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Malakan Rad E, Elhamian R, Zanjani KS, Shabanian R, Moghadam EA, Majnoon MT, Zeinaloo A. Echocardiographic estimation of pulmonary arterial and right atrial pressures in children with congenital heart disease: a comprehensive prospective study and introduction of novel equations. J Cardiovasc Imaging 2024; 32:23. [PMID: 39113161 PMCID: PMC11308456 DOI: 10.1186/s44348-024-00023-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Accepted: 12/03/2023] [Indexed: 08/10/2024] Open
Abstract
BACKGROUND Pediatric pulmonary hypertension (PH) is characterized by a mean pulmonary arterial pressure exceeding 20 mmHg. There is limited research on the suitability of adult-based methods for estimating PH in pediatric populations. Using established formulas for adults, this study aimed to evaluate the correlation between echocardiographic estimates of systolic, diastolic, and mean pulmonary arterial pressures, and mean right atrial pressures in children with congenital heart disease (CHD). METHODS A prospective study was conducted involving children with CHD undergoing cardiac catheterization without prior cardiac surgery. We used echocardiography to estimate pulmonary and right atrial pressures and compared these with invasively measured values. Four reliable regression equations were developed to estimate systolic, diastolic, and mean pulmonary arterial pressures, and mean right atrial pressures. Cutoff values were determined to predict the occurrence of PH. Linear regression, Bland-Altman analysis, and receiver operating characteristic curve analysis were performed to assess the accuracy of echocardiography and establish diagnostic thresholds for PH. RESULTS The study involved 55 children (23 with normal pulmonary arterial pressure and 32 with PH) with acyanotic CHD aged 1 to 192 months. Four equations were developed to detect high pulmonary arterial pressures, with cutoff values of 32.9 for systolic pulmonary arterial pressure, 14.95 for diastolic pulmonary arterial pressure, and 20.7 for mean pulmonary arterial pressure. The results showed high sensitivity and moderate specificity but a tendency to underestimate systolic and mean pulmonary arterial pressures at higher pressures. CONCLUSIONS The study provides valuable insights into the use of adult-based echocardiographic formulas for estimating PH in pediatric patients with acyanotic CHD.
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Affiliation(s)
- Elaheh Malakan Rad
- Department of Pediatric Cardiology, Children's Medical Center (Pediatric Center of Excellence), Tehran University of Medical Sciences, Tehran, Iran.
- Fetal and Pediatric Cardiovascular Research Center, Children's Medical Center (Pediatric Center of Excellence), Tehran University of Medical Sciences, Tehran, Iran.
| | - Reza Elhamian
- Fetal and Pediatric Cardiovascular Research Center, Children's Medical Center (Pediatric Center of Excellence), Tehran University of Medical Sciences, Tehran, Iran
| | - Keyhan Sayadpour Zanjani
- Department of Pediatric Cardiology, Children's Medical Center (Pediatric Center of Excellence), Tehran University of Medical Sciences, Tehran, Iran
- Fetal and Pediatric Cardiovascular Research Center, Children's Medical Center (Pediatric Center of Excellence), Tehran University of Medical Sciences, Tehran, Iran
| | - Reza Shabanian
- Hakim Children's Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Ehsan Aghaei Moghadam
- Department of Pediatric Cardiology, Children's Medical Center (Pediatric Center of Excellence), Tehran University of Medical Sciences, Tehran, Iran
- Fetal and Pediatric Cardiovascular Research Center, Children's Medical Center (Pediatric Center of Excellence), Tehran University of Medical Sciences, Tehran, Iran
| | - Mohamad Taghi Majnoon
- Department of Pediatric Cardiology, Children's Medical Center (Pediatric Center of Excellence), Tehran University of Medical Sciences, Tehran, Iran
- Fetal and Pediatric Cardiovascular Research Center, Children's Medical Center (Pediatric Center of Excellence), Tehran University of Medical Sciences, Tehran, Iran
| | - Aliakbar Zeinaloo
- Department of Pediatric Cardiology, Children's Medical Center (Pediatric Center of Excellence), Tehran University of Medical Sciences, Tehran, Iran
- Fetal and Pediatric Cardiovascular Research Center, Children's Medical Center (Pediatric Center of Excellence), Tehran University of Medical Sciences, Tehran, Iran
