ORLANDO -- Children with severe spinale curving from scoliosis were more likely to have worsening risk indicators for pulmonary hypertension, researchers reported here.
A retrospective chart review of all patients with adolescent idiopathic scoliosis who received spinal fusion surgery at a single center showed a significant Spearman correlation coefficient between degree of spinal bending -- Cobb angle -- and right ventricular systolic pressure (Spearman correlation 0.32, P=0.04), according to Rachel Borlack, BS, a resident at Albert Einstein College of Medicine in New York City, and colleagues.
Action Points
- This study was published as an abstract and presented at a conference. These data and conclusions should be considered to be preliminary until published in a peer-reviewed journal.
Among patients with scoliosis, there was a threefold risk for abnormal tricuspid regurgitant jet velocity (odds ratio 3.29, P=0.007), which is an indirect measure of pulmonary hypertension, Borlack said at an oral presentation at the meeting of the American Academy of Pediatrics.
They recommended patients with scoliosis receive screening via echocardiogram to identify structural heart defects and pulmonary hypertension, and that those with elevated right ventricular systolic pressure "be considered for early surgery to prevent progression of pulmonary hypertension and even possible mortality."
The study was limited by the researcher's definition of idiopathic scoliosis, according to AAP session moderator , of Phoenix Children's Hospital in Arizona.
Segal noted that their definition of idiopathic disease may not accurately represent patients who would be considered idiopathic in the clinic, cautioning that the threefold risk seemed anomalous.
"Are we really talking about the same patient population?" Segal told ڴŮ.
Spine curvature can be corrected with back braces and magnetic rods, though the authors did not test to see if there was a link between treatment for the spine disorder and changes in hypertension risks.
To test for associations between degree of scoliosis curvature and cardiac function and to measure the incidence of pulmonary hypertension with adolescent idiopathic scoliosis, the authors conducted a chart review of 160 patients (ages 11 to 21) who underwent spinal fusion therapy from 2009 to 2012.
Participants were compared with 100 age-matched healthy control patients who visited the center for 2D-echocardiogram for innocent flow murmurs.
In addition to echocardiogram outcomes, participants received measurement of scoliosis Cobb angle, aortic root dimensions, and tricuspid regurgitant jet velocity. The authors also reviewed patient demographics.
Borlack noted that right ventricular systolic pressure was a marker for pulmonary hypertension in cases where pressure was at or exceeded 25 mm/Hg.
Spearman correlation was done to assess associations between spine curvature and systolic pressure, while logistic regressions were used to measure tricuspid regurgitant jet velocity between idiopathic scoliosis and control groups.
Patients had an average age of 14.8 , an average body mass index of 22.4 kg/m2, and an average Cobb angle of 50.9 degrees. Also, 107 patients with idiopathic curvature had preoperative echoes.
In those with idiopathic scoliosis, 56% had trivial mitral regurgitation, 22.4% had mild tricuspid regurgitation, 3.7% had mild mitral regurgitation, 2.8% had mitral valve prolapse, 1.7% had atrial septal defect, and 1,7% had ventricular septal defect.
There was one control with an abnormal tricuspid regurgitant jet velocity.
Right ventricular systolic pressure was significantly lower in control participants compared with the patients (19 mm/Hg versus 26.5 mm/Hg, P=0.04).
Borlack said that follow-up studies would include postoperative echocardiograms of patients with elevated systolic pressure.
Disclosures
The authors reported no conflicts of interest.
Primary Source
American Academy of Pediatrics
Source Reference: Borlack R, et al "Adolescent idiopathic scoliosis patients are at increased risk for pulmonary hypertension" AAP 2013.