Factors Leading to Supranormal Cardiac Index in Pediatric Pulmonary Hypertension Patients Treated with Parenteral Prostanoid Therapy

Overview

Journal Pulm Circ

Publisher Wiley

Specialty Pulmonary Medicine

Date 2023 Jul 10

PMID 37427091

Authors

Kimberley G Miles

Paul J Critser

Patrick D Evers

Michelle Cash

Melissa Magness

Elizabeth Geers

Meredith ONeil

Zhiqian Gao

Nicholas J Ollberding

Russel Hirsch

Affiliations

Soon will be listed here.

Abstract

Parenteral prostanoid therapy (PPT) can result in supranormal cardiac index (SCI; >4 L/min/m) in pediatric pulmonary hypertension (PPH) patients. We evaluated the incidence, hemodynamic factors, and outcomes associated with SCI in PPH. This retrospective cohort study included 22 PPH patients on PPT from 2005 to 2020. Hemodynamic profiles were compared between the baseline and 3-6 month follow-up catheterization in the SCI and non-SCI cohorts. Cox regression analysis examined time to composite adverse outcome (CAO; Potts shunt, lung transplant, or death) controlling for initial disease severity. SCI developed in 17 (77%) patients, of whom 11 (65%) developed SCI within 6 months. The SCI cohort was characterized by significant augmentation of cardiac index (CI) and stroke volume (SV) as well as reductions in systemic vascular resistance (SVR) and pulmonary vascular resistance (PVR). Conversely, the non-SCI cohort had unchanged SV despite a modest rise in CI as well as persistent vasoconstriction. After median follow-up of 4.3 years (range 0.2-13 years), non-SCI patients were at significantly increased risk for the CAO (5/5: three deaths, two Potts shunts) compared with SCI patients (5/17: two deaths, three lung transplants; adjusted hazard ratio 14.0 [95% confidence interval: 2.1-91.3], < 0.001). A majority of PPH patients developed SCI within 6-12 months of starting PPT and demonstrated lower risk of adverse outcomes compared with non-SCI patients. These data suggest that change in SVR and SV after 3-6 months of PPT may be early markers of therapeutic response and prognosis.

Citing Articles

Factors leading to supranormal cardiac index in pediatric pulmonary hypertension patients treated with parenteral prostanoid therapy.

Miles K, Critser P, Evers P, Cash M, Magness M, Geers E Pulm Circ. 2023; 13(3):e12264.

PMID: 37427091 PMC: 10323166. DOI: 10.1002/pul2.12264.

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