A research team from Egypt identified potential predictive markers for poor prognosis in children with pulmonary arterial hypertension associated with congenital heart disease (PAH-CHD).

“Platelet activation markers levels were significantly higher in children with a poor prognosis compared to patients with good prognosis,” said the authors of the prospective cohort study recently published in Pediatric Cardiology.

The markers included mean platelet volume (MPV), platelet distribution width (PDW), and platecrit levels. The best cut-off values to predict a poor prognosis in children with PAH-CHD were >11.2 fL for MPV (sensitivity, 75%, specificity, 96.6%), >12.7 fL for PDW (sensitivity, 75%, specificity, 61.5%), and >0.505% for platecrit (sensitivity, 75%, specificity, 93%).


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The study enrolled children diagnosed with PAH-CHD (n=60, median age, 5.5 months) or CHD only (n=60, median age, 3.5 months) and 60 healthy children (median age, 9 months). Out of the 60 children with PAH-CHD, 8 had unfavorable prognoses (ie, death or readmission due to right ventricular heart failure) within the 6-month follow-up.

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Children with PAH-CHD had higher MPV, PDW, and platecrit levels than children with CHD only or healthy children. Moreover, children with severe PAH had higher MPV, PDW, and platecrit than those with moderate or mild PAH, who showed similar levels.

In addition, children with PAH-CHD had lower right ventricular fractional area change (FAC) and right ventricular E/A ratio, as well as higher mean pulmonary artery pressure (mPAP), and right ventricular diameter than children with CHD only or healthy children. No significant alteration was observed in the left ventricular fraction shortening.

The authors also identified several correlations between platelet activation markers and echocardiographic parameters:

  • Positive correlations between MPV/PDW/platecrit and RV diameter and mPAP
  • Negative correlations between MPV/platecrit and right ventricular FAC, right ventricular E/A ratio, and oxygen saturation
  • Negative correlation between PDW with right ventricular FAC and right ventricular E/A ratio

Reference

Awad A, Elnemr S, Hodeib H, El Amrousy D. Platelet activation markers in children with pulmonary arterial hypertension associated with congenital heart disease. Pediatr Cardiol. Published online March 2, 2022. doi:10.1007/s00246-022-02847-7