Comparison of three Doppler ultrasound methods in the prediction of pulmonary artery pressure

Abstract

Pulmonary artery pressure was noninvasively estimated by three Doppler echocardiographic methods in 50 consecutive patients undergoing cardiac catheterization. First, a systolic transtricuspid gradient was calculated from Doppler-detected tricuspid regurgitation; clinical jugular venous pressure or a fixed value of 14 mm Hg was added to yield systolic pulmonary artery pressure. Second, acceleration time from pulmonary flow analysis was used in a regression equation to derive mean pulmonary artery pressure. Third, right ventricular isovolumic relaxation time was calculated from Doppler-determined pulmonary valve closure and tricuspid valve opening; systolic pulmonary artery pressure was then derived from a nomogram. In 48 patients (96%) at least one of the methods could be employed. A tricuspid pressure gradient, obtained in 36 patients (72%), provided reliable prediction of systolic pulmonary artery pressure. The prediction was superior when 14 mm Hg rather than estimated jugular venous pressure was used to account for right atrial pressure. In 44 patients (88%), pulmonary flow was analyzed. Prediction of mean pulmonary artery pressure was unsatisfactory (r = 0.65) but improved (r = 0.85) when only patients with a heart rate between 60 and 100 beats/min were considered. The effect of correcting pulmonary flow indexes for heart rate was examined by correlating different flow indexes before and after correction for heart rate. There was a good correlation between corrected acceleration time and either systolic (r = -0.85) or mean (r = -0.83) pulmonary artery pressure. Because of a high incidence of arrhythmia, right ventricular relaxation time could be determined in only 11 patients (22%). Noninvasive prediction of pulmonary artery pressure is feasible in most patients.(ABSTRACT TRUNCATED AT 250 WORDS)

T cell polarization identifies distinct clinical phenotypes in scleroderma lung disease

“…Most of our patients did not undergo right heart catheterization. Nevertheless, evaluating the eRVSP by echocardiography represents a widely accepted and validated screening method for determining the presence of pulmonary vascular disease (33). Thus, the presence of a prevalent Th1/Tc1 T cell phenotype in patients with a high eRVSP may suggest a possible association with emerging or actual PAH, which will need to be further confirmed using direct measures (right heart catheterization) in longitudinal studies.…”

Cardiac involvement in sickle β-thalassemia

“…Additionally, using tissue Doppler imaging from the four-chamber apical view, with the sample volume placed at the lateral border of mitral annulus and the lateral border of tricuspid annulus, three velocities were recorded, one during systole (s), a second during early diastole (e), and a third at late diastole (a). Systolic pulmonary artery pressure was evaluated by the peak systolic right ventricular to right atrial (tricuspid) pressure gradient, derived by the continuous-Doppler tracing of the tricuspid valve flow in the presence of tricuspid regurgitation [14]; the apical fourchamber, the parasternal short-axis, and the parasternal long-axis views were used while the subject suspended breathing at the end of a normal expiration. According to the recent literature, increased systolic pulmonary artery pressure was defined by a tricuspid gradient >30 mmHg [15,16].…”

Clinical predictors of pulmonary hypertension in patients undergoing liver transplant evaluation

“…The operator must make every effort to identify the TR jet, which is present in approximately 72% of adult patients with pulmonary HTN. 22 An adequate Doppler signal is imperative because the SPAP may be otherwise underestimated. The only reason the Doppler-derived SPAP is not an ideal screening tool in experienced hands is that a little less than a third of adult patients with pulmonary HTN do not have TR jets to allow the application of this method.…”