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Buendía JA, Lindarte EF, Guerrero Patiño D. Phosphodiesterase 5 Inhibitor for Pediatric Pulmonary Arterial Hypertension: A Cost-Utility Analysis. Value Health Reg Issues 2023; 36:44-50. [PMID: 37028260 DOI: 10.1016/j.vhri.2023.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2022] [Revised: 12/06/2022] [Accepted: 02/28/2023] [Indexed: 04/09/2023]
Abstract
OBJECTIVES Despite the growing evidence of efficacy, scarce information exists regarding the cost of tadalafil to improve the functional classes of pediatric patients with pulmonary arterial hypertension. This study aims to determine the cost-utility of tadalafil compared sildenafil to treat pediatric patients with pulmonary arterial hypertension in Colombia. METHODS A Markov model was developed to compare expected costs, outcomes, and quality-adjusted life-years of sildenafil and tadalafil in pediatric patients with pulmonary arterial hypertension. The model was analyzed probabilistically, and a value of information analysis was conducted to inform the value of conducting further research to reduce current uncertainties in the evidence base. Cost-effectiveness was evaluated at a willingness-to-pay value of US $5180. RESULTS The mean incremental cost of tadalafil versus sildenafil is US $15 270. The 95% credible interval for the incremental cost ranges from US $28 033.65 to US $5940.86. The mean incremental benefit of tadalafil versus sildenafil is 1.00 quality-adjusted life-years (QALY). The 95% credible interval for the incremental benefit ranges from 1.88 to 0.31 QALY. The expected incremental cost per QALY is estimated at US $15 286. There is a probability less than 1% that tadalafil is more cost-effective than sildenafil at a threshold of US $5180 per QALY. Form the value of information analysis, the theoretical upper bound on the value of further research was US $9.298 for Colombia. CONCLUSION Our economic evaluation shows that tadalafil is not cost-effective regarding sildenafil to treat pediatric patients with pulmonary arterial hypertension in Colombia. Our study provides evidence that should be used by decision-makers to improve clinical practice guidelines.
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Affiliation(s)
- Jefferson Antonio Buendía
- Research group in Pharmacology and Toxicology "INFARTO," Department of Pharmacology and Toxicology, University of Antioquia, Medellin, Colombia.
| | - Erika Fernanda Lindarte
- Research group in Pharmacology and Toxicology "INFARTO," Department of Pharmacology and Toxicology, University of Antioquia, Medellin, Colombia
| | - Diana Guerrero Patiño
- Research group in Pharmacology and Toxicology "INFARTO," Department of Pharmacology and Toxicology, University of Antioquia, Medellin, Colombia
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Nelson EJ, Cook E, Nelson S, Brown R, Pierce M, Seelos AB, Stickle H, Johansen M. Quantifying side effects and caregiver burdens of pediatric pulmonary hypertension therapies. BMC Pediatr 2023; 23:43. [PMID: 36698086 PMCID: PMC9875396 DOI: 10.1186/s12887-023-03860-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Accepted: 01/20/2023] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Pulmonary hypertension (PH) is a rare, but serious disease among children. However, PH has been primarily evaluated among adults. Consequently, treatment therapies have not been fully evaluated among pediatric populations and are used in an 'off label' manner. The purpose of this study was to estimate the side effect profiles of the most commonly prescribed pediatric PH therapies and to understand the burdens placed upon families caring for children living with PH. METHODS Participants were recruited online through the "Families of children with pulmonary hypertension" Facebook group and asked to complete a survey about PH treatments. RESULTS A total of 139 parents of a child living with PH completed the survey. Almost all children used ≥ 1 medication to treat PH, with 52% using ≥ 3 medications. The highest average number of side effects was reported by users of Treprostinil, Selexipag and type-5 phosphodiesterase (PDE5) inhibitors. The most common side effects were skin flushing, headache, nasal congestion, joint/muscle pain, and nausea. In terms of accessing care, 81% travel ≥ 20 miles and 68% travel for ≥ 60 min to receive care. CONCLUSIONS We found an array of treatment combinations employed to mitigate symptoms of PH in children, with a wide range of side effects. We also found a large, unseen economic, emotional, and time burden of caring for a child living with PH. Further research is warranted to understand the clinical implications of these side effects to move towards labeled usage of these therapies rather than post-hoc off-label usage.
