{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,30]],"date-time":"2026-10-30T17:11:52Z","timestamp":1793380312373,"version":"4.5.0"},"reference-count":23,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"6","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["JAHA"],"published-print":{"date-parts":[[2023,3,21]]},"abstract":"<jats:sec xml:lang=\"en\">\n            <jats:title>Background<\/jats:title>\n            <jats:p xml:lang=\"en\">Transthoracic echocardiography is part of the regular follow\u2010up protocol at most pediatric pulmonary arterial hypertension (PAH) centers. We aimed to develop a comprehensive and simple echocardiographic risk stratification for children with PAH.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec xml:lang=\"en\">\n            <jats:title>Methods and Results<\/jats:title>\n            <jats:p xml:lang=\"en\">\n              We included 63 children with PAH and a biventricular cardiac anatomy without relevant shunt lesions (60% female patients; mean age, 9.0\u00a0years; 42 idiopathic PAH and 21 associated PAH) undergoing a standardized transthoracic echocardiographic assessment. The prognostic value of echocardiographic parameters was assessed using Cox proportional hazards survival analysis and recursive partitioning for classification tree methods. Over a median follow\u2010up period of 4.0\u00a0years, 17 patients died and 4 underwent lung transplantation. Various echocardiographic parameters were associated with the combined endpoint of death and transplantation on univariate analysis. On further analysis, right atrial area (\n              <jats:italic>z<\/jats:italic>\n              score) and left ventricular diastolic eccentricity index (LVEId) emerged as robust and independent predictors of transplant\u2010free survival. Considering mortality alone as an end point, a combination of right atrial area, left ventricular diastolic eccentricity index, and tricuspid annular plane systolic excursion were identified as independent predictors of outcome. Based on these parameters, we propose simple risk scores that can be applied at the bedside without computer assistance.\n            <\/jats:p>\n          <\/jats:sec>\n          <jats:sec xml:lang=\"en\">\n            <jats:title>CONCLUSIONS<\/jats:title>\n            <jats:p xml:lang=\"en\">Echocardiographic parameters predict prognosis in children with pulmonary hypertension. A combination of widely available parameters including right atrial area, left ventricular eccentricity index, and tricuspid annular plane systolic excursion emerged as risk stratifiers that await external validation but may assist clinicians determining the prognosis of children with PAH.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1161\/jaha.121.023118","type":"journal-article","created":{"date-parts":[[2023,3,16]],"date-time":"2023-03-16T12:19:21Z","timestamp":1678969161000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":17,"title":["Prognostic Value of Transthoracic Echocardiography in Children With Pulmonary Arterial Hypertension"],"prefix":"10.1161","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7001-9204","authenticated-orcid":false,"given":"Astrid E.","family":"Lammers","sequence":"first","affiliation":[{"name":"Paediatric Cardiology and the UK Pulmonary Hypertension Service for Children Great Ormond Street Hospital for Children London United Kingdom"},{"name":"Paediatric Cardiology and Specialist Clinic for Paediatric Pulmonary Hypertension Muenster University Hospital Muenster Germany"},{"name":"Adult Congenital Heart Disease Unit Muenster University Hospital Muenster Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jan","family":"Marek","sequence":"additional","affiliation":[{"name":"Paediatric Cardiology and the UK Pulmonary Hypertension Service for Children Great Ormond Street Hospital for Children London United Kingdom"},{"name":"Institute of Cardiovascular Sciences University College London United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gerhard\u2010Paul","family":"Diller","sequence":"additional","affiliation":[{"name":"Adult Congenital Heart Disease Unit Muenster University Hospital Muenster Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sheila G.","family":"Haworth","sequence":"additional","affiliation":[{"name":"Paediatric Cardiology and the UK Pulmonary Hypertension Service for Children Great Ormond Street Hospital for Children London United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0262-2340","authenticated-orcid":false,"given":"Shahin","family":"Moledina","sequence":"additional","affiliation":[{"name":"Paediatric Cardiology and the UK Pulmonary Hypertension Service for Children Great Ormond Street Hospital for Children London United 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