title: Cardiomyopathy in children: Can we rely on echocardiographic tricuspid regurgitation gradient estimates of right ventricular and pulmonary arterial pressure?
abstract: Introduction Agreement between echocardiography and right heart catheterisation-derived right ventricular systolic pressure is modest in the adult heart failure population, but is unknown in the paediatric cardiomyopathy population.
  
  
  METHODS
  All patients at a single centre from 2001 to 2012 with a diagnosis of cardiomyopathy who underwent echocardiography and catheterisation within 30 days were included in this study. The correlation between tricuspid regurgitation gradient and catheterisation-derived right ventricular systolic pressure and mean pulmonary artery pressure was determined. Agreement between echocardiography and catheterisation-derived right ventricular systolic pressure was assessed using Bland-Altman plots. Analysis was repeated for patients who underwent both procedures within 7 days. Haemodynamic data from those with poor agreement and good agreement between echocardiography and catheterisation were compared.
  
  
  RESULTS
  A total of 37 patients who underwent 48 catheterisation procedures were included in our study. The median age was 11.8 (0.1-20.6 years) with 22 males (58% total). There was a modest correlation (r=0.65) between echocardiography and catheterisation-derived right ventricular systolic pressure, but agreement was poor. Agreement between tricuspid regurgitation gradient and right ventricular systolic pressure showed wide 95% limits of agreement. There was a modest correlation between the tricuspid regurgitation gradient and mean pulmonary artery pressure (r=0.6). Shorter time interval between the two studies did not improve agreement. Those with poor agreement between echocardiography and catheterisation had higher right heart pressures, but this difference became insignificant after accounting for right atrial pressure.
  
  
  CONCLUSIONS
  Transthoracic echocardiography estimation of right ventricular systolic pressure shows modest correlation with right heart pressures, but has limited agreement and may underestimate the degree of pulmonary hypertension in paediatric cardiomyopathy patients.
authors.affiliation: 1Department of Pediatrics,Icahn School of Medicine at Mount Sinai,Division of Cardiology,Kravis Children's Hospital,New York,New York.
authors.forename: Simon
authors.initials: S
authors.lastname: Lee
authors.affiliation: 1Department of Pediatrics,Icahn School of Medicine at Mount Sinai,Division of Cardiology,Kravis Children's Hospital,New York,New York.
authors.forename: Irene D
authors.initials: ID
authors.lastname: Lytrivi
authors.affiliation: 1Department of Pediatrics,Icahn School of Medicine at Mount Sinai,Division of Cardiology,Kravis Children's Hospital,New York,New York.
authors.forename: Zhanna
authors.initials: Z
authors.lastname: Roytman
authors.affiliation: 1Department of Pediatrics,Icahn School of Medicine at Mount Sinai,Division of Cardiology,Kravis Children's Hospital,New York,New York.
authors.forename: Hyun-Sook Helen
authors.initials: HS
authors.lastname: Ko
authors.affiliation: 2Department of Pediatrics,Kravis Children's Hospital,New York,New York.
authors.forename: Cheryl
authors.initials: C
authors.lastname: Vinograd
authors.affiliation: 1Department of Pediatrics,Icahn School of Medicine at Mount Sinai,Division of Cardiology,Kravis Children's Hospital,New York,New York.
authors.forename: Shubhika
authors.initials: S
authors.lastname: Srivastava
mesh_terms: D000293:Adolescent; D062186:Arterial Pressure; D006328:Cardiac Catheterization; D009202:Cardiomyopathies / Q000503:physiopathology*; D002648:Child; D002675:Child, Preschool; D004452:Echocardiography; D005260:Female; D006352:Heart Ventricles / Q000000981:diagnostic imaging*; D006801:Humans; D006976:Hypertension, Pulmonary / Q000000981:diagnostic imaging*; D007223:Infant; D008297:Male; D011651:Pulmonary Artery / Q000503:physiopathology*; D012189:Retrospective Studies; D014262:Tricuspid Valve Insufficiency / Q000000981:diagnostic imaging*; D016278:Ventricular Function, Right; D055815:Young Adult
keywords: Cardiomyopathy; pulmonary hypertension; tricuspid regurgitation