M Beghetti1, I Schulze-Neick2, R M F Berger3, D D Ivy4, D Bonnet5, R G Weintraub6, T Saji7, D Yung8, G B Mallory9, R Geiger10, J T Berger11, R J Barst12, T Humpl13. 1. Pediatric Cardiology, Department of the Child and Adolescents, Hôpital des Enfants, University of Geneva, Switzerland. Electronic address: maurice.beghetti@hcuge.ch. 2. Cardiac Unit, Great Ormond Street Hospital for Children, London, UK. 3. Center for Congenital Heart Diseases, Pediatric Cardiology, Beatrix Children's Hospital, University Medical Center Groningen, University of Groningen, Netherlands. 4. Pediatrics, University of Colorado School of Medicine, Aurora, USA. 5. M3C-Paediatric Cardiology, Université Paris Descartes, Necker Enfants Malades, AP-HP, Paris, France. 6. Royal Children's Hospital, Murdoch Children's Research Institute, Melbourne, Australia. 7. Toho University Medical Center Omori Hospital, Tokyo, Japan. 8. Seattle Children's Hospital, University of Washington School of Medicine, Seattle, USA. 9. Texas Children's Hospital, Baylor College of Medicine, Houston, USA. 10. Innsbruck Medical University, Pediatric Cardiology, Innsbruck, Austria. 11. Children's National Medical Center, Pediatric Critical Care and Cardiology, WA, USA. 12. Pediatrics, Columbia University, New York, USA. 13. Cardiology and Critical Care, University of Toronto, Toronto, ON, Canada.
Abstract
BACKGROUND: The TOPP Registry has been designed to provide epidemiologic, diagnostic, clinical, and outcome data on children with pulmonary hypertension (PH) confirmed by heart catheterisation (HC). This study aims to identify important characteristics of the haemodynamic profile at diagnosis and HC complications of paediatric patients presenting with PH. METHODS AND RESULTS: HC data sets underwent a blinded review for confirmation of PH (defined as mean pulmonary arterial pressure ≥ 25 mmHg, pulmonary capillary wedge pressure ≤ 12 mmHg and pulmonary vascular resistance index [PVRI] of >3 WU × m(2)). Of 568 patients enrolled, 472 who fulfilled the inclusion criteria and had sufficient data from HC were analysed. A total of 908 diagnostic and follow-up HCs were performed and complications occurred in 5.9% of all HCs including five (0.6%) deaths. General anaesthesia (GA) was used in 53%, and conscious sedation in 47%. Complications at diagnosis were more likely to occur if GA was used (p=0.04) and with higher functional class (p=0.02). Mean cardiac index (CI) was within normal limits at diagnosis when analysed for the entire group (3.7 L/min/m(2); 95% confidence interval 3.4-4.1), as was right atrial pressure despite a severely increased PVRI (16.6 WU × m(2,) 95% confidence interval 15.6-17.76). However, 24% of the patients had a CI of <2.5L/min/m(2) at diagnosis. A progressive increase in PVRI and decrease in CI was observed with age (p<0.001). CONCLUSION: In TOPP, haemodynamic assessment was remarkable for preserved CI in the majority of patients despite severely elevated PVRI. HC-related complication incidence was 5.9%, and was associated with GA and higher functional class.
BACKGROUND: The TOPP Registry has been designed to provide epidemiologic, diagnostic, clinical, and outcome data on children with pulmonary hypertension (PH) confirmed by heart catheterisation (HC). This study aims to identify important characteristics of the haemodynamic profile at diagnosis and HC complications of paediatric patients presenting with PH. METHODS AND RESULTS: HC data sets underwent a blinded review for confirmation of PH (defined as mean pulmonary arterial pressure ≥ 25 mmHg, pulmonary capillary wedge pressure ≤ 12 mmHg and pulmonary vascular resistance index [PVRI] of >3 WU × m(2)). Of 568 patients enrolled, 472 who fulfilled the inclusion criteria and had sufficient data from HC were analysed. A total of 908 diagnostic and follow-up HCs were performed and complications occurred in 5.9% of all HCs including five (0.6%) deaths. General anaesthesia (GA) was used in 53%, and conscious sedation in 47%. Complications at diagnosis were more likely to occur if GA was used (p=0.04) and with higher functional class (p=0.02). Mean cardiac index (CI) was within normal limits at diagnosis when analysed for the entire group (3.7 L/min/m(2); 95% confidence interval 3.4-4.1), as was right atrial pressure despite a severely increased PVRI (16.6 WU × m(2,) 95% confidence interval 15.6-17.76). However, 24% of the patients had a CI of <2.5L/min/m(2) at diagnosis. A progressive increase in PVRI and decrease in CI was observed with age (p<0.001). CONCLUSION: In TOPP, haemodynamic assessment was remarkable for preserved CI in the majority of patients despite severely elevated PVRI. HC-related complication incidence was 5.9%, and was associated with GA and higher functional class.
Authors: K T N Breeman; M Dufva; M J Ploegstra; V Kheyfets; T P Willems; J Wigger; K S Hunter; D D Ivy; R M F Berger; U Truong Journal: Int J Cardiol Date: 2019-05-10 Impact factor: 4.164
Authors: Michael L O'Byrne; Kevin F Kennedy; Joshua P Kanter; John T Berger; Andrew C Glatz Journal: J Am Heart Assoc Date: 2018-02-28 Impact factor: 5.501
Authors: Erika B Rosenzweig; Steven H Abman; Ian Adatia; Maurice Beghetti; Damien Bonnet; Sheila Haworth; D Dunbar Ivy; Rolf M F Berger Journal: Eur Respir J Date: 2019-01-24 Impact factor: 16.671
Authors: Cécile Ollivier; Haihao Sun; Wayne Amchin; Maurice Beghetti; Rolf M F Berger; Stefanie Breitenstein; Christine Garnett; Ninna Gullberg; Patrik Hassel; Dunbar Ivy; Steven M Kawut; Agnes Klein; Catherine Lesage; Marek Migdal; Barbara Nije; Michal Odermarsky; James Strait; Pieter A de Graeff; Norman Stockbridge Journal: J Am Heart Assoc Date: 2019-05-21 Impact factor: 5.501