Faculty Collaboration Database

Electrical and mechanical dyssynchrony in pediatric pulmonary hypertension. J Heart Lung Transplant 2012 Aug;31(8):825-30

Date

06/12/2012

Pubmed ID

22682994

DOI

10.1016/j.healun.2012.04.004

Scopus ID

2-s2.0-84863325667 (requires institutional sign-in at Scopus site)   14 Citations

Abstract

BACKGROUND: Electrical and mechanical dyssynchrony are often seen in patients with left ventricular failure. In pediatric pulmonary hypertension (PH), right ventricular failure predominates; however, the prevalence of electrical and/or mechanical dyssynchrony in these patients is unknown. We examined the prevalence of electrical and mechanical dyssynchrony in pediatric PH patients.

METHODS: Medical records (including, functional status, electrocardiograms and echocardiograms) of pediatric PH patients were reviewed. QRS duration z-scores were calculated to determine electrical dyssynchrony. Echo vector velocity imaging was used to calculate the mechanical dyssynchrony index (DI).

RESULTS: Seventy-seven PH patients (idiopathic pulmonary arterial hypertension [IPAH]: n = 26; congenital heart disease: n = 41; other: n = 10) were studied. Electrical dyssynchrony was seen in 84% (p < 0.01 vs historic controls), with a mean z-score of 4.3 (95% CI 3.5 to 5.1). There was no difference between those with IPAH, z = 3.6 (95% CI 2.5 to 4.6), and those without, z = 4.7 (95% CI 3.6 to 5.8). Mechanical dyssynchrony was seen in 76% of patients (mean DI = 66 ± 47 vs 18 ± 8 milliseconds in historic controls, p < 0.01) in both IPAH and non-IPAH patients. Post-operative congenital heart disease patients had the largest dyssynchrony index. No correlation was found among electrical or mechanical dyssynchrony, hemodynamics or disease severity.

CONCLUSIONS: Significant electrical and mechanical dyssynchrony is present in pediatric PH patients, regardless of etiology. The overall effect of electrical and mechanical dyssynchrony on outcomes in this patient population is still unknown. Select patients may benefit from resynchronization therapy.

Author List

Hill AC, Maxey DM, Rosenthal DN, Siehr SL, Hollander SA, Feinstein JA, Dubin AM

Author

Stephanie S. Handler MD Associate Professor in the Pediatrics department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Adolescent
Biomechanical Phenomena
Child
Child, Preschool
Echocardiography
Electrocardiography
Female
Heart Defects, Congenital
Hemodynamics
Humans
Hypertension, Pulmonary
Infant
Male
Retrospective Studies
Severity of Illness Index
Ventricular Dysfunction, Right