Pulmonary pressure in the first twelve-months of live: What should we expect?

IF 2.3 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Archives of Cardiovascular Diseases Pub Date : 2024-08-01 DOI:10.1016/j.acvd.2024.07.003

A. Callegari, J. Grynblat, M. Mathilde, I. Szezepanski, S. Malekzadeh-Milani, D. Bonnet

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引用次数: 0

Abstract

Introduction

Mean pulmonary artery pressure (mPAP) ≥ 20 mmHg defines pulmonary hypertension (PH).

Objective

Critically evaluate this cut-off in very young patients.

Methods

In total, 1129 consecutive patients had a reliable mPAP measurement between 1–12 months of life. These invasive measurements and their clinical history were reviewed.

Results

Age was mean ± SD 158 ± 100 days, weight 5.5 ± 1.9 kg. Patients with a palliated single ventricle anatomy 129/1129, peripheral PA-branch stenosis or MAPCAs 45/1129, PA-banding for open shunt 30/1129, or severe RVOTO 185/1129 were excluded. Of the remaining 726 patients 163/726 (22%) had mPAP < 20 mmHg while 563 (78%) had PH with mPAP ≥ 20 mmHg.

Overall, PH at TTE was the reason for invasive mPAP measurement in 236 patients and only 16/236 patients (7%) had a mPAP < 20 mmHg but 12/16 (75%) had a mPAP ≥ 18 mmHg. In the group with mPAP ≥ 20 mmHg PH persisted at 6-months in 109/236 (46%) (Fig. 1A) and in 68/236 (28%) at long-term follow-up (Fig. 1B). In the group with mPAP between 18 and 20 mmHg PH persisted at 6-months in 9/12 (75%) and in 3/12 (25%) at long-term follow-up. None of the patients with mPAP < 18 mmHg had PH at follow-up.

In patients with less than 3 months of age, PH at TTE was the reason for invasive mPAP measurement in 73/306 (23%) and only 3/73 patients (4%) had a mPAP < 20 mmHg, but 2/3 (75%) had a mPAP ≥ 18 mmHg. In the group with mPAP ≥ 20 mmHg PH persisted at 6-months in 34/70 (48%) (Fig. 2A) and in 34/70 (48%) at long-term follow-up (Fig. 2B). In the group with mPAP between 18 and 20 mmHg PH persisted at 6-months in 2/2 (100%) and in 2/2 (100%) at long-term follow-up. None of those with mPAP < 18 mmHg had PH at follow-up.

Conclusion

Pulmonary hypertension defined by mPAP ≥ 20 mmHg is very common in this cohort of young patients, especially in case of suspected PH at echo. A different cut-off defined as 18 mmHg should be discussed in patients with less than 12-months.

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出生后头 12 个月的肺活量：我们应该期待什么？

导言平均肺动脉压（mPAP）≥ 20 mmHg 即为肺动脉高压（PH）。结果年龄平均（±SD）为 158±100 天，体重为 5.5±1.9 公斤。排除了129/1129例单心室姑息解剖的患者、45/1129例外周PA支狭窄或MAPCAs患者、30/1129例开放分流PA带患者或185/1129例严重RVOTO患者。在剩余的 726 例患者中，有 163/726 例（22%）的 mPAP≥20 mmHg，而有 563 例（78%）的 PH 患者的 mPAP≥20 mmHg。总体而言，236 例患者在 TTE 时因 PH 而进行了有创 mPAP 测量，只有 16/236 例患者（7%）的 mPAP≥20 mmHg，但有 12/16 例患者（75%）的 mPAP≥18 mmHg。在 mPAP ≥ 20 mmHg 的患者中，109/236（46%）人在 6 个月后仍有 PH（图 1A），68/236（28%）人在长期随访时仍有 PH（图 1B）。在 mPAP 介于 18 和 20 mmHg 之间的组别中，9/12（75%）的患者在 6 个月后 PH 持续存在，3/12（25%）的患者在长期随访时 PH 持续存在。在年龄小于 3 个月的患者中，73/306（23%）的患者在 TTE 测量时出现 PH，只有 3/73 的患者（4%）的 mPAP 为 20 mmHg，但有 2/3（75%）的患者 mPAP ≥ 18 mmHg。在 mPAP ≥ 20 mmHg 组中，34/70（48%）的患者在 6 个月后仍有 PH 存在（图 2A），34/70（48%）的患者在长期随访时仍有 PH 存在（图 2B）。在 mPAP 介于 18 和 20 mmHg 之间的人群中，2/2（100%）人在 6 个月时 PH 持续存在，2/2（100%）人在长期随访时 PH 持续存在。结论 mPAP ≥ 20 mmHg 定义的肺动脉高压在这组年轻患者中非常常见，尤其是在回声检查时怀疑有 PH 的情况下。应讨论将 18 mmHg 定义为不同的临界值，适用于病程不足 12 个月的患者。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Archives of Cardiovascular Diseases 医学-心血管系统

CiteScore

4.40

自引率

6.70%

发文量

审稿时长

34 days

期刊介绍： The Journal publishes original peer-reviewed clinical and research articles, epidemiological studies, new methodological clinical approaches, review articles and editorials. Topics covered include coronary artery and valve diseases, interventional and pediatric cardiology, cardiovascular surgery, cardiomyopathy and heart failure, arrhythmias and stimulation, cardiovascular imaging, vascular medicine and hypertension, epidemiology and risk factors, and large multicenter studies. Archives of Cardiovascular Diseases also publishes abstracts of papers presented at the annual sessions of the Journées Européennes de la Société Française de Cardiologie and the guidelines edited by the French Society of Cardiology.