Early partial systolic closure of the pulmonic valve relates to severity of pulmonary hypertension

Turkevich, Darya; Groves, Bertron Μ.; Micco, A. J.; Trapp, J.A.; Reeves, John Τ.

doi:10.1016/0002-8703(88)90489-9

Cited by 34 publications

(9 citation statements)

References 16 publications

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“…During the midsystolic period, when the pressure gradient between the right ventricle and pulmonary artery is already close to zero, a short positive wave occurs in the time course of the pressure gradient for patients with manifest PH. 25,26 We conjecture that this wave, supported by the present high velocities, triggers vortex formation in the main pulmonary artery.…”

Section: Vortex Formationmentioning

confidence: 54%

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Magnetic Resonance–Derived 3-Dimensional Blood Flow Patterns in the Main Pulmonary Artery as a Marker of Pulmonary Hypertension and a Measure of Elevated Mean Pulmonary Arterial Pressure

Reiter

Kovàcs

et al. 2008

Circ: Cardiovascular Imaging

216

194

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Background-Pulmonary hypertension is a disease characterized by an elevation in pulmonary arterial pressure that is diagnosed invasively via right heart catheterization. Such pathological altered pressures in the pulmonary vascular system should lead to changes in blood flow patterns in the main pulmonary artery. Methods and Results-Forty-eight subjects (22 with manifest pulmonary hypertension, 13 with latent pulmonary hypertension, and 13 normal control subjects) underwent time-resolved 3D magnetic resonance phase-contrast imaging of the main pulmonary artery. Velocity fields that resulted from measurements were calculated, visualized, and analyzed with dedicated software. Main findings were as follows: (1) Manifest pulmonary hypertension coincides with the appearance of a vortex of blood flow in the main pulmonary artery (sensitivity and specificity of 1.00, 95% confidence intervals of 0.84 to 1.00 and 0.87 to 1.00, respectively), and (2) the relative period of existence of the vortex correlates significantly with mean pulmonary arterial pressure at rest (correlation coefficient of 0.94). To test the diagnostic performance of the vortex criterion, we furthermore investigated 55 patients in a blinded prospective study (22 with manifest pulmonary hypertension, 32 with latent pulmonary hypertension, and 1 healthy subject), which resulted in a sensitivity of 1.00 and specificity of 0.91 (95% confidence intervals of 0.84 to 1.00 and 0.76 to 0.98, respectively).Comparison of catheter-derived mean pulmonary artery pressure measurements and calculated mean pulmonary artery pressure values resulted in a standard deviation of differences of 3.6 mm Hg. Conclusions-Vortices

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Section: Vortex Formationmentioning

confidence: 54%

“…25,26 This fact explains the reduced acceleration time in patients with manifest PH, which is the rationale for attempts to assess mPAP and PH directly by noninvasive methods. 2,3,[7][8][9][10][11] We also observed reduced acceleration times in patients with manifest PH.…”

Section: Vortex Formationmentioning

confidence: 99%

Magnetic Resonance–Derived 3-Dimensional Blood Flow Patterns in the Main Pulmonary Artery as a Marker of Pulmonary Hypertension and a Measure of Elevated Mean Pulmonary Arterial Pressure

Reiter

Kovàcs

et al. 2008

Circ: Cardiovascular Imaging

216

194

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“…By increasing both the velocity and amplitude of the reflected wave, pulmonary hypertension causes its earlier return manifesting itself as midsystolic deceleration, found on Doppler-derived SFVC [12, 18±20]. While TURKEVITCH et al [21] found a correlation between the time-to-notch and the severity of pulmonary hypertension, it might also be affected by the site of vascular changes. FURUNO et al [12] compared pulmonary pressure and flow responses in dogs submitted either to distal pulmonary embolization or proximal pulmonary constriction.…”

Section: Discussionmentioning

confidence: 99%

Proximal pulmonary emboli modify right ventricular ejection pattern

Torbicki¹,

Kurzyna²,

Ciurzyński³

et al. 1999

Eur Respir J

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Proximal pulmonary emboli modify right ventricular ejection pattern. A. Torbicki, M. Kurzyna, M. Ciurzynski, P. Pruszczyk, R. Pacho, A. Kuch-Wocial, M. Szulc. #ERS Journals Ltd 1999. ABSTRACT: Analysis of the systolic flow velocity curve (SFVC) in the right ventricular outflow tract is considered as an alternative to the tricuspid valve pressure gradient (TVPG) method for echo-Doppler assessment of pulmonary arterial pressure (Ppa). The present study checked whether or not SFVC is affected by the cause of pulmonary hypertension.Doppler recordings of 86 patients (39 female, aged 55.515.2 yrs) with acute (AP-PE) or chronic (CP-PE) proximal pulmonary embolism, chronic obstructive pulmonary disase (COPD) or primary pulmonary hypertension (PPH) were retrospectively analysed by two observers unaware of the purpose of the study.Despite having the lowest TVPG (4813 mmHg), patients with AP-PE had the shortest acceleration time (tacc; 5615 ms) and time to midsystolic deceleration (tmsd; 10516 ms). tacc <60 ms in patients with TVPG <60 mmHg had 98% specificity and 48% sensitivity for AP-PE. In PPH, SFVC was less abnormal (tacc 6414 ms, tmsd 12525 ms, both p<0.03) despite having a TVPG twice as high (9212 mmHg, p< 0.001). In contrast to tacc, TVPG showed strong correlation with direct Ppa measurements whenever performed (r=-0.43, p=0.02, versus r=0.80, p<0.001; n=30). There was no correlation between tacc and TVPG in a pooled study group and SFVC seemed strongly affected by the presence of both AP-PE and CP-PE.While potentially useful for evaluation of the true right ventricular afterload during pulsatile flow conditions, the systolic flow velocity curve does not provide a reliable estimate of pulmonary arterial pressure. Eur Respir J 1999; 13: 616±621. The method of choice for noninvasive estimation of pulmonary arterial pressure (Ppa) is based on continuous wave Doppler measurement of the peak velocity of the regurgitant jet across the tricuspid valve (tricuspid valve pressure gradient; TVPG). This method, based on the simplified Bernoulli equation and a straightforward pathophysiological concept, proved highly reliable in a wide spectrum of cardiovascular disease [1±4].However, the pulsed wave Doppler-derