Normal Reference Values and z Scores of the Pulmonary Artery Acceleration Time in Children and Its Importance for the Assessment of Pulmonary Hypertension

Abstract

Background— Pulsed-wave Doppler determination of the pulmonary artery acceleration time (PAAT) as a surrogate for pulmonary artery pressure was found to be of clinical value for assessment of pulmonary hypertension (PH) with studies to date exclusively performed in adults. This study aims to provide representative, normal reference values for PAAT in children of all ages. Moreover, we validated abnormal PAAT values in 54 children with PH. Methods and Results— We conducted a prospective echocardiographic study in 756 healthy children (aged 1 day to 18 years) and in 54 children with PH. Possible associations of age, body length, body weight, body surface area, and heart rate on PAAT were investigated. The PAAT correlated positively with age ( r =0.848), body length ( r =0.871), body surface area ( r =0.856), and body weight ( r =0.825) and negatively with heart rate ( r =−0.906). PAAT increased with age (neonates: median: 81 ms, range: 53–104; 18th year of life: median: 151 ms, range: 107–187). Receiver operating characteristic analysis for detecting PH patients using age-specific z scores showed an excellent performance of PAAT ( P <0.001; area under the curve, 0.98; 95% confidence interval, 0.97–0.99) with a best cutoff score according to Youden index of –1.565 (sensitivity: 92%, specificity: 96%). PAAT values of PH patients negatively correlated (ρ=−0.497) with pulmonary vascular resistance. Conclusions— The PAAT normal reference values and z scores we provide here will be useful to identify children with a shortened PAAT. Abnormal PAAT values with scores <−2 were predictive of PH.