Results
A total of 159 children were included in this study, 150 of which had
useable echocardiographic data. 39 children were identified as having
clinically-diagnosed pulmonary hypertension while 111 children had an
atrial septal defect requiring closure in the cardiac catheterization
laboratory. Slightly over half (56%) of patients were less than 5 years
of age, approximately 13% of patients were between the age of 5-10
years, 20% between the age of 10-15, and 11% were between 15-21 years.
The mean age of the total group of patients was 7.1 years (SD=5.3), with
a minimum age of 54 days and a maximum of 19.1 years. The echo was
obtained at a median of 6.5 days (0-88 days) prior to the
catheterization.
A table summarizing the echocardiographic and catheterization findings
of the two groups (ASD and pulmonary hypertension patients) is provided
below (Table 1).
An EDSPA of ≤39° predicted a mean MPA pressure >20 mmHg (as
measured by cardiac catheterization) with a 76% sensitivity and 76%
specificity (AUC 0.85) (Figure 3) and an EDSPA of ≤37° predicted a mean
MPA pressure >40 mmHg (as measured by cardiac
catheterization) with a 80% sensitivity and 81% specificity (AUC
0.85). A graphical depiction of the EDSPA values in those with MPA
pressures less than and greater than 40 mmHg is seen in figure 4. In
addition an EDSPA ≤40° predicted a RV/LV systolic pressure ratio
>0.5 (as measured by cardiac catheterization) with a 76%
sensitivity and 77% specificity (AUC 0.888) (Figure 5).
Inter-observer variability between the two readers was small with a
Pearson correlation coefficient of 0.913 (p <0.001) and the
Lin’s correlation coefficient of 0.907 when using a mean of the 3
measurements per observer (Figure 3). In addition, intra-observer
variability was low with an intraclass correlation coefficient (ICC) for
each observer of 0.95 (0.9-0.97 95% CI) for reader 1 and 0.94
(0.89-0.97) for reader 2.