0.0001), but with a lower correlation coefficient than with Ea/Emax derived from combined hemodynamic and CMR data... Regression of Ea/Emax and PVRi demonstrated differing lines when separated by reactivity, however, the lines were not significantly different (Figure 1)... ROC curve analysis (Figure 2) revealed high accuracy of the Ea/Emax ratio in determining vascular reactivity... Ea/Emax of 0.85 had a sensitivity of 100% and a specificity of 80%... The area under the curve is 0.89 (p = 0.008), suggesting good discrimination between those who were and were not reactive... Measurement of ventricular arterial coupling, Ea/Emax, in pediatrics is feasible... Pulmonary vascular non-reactivity may be due to ventricular-arterial decoupling in which ventricular contractility fails to parallel increasing afterload in severe PAH... Use of Ea/Emax may have significant prognostic implication.

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Receiver operating characteristic curve demonstrating an optimal threshold Ea/Emax ratio of 0.85. Using this criterion, is associated with a sensitivity of 100% and a specificity of 80%.
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Figure 2: Receiver operating characteristic curve demonstrating an optimal threshold Ea/Emax ratio of 0.85. Using this criterion, is associated with a sensitivity of 100% and a specificity of 80%.

Mentions: Sixteen subjects were identified for inclusion with equal gender distributions. Age ranged from 3 months to 23 years (mean 11.3+7.4 years). Ea and Ea/Emax increased with increasing severity defined by PVRi, with p < 0.001 for both. Ea/Emax (range 0.43-2.82) was highly correlated with PVRi (r = 0.92, 95% CI 0.79-0.97, p < 0.0001). Non-invasively derived ventricular arterial coupling was found to be significantly correlated with PVRi (r = 0.85, 95% CI 0.62-0.95, p < 0.0001), but with a lower correlation coefficient than with Ea/Emax derived from combined hemodynamic and CMR data. Regression of Ea/Emax and PVRi demonstrated differing lines when separated by reactivity, however, the lines were not significantly different (Figure 1). ROC curve analysis (Figure 2) revealed high accuracy of the Ea/Emax ratio in determining vascular reactivity. Ea/Emax of 0.85 had a sensitivity of 100% and a specificity of 80%. The area under the curve is 0.89 (p = 0.008), suggesting good discrimination between those who were and were not reactive.


Combined CMR and catheterization data in determining right ventricular-arterial coupling in children and adolescents with pulmonary arterial hypertension
Receiver operating characteristic curve demonstrating an optimal threshold Ea/Emax ratio of 0.85. Using this criterion, is associated with a sensitivity of 100% and a specificity of 80%.
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4044105&req=5

Figure 2: Receiver operating characteristic curve demonstrating an optimal threshold Ea/Emax ratio of 0.85. Using this criterion, is associated with a sensitivity of 100% and a specificity of 80%.
Mentions: Sixteen subjects were identified for inclusion with equal gender distributions. Age ranged from 3 months to 23 years (mean 11.3+7.4 years). Ea and Ea/Emax increased with increasing severity defined by PVRi, with p < 0.001 for both. Ea/Emax (range 0.43-2.82) was highly correlated with PVRi (r = 0.92, 95% CI 0.79-0.97, p < 0.0001). Non-invasively derived ventricular arterial coupling was found to be significantly correlated with PVRi (r = 0.85, 95% CI 0.62-0.95, p < 0.0001), but with a lower correlation coefficient than with Ea/Emax derived from combined hemodynamic and CMR data. Regression of Ea/Emax and PVRi demonstrated differing lines when separated by reactivity, however, the lines were not significantly different (Figure 1). ROC curve analysis (Figure 2) revealed high accuracy of the Ea/Emax ratio in determining vascular reactivity. Ea/Emax of 0.85 had a sensitivity of 100% and a specificity of 80%. The area under the curve is 0.89 (p = 0.008), suggesting good discrimination between those who were and were not reactive.

View Article: PubMed Central - HTML

AUTOMATICALLY GENERATED EXCERPT
Please rate it.

Pulmonary arterial hypertension (PAH) remains a disease with high morbidity/mortality in pediatrics... Ea/Emax (range 0.43-2.82) was highly correlated with PVRi (r = 0.92, 95% CI 0.79-0.97, p < 0.0001)... Non-invasively derived ventricular arterial coupling was found to be significantly correlated with PVRi (r = 0.85, 95% CI 0.62-0.95, p < 0.0001), but with a lower correlation coefficient than with Ea/Emax derived from combined hemodynamic and CMR data... Regression of Ea/Emax and PVRi demonstrated differing lines when separated by reactivity, however, the lines were not significantly different (Figure 1)... ROC curve analysis (Figure 2) revealed high accuracy of the Ea/Emax ratio in determining vascular reactivity... Ea/Emax of 0.85 had a sensitivity of 100% and a specificity of 80%... The area under the curve is 0.89 (p = 0.008), suggesting good discrimination between those who were and were not reactive... Measurement of ventricular arterial coupling, Ea/Emax, in pediatrics is feasible... Pulmonary vascular non-reactivity may be due to ventricular-arterial decoupling in which ventricular contractility fails to parallel increasing afterload in severe PAH... Use of Ea/Emax may have significant prognostic implication.

No MeSH data available.