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Reliability of Doppler echocardiography in the assessment of high pulmonary vascular resistance in patients with severe pulmonary arterial hypertension.

ABSTRACT: BACKGROUND:The objective is to assess whether the squaring of tricuspid regurgitation velocity (TRV) gives an improved estimate of pulmonary vascular resistance (PVR) or is equivalent to the ratio of TRV and time velocity integral of right ventricular outflow tract (TVIRVOT) (TRV/TVIRVOT) for assessing PVR in patients with high PVR values. METHODS:Thirty patients predicted to have PVR >6 WU by Doppler were included in the present study. TRV and TVIRVOT were measured by echo Doppler. TRV/TVIRVOT and TRV2/TVIRVOT were calculated. PVRCATH was estimated within 2 h of Doppler study. Regression equations for calculating PVR from TRV/TVIRVOT (PVRECHO1) and TRV2/TVIRVOT (PVRECHO2) were developed. Bland-Altman analysis for agreement between PVRCATH and PVRECHO1, PVRECHO2 was carried out. RESULTS:The mean value of PVRCATH was found to be 15.08 ± 7.03 WU. The calculated values of PVRECHO1 and PVRECHO2 were found to be 15.08 ± 6.34 WU and 15.05 ± 6.08 WU, respectively. The linear regression analysis carried out for PVRCATH and TRV/TVIRVOT showed good correlation (R = 0.84). Bland-Altman analysis showed excellent agreement between the two Doppler methods and invasive PVR with negligible bias. CONCLUSION:Noninvasive estimation of PVR by Doppler is reliable even in patients with high PVR (>6 WU) and, squaring TRV is not superior to TRV alone.

SUBMITTER: Bhyravavajhala S

PROVIDER: S-EPMC6310071 | biostudies-literature | 2018 Dec

REPOSITORIES: biostudies-literature

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Reliability of Doppler echocardiography in the assessment of high pulmonary vascular resistance in patients with severe pulmonary arterial hypertension.

Bhyravavajhala Srinivas S Yerram Sreekanth S Galla Raghukishore R Kotapati Venkata Siva Krishna VSK

Indian heart journal 20181102

<h4>Background</h4>The objective is to assess whether the squaring of tricuspid regurgitation velocity (TRV) gives an improved estimate of pulmonary vascular resistance (PVR) or is equivalent to the ratio of TRV and time velocity integral of right ventricular outflow tract (TVI<sub>RVOT</sub>) (TRV/TVI<sub>RVOT</sub>) for assessing PVR in patients with high PVR values.<h4>Methods</h4>Thirty patients predicted to have PVR >6 WU by Doppler were included in the present study. TRV and TVI<sub>RVOT</ ...[more]

PMID: 30595266

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Project description:BackgroundTransthoracic Doppler-echocardiography (TTE) can estimate mean pulmonary arterial pressure (MPAP) and pulmonary capillary wedge pressure (PCWP) reliably, and cardiac magnetic resonance (CMR) is the best modality for non-invasive measurement of cardiac output (CO). We speculated that the combined use of TTE and CMR could provide a feasible method for non-invasive measurement of pulmonary vascular resistance (PVR) in pulmonary arterial hypertension (PAH).Methods and resultsRight heart catheterization (RHC) was undertaken in 77 patients (17M/60F) with PAH, and simultaneous TTE was carried out to evaluate MPAP, PCWP and CO. Within 2 days, CO was measured again with CMR in similar physiological status. Then, PVR was calculated with the integrated non-invasive method: TTE-derived (MPAP-PCWP)/CMR-derived CO and the isolated TTE method: TTE-derived (MPAP-PCWP)/TTE-derived CO, respectively. The PVR calculated with integrated non-invasive method correlated well with RHC-calculated PVR (r = 0.931, 95% confidence interval 0.893 to 0.956). Between the integrated non-invasive PVR and RHC-calculated PVR, the Bland-Altman analysis showed the satisfactory limits of agreement (mean value: - 0.89 ± 2.59). In comparison, the limits of agreement were less satisfactory between TTE-calculated PVR and RHC-calculated PVR (mean value: - 1.80 ± 3.33). Furthermore, there were excellent intra- and inter-observer correlations for the measurements of TTE and CMR (P < 0.001 for all).ConclusionsThe combined use of TTE and CMR provides a clinically reliable method to determine PVR non-invasively. In comparison with RHC, the integrated method shows good accuracy and repeatability, which suggests the potential for the evaluation and serial follow-up in patients with PAH.Translational perspectiveIn PAH, the non-invasive measurement of PVR is very important in clinical practice. Up to now, however, the widely accepted non-invasive method is still unavailable. Since TTE can estimate (MPAP-PCWP) reliably and CMR is the best image modality for the measurement of CO, the combined use of two modalities has the potential to determine PVR non-invasively. In this research, the integrated non-invasive method showed good diagnostic accuracy and repeatability compared with RHC. Therefore, it might be a feasible method for non-invasive measurement of PVR in patients with PAH.

Dataset Information

Reliability of Doppler echocardiography in the assessment of high pulmonary vascular resistance in patients with severe pulmonary arterial hypertension.

Publications

Reliability of Doppler echocardiography in the assessment of high pulmonary vascular resistance in patients with severe pulmonary arterial hypertension.

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