title: Three-dimensional Echocardiography of Right Ventricular Function Correlates with Severity of Pediatric Pulmonary Hypertension.
abstract: BACKGROUND
  Right ventricular function and biomarkers of B-type natriuretic peptide (BNP) and N-Terminal pro-BNP (NT pro-BNP) are used to determine the severity of right ventricular failure and outcomes from pulmonary hypertension. Real-time three-dimensional echocardiography (3DE) is a novel quantitative measure of the right ventricle and decreases the geometric assumptions from conventional two-dimensional echocardiography (2DE). We correlated right ventricular functional measures using 2DE and single-beat 3DE with biomarkers and hemodynamics to determine the severity of pediatric pulmonary hypertension.
  
  
  METHODS
  We retrospectively evaluated 35 patients (mean age 12.67 ± 5.78 years) with established pulmonary hypertension who had echocardiograms and biomarkers on the same day. Ten out of 35 patients had hemodynamic evaluation within 3 days. 2DE evaluation included tricuspid annular plane systolic excursion (TAPSE), right ventricular myocardial performance index from tissue Doppler imaging (RV TDI MPI), and right ventricular fractional area change (FAC). Three-dimensional echocardiography evaluation included right ventricular ejection fraction (EF), end-systolic volume, and end-diastolic volume. The quality of the 3DE was graded as good, fair, or poor. Pearson correlation coefficients were utilized to evaluate between biomarkers and echocardiographic parameters and between hemodynamics and echocardiography.
  
  
  RESULTS
  Three-dimensional echocardiography and FAC correlated significantly with BNP and NT pro-BNP. TAPSE and RV TDI MPI did not correlate significantly with biomarkers. 3D right ventricular EF correlated significantly with hemodynamics. Two-dimensional echocardiography did not correlate with hemodynamics.
  
  
  CONCLUSIONS
  Single-beat 3DE is a noninvasive, feasible tool in the quantification of right ventricular function and maybe more accurate than conventional 2DE in evaluating severity of pulmonary hypertension.
authors.affiliation: Pediatric Cardiology, Department of Pediatrics, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, Colo, USA.
authors.forename: Pei-Ni
authors.initials: PN
authors.lastname: Jone
authors.affiliation: Pediatric Cardiology, Department of Pediatrics, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, Colo, USA.
authors.forename: Sonali S
authors.initials: SS
authors.lastname: Patel
authors.affiliation: Pediatric Cardiology, Department of Pediatrics, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, Colo, USA.
authors.forename: Courtney
authors.initials: C
authors.lastname: Cassidy
authors.affiliation: Pediatric Cardiology, Department of Pediatrics, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, Colo, USA.
authors.forename: David Dunbar
authors.initials: DD
authors.lastname: Ivy
mesh_terms: D000293:Adolescent; D062186:Arterial Pressure; D015415:Biomarkers / Q000097:blood; D006328:Cardiac Catheterization; D002648:Child; D015150:Echocardiography, Doppler; D019560:Echocardiography, Three-Dimensional; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D006976:Hypertension, Pulmonary / Q000097:blood / Q000000981:diagnostic imaging* / Q000503:physiopathology; D008297:Male; D020097:Natriuretic Peptide, Brain / Q000097:blood; D010446:Peptide Fragments / Q000097:blood; D011237:Predictive Value of Tests; D011651:Pulmonary Artery / Q000503:physiopathology*; D012189:Retrospective Studies; D012720:Severity of Illness Index; D018497:Ventricular Dysfunction, Right / Q000097:blood / Q000000981:diagnostic imaging* / Q000503:physiopathology; D016278:Ventricular Function, Right
chemical_list: D015415:Biomarkers; D010446:Peptide Fragments; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain
keywords: Biomarkers of Pulmonary Hypertension; Pulmonary Hypertension; Right Ventricular Function; Three-dimensional Echocardiography