RV Base/Apex Ratio May Help Diagnose Pulmonary Arterial Hypertension in Children

Echocardiograph showing hypertension
Echocardiograph showing hypertension
Right ventricular base/apex ratio reference values may help clinicians diagnose children with pulmonary arterial hypertension.

Reference right ventricular base/apex ratio (RVES b/a) values may help diagnose children with pulmonary arterial hypertension (PAH), and impaired ratios may indicate a deteriorating condition, according to the results of a recent study published in Clinical Cardiology.

Electrocardiograms and hemodynamic measurements were obtained from pediatric patients with PAH and healthy matched controls. RVES b/a ratios were calculated and compared between groups.

Among the 157 healthy children, the mean RVES b/a ratio was 1.87. These values tended to increase slightly with age (r=0.20; P =.011). The median RVES b/a ratio in children with PAH was significantly lower (1.3). This was most likely because of the significantly enlarged RV basal and apical diameters of the RV in children with PAH.

Furthermore, 43 of 51 children with PAH were identified as having a decreased RVES b/a ratio. RVES b/a ratio was inversely correlated with the RV/left ventricular end-systolic diameter ratio (P =.001), but not with the RV systolic function parameters, tricuspid annular plane systolic excursion and velocity (P =.127 and .168, respectively).

The study authors wrote, “We found dilation of the RV base and RV apex (a low RV b/a ratio) to be an echocardiographic signature of PAH, and show an association of the parameter with echocardiographically determined RV parameters, with the [New York Heart Association functional class], and with invasive hemodynamic variables.”

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They also noted the possibility of the ratio acting as a diagnostic or monitoring tool, suggesting, “The RVES b/a ratio negatively correlated with invasive hemodynamics (eg, PVRi [pulmonary vascular resistance index]) in our pediatric PH patients, which suggests that RVES b/a ratio decreased with increasing disease severity in pediatric PAH, making it a valuable future diagnostic variable.”


Koestenberger M, Avian A, Gamillscheg A, et al. Right ventricular base/apex ratio in the assessment of pediatric pulmonary arterial hypertension — results from the European Pediatric Pulmonary Vascular Disease Network [published June 12, 2018]. Clin Cardiol. doi:10.1002/clc.22994