This study was designed as a retrospective study of patients with and
without pulmonary hypertension who had a transthoracic echocardiogram
and cardiac catheterization less than 90 days apart. Subjects were
identified for the study based on a survey of the EPIC database and
Syngodynamics Echocardiographic database (Siemens Medical Solutions,
Malvern, PA) for having a history of primary or secondary pulmonary
hypertension from 1/1/2007 through 6/1/18. All patients from newborn
through 21 years of age were included. Subjects with small intracardiac
shunts were included, but subjects with other structural heart defects
were excluded. Age matched controls who were undergoing cardiac
catheterization for atrial septal defect device closure and had normal
pulmonary artery pressures were selected. Echocardiograms were performed
within 90 days prior to catheterization.
Echocardiograms were reviewed and measured by 2 blinded readers. Studies
were assessed for overall quality, presence and velocity of tricuspid
regurgitation, pulmonary insufficiency, pulmonary stenosis, peripheral
pulmonary artery stenosis, atrial level shunt, ventricular level shunt,
and ventricular systolic function. The “septal positional angle” (see
figure 1) was made in the parasternal short axis at peak systole at the
level of the papillary muscles by drawing a primary midpoint line (M)
that bisects the right and left ventricular area equally. A secondary
perpendicular line (S) was drawn at the widest dimension of the left
ventricle. A third line (A) was drawn which intersected the secondary
line at the inferior portion of the left ventricular epicardium and the
right ventricular side of the interventricular septum along the midpoint
line. The angle (α) was calculated utilizing the angle tool in the
Syngodynamics software, from the intersection of the second and third
line and defined as the echocardiographically-derived septal positional
angle (EDSPA).
Data was obtained from the Epic electronic medical record database for
these patients including dose and duration of medical therapy, other
co-morbidities, and quantitative assessment of right ventricular
systolic pressures from cardiac catheterization (RV systolic and
diastolic pressures, LV systolic and diastolic pressures, mean pulmonary
artery pressure, qualitative ventricular systolic function assessment,
Qp:Qs, cardiac index and response to therapy).