Determination of pressure in the pulmonary artery by external graphic recordings.

Abstract

Pulmonary hypertension is a fundamental problem in the study of diseases of the heart and lungs. Because of its importance with regard to patho- METHODThe determination of systolic pulmonary arterial pressure (SPAP) by external graphic recordings is based on the measurement of the phase of isometric relaxation of the right ventricle, which begins with the closure of the pulmonary valve and ends with the opening of the tricuspid (IIp-T interval). To measure this interval several points of reference on the graphic recordings are used (Fig. 1). The closure of the pulmonary valve is represented by the pulmonary component of the second sound of the phonocardiogram (HIp), which is easily identifiable following the aortic component (IIa), especially when there is pulmonary hypertension or the second sound is split. With paradoxical splitting of the second sound, the vertex of the incisura of the carotid pulse is useful in identifying IIa, and, therefore, by exclusion, IIp. When it is difficult to distinguish IIp, the recording ofthe external cardiogram ofthe pulmonary artery (Fishleder and Friedland, 1957) frequently demonstrates a notch that signals the closure of the pulmonary valve (Fig. 2). The opening of the tricuspid

Pulmonary Artery Acceleration Time Provides an Accurate Estimate of Systolic Pulmonary Arterial Pressure during Transthoracic Echocardiography

“…Together, these studies established the capacity of Dopplerderived measurements of pulmonary arterial flow to provide accurate estimates of MPAP. RV isovolumic relaxation time (RVIRT) 19 and tissue Doppler-derived RVIRT 10 have also been studied to determine their suitability to estimate systolic pulmonary artery pressure (SPAP). Brechot et al 10 studied 26 patients by echocardiography and cardiac catheterization.…”

Right Ventricular Myocardial Isovolumic Relaxation Time as Novel Method for Evaluation of Pulmonary Hypertension: Correlation with Endothelin-1 Levels

“…Nevertheless, the method did not become widely used in clinical practice, despite very promising results. 8 In this study, myocardial IVRT (both corrected and noncorrected), blood pool-derived IVRTc, Figure 5 Scatter diagram of blood pool-derived isovolumic relaxation time corrected for heart rate (IVRTc) and endothelin (ET )-1 (pg/mL). echocardiographically derived PASP, and ET-1 levels were significantly higher in patients with PH than in control subjects.…”

“…This is because the higher the RV pressure is at PVc, the longer it takes before it decreases to the level of right atrial (RA) pressure, provided that the RV isovolumic relaxation rate is unchanged. [8][9][10][11] Doppler tissue imaging (DTI) is a recent echocardiographic technique that enables measurements of atrioventricular annular and regional myocardial velocities. This recent method allows derivation of regional RV IVRT from tissue velocity recordings of RV myocardial wall motion from the same cardiac cycle, therefore, facilitating the methodology and enabling overcoming the limitation of the conventional method.…”

Right ventricular myocardial velocities and timing estimate pulmonary artery systolic pressure

“…This has been shown by us as well as others to correlate with PA pressure. Even before non-invasive techniques became available Luis Burstin showed in 1967 that PASP could be assessed from the time interval between pulmonary valve closure and the onset of tricuspid flow [28]. However, despite the fact that it is easy to obtain in most patients it is affected by a number of factors; the degree of right ventricular asynchrony, septal incoordination and the degree of rise of right atrial pressure.…”