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Affiliation(s)
- Erik J. Nelson
- grid.253294.b0000 0004 1936 9115Department of Public Health, Brigham Young University, 2148 LSB, Provo, UT 84660 USA
| | - Ella Cook
- grid.253294.b0000 0004 1936 9115Department of Public Health, Brigham Young University, 2148 LSB, Provo, UT 84660 USA
| | - Samara Nelson
- grid.53857.3c0000 0001 2185 8768Emma Eccles Jones College of Education & Human Services, Utah State University, Logan, UT USA
| | - Rebecca Brown
- grid.253294.b0000 0004 1936 9115Department of Public Health, Brigham Young University, 2148 LSB, Provo, UT 84660 USA
| | - Megan Pierce
- grid.253294.b0000 0004 1936 9115Department of Public Health, Brigham Young University, 2148 LSB, Provo, UT 84660 USA
| | - Ashley Bangerter Seelos
- grid.253294.b0000 0004 1936 9115Department of Public Health, Brigham Young University, 2148 LSB, Provo, UT 84660 USA
| | - Heather Stickle
- grid.253294.b0000 0004 1936 9115Department of Public Health, Brigham Young University, 2148 LSB, Provo, UT 84660 USA
| | - Michael Johansen
- grid.257413.60000 0001 2287 3919Indiana University School of Medicine, Indianapolis, IN USA
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Youssef D, Richards S, Lague S, Sheppard C, Smith J, Vorhies E, Hosking M, Pietrosanu M, Bates A. A Canadian, retrospective, multicenter experience with selexipag for a heterogeneous group of pediatric pulmonary hypertension patients. Front Pediatr 2023; 11:1055158. [PMID: 36925667 PMCID: PMC10011093 DOI: 10.3389/fped.2023.1055158] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Accepted: 02/13/2023] [Indexed: 03/18/2023] Open
Abstract
Introduction Selexipag, an oral nonprostanoid prostaglandin receptor agonist, has led to reduced morbidity and mortality in adults with pulmonary arterial hypertension (PAH). While the adult literature has been extrapolated to suggest selexipag as an oral treatment for severe pediatric pulmonary hypertension (PH), longitudinal, multicenter data on the benefits of selexipag in this population are lacking. The purpose of this study is to present a longitudinal, multicentre experience with selexipag in a relatively large cohort of pediatric PH patients and add to the existing selexipag literature. Materials and methods We performed a retrospective, multicenter review describing the clinical outcomes of pediatric PH patients receiving selexipag in addition to standard oral pulmonary vasodilator therapy across three Canadian centers between January 2005 and June 2021. Results Twenty-four pediatric patients (fifteen female) with a mean age of 9.7 (range 2.0-15.5) years were included. Of this cohort, eighteen (75.0%) were in group 1, one (4.2%) was in group 2, four (16.7%) were in group 3, and one (4.2%) was in group 4. Twenty-two (91.7%) patients were on dual PH therapy after six months. Dosing was targeted to achieve 20-30 mcg/kg/dose orally every twelve hours. Median dose after twelve months was 30 mcg/kg/dose. Twelve months following selexipag initiation, median decreases of 0.2 cm in tricuspid annular plane systolic excursion, 3.5 mmHg in right-ventricular systolic pressure, and 6.1 mmHg in mean pulmonary arterial pressure were observed; none of these changes were statistically significant. Three patients died, one clinically deteriorated and required admission to a pediatric intensive care unit, ten had gastrointestinal symptoms, and three had flushing. Conclusion Selexipag appears to be a safe and effective adjunctive therapy for pediatric PH patients and has a tolerable adverse effect profile aside from gastrointestinal disturbances. Additional prospective studies of changes in hemodynamics and functional classification over a longer period and with a larger sample are needed. Future research should aim to identify subgroups that stand to benefit from the addition of selexipag as well as optimal timing and dosing for the pediatric population.
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Affiliation(s)
- David Youssef
- Department of Pediatric Pulmonary Hypertension, Stollery Children's Hospital, Edmonton, AB, Canada
| | - Susan Richards
- Department of Pediatric Pulmonary Hypertension, Stollery Children's Hospital, Edmonton, AB, Canada
| | - Sabine Lague
- Department of Pediatrics, BC Children's Hospital, Vancouver, BC, Canada
| | - Catherine Sheppard
- Department of Pediatric Pulmonary Hypertension, Stollery Children's Hospital, Edmonton, AB, Canada
| | - Jenna Smith
- Department of Pharmacy, Stollery Children's Hospital, Edmonton, AB, Canada
| | - Erika Vorhies
- Department of Pediatric Cardiology, Alberta Children's Hospital, Calgary, AB, Canada
| | - Martin Hosking
- Department of Pediatric Cardiology, BC Children's Hospital, Vancouver, BC, Canada
| | - Matthew Pietrosanu
- Department of Mathematical and Statistical Sciences, University of Alberta, Edmonton, AB, Canada
| | - Angela Bates
- Department of Pediatric Pulmonary Hypertension, Stollery Children's Hospital, Edmonton, AB, Canada.,Division of Pediatric Critical Care, Department of Pediatrics, University of Alberta, Edmonton, AB, Canada
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Alakhfash AA, Alqwaiee A, Alakhfash GA, Alhajjaj A, Almesned AA. Pulmonary hypertension associated with congenital heart disease; clinical decision scenario. Respir Med Case Rep 2020; 31:101286. [PMID: 33294357 PMCID: PMC7683341 DOI: 10.1016/j.rmcr.2020.101286] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Revised: 10/18/2020] [Accepted: 11/07/2020] [Indexed: 11/26/2022] Open
Abstract
Pulmonary arterial hypertension associated with congenital heart disease (PAH-CHD) is one type under group 1 PH. Undiagnosed or delayed diagnosis of significant CHD might lead to significant PAH and at the end might lead to Eisenmenger syndrome. We could expect the degree of PAH in patients with CHD by proper clinical assessment as well as by the basic assessment tools including the chest x-ray (CXR), ECG, and transthoracic echocardiography (TTE). We are presenting a three and half years old child with a delayed/missed diagnosis of large patent ductus arteries (PDA) who present with significant PAH. Clinical evaluation, CXR, ECG, TTE, as well as cardiac catheterization data are presented, with a review of the current guidelines regarding the management of pediatric patients with PAH-CHD.
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Key Words
- APW, Aortopulmonary window
- BPD, Bronchopulmonary dysplasia
- CHD, Congenital Heart Disease
- Congenital heart defects
- PAH, Pulmonary arterial hypertension
- PCW, pulmonary capillary wedge
- PDA closure
- PDA, Patent ductus arteriosus
- PH, Pulmonary hypertension
- PVR, pulmonary vascular resistance
- Pulmonary arterial hypertension
- Qp, pulmonary blood flow
- Qs, Systemic blood flow
- SVR, Systemic vascular resistance
- VSD, Ventricular septal defect
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Affiliation(s)
- Ali A Alakhfash
- Consultant Pediatric Cardiologist, Prince Sultan Cardiac Center-Qassim, Saudi Arabia
| | - Abdullah Alqwaiee
- Consultant Pediatric Cardiologist, Prince Sultan Cardiac Center-Qassim, Saudi Arabia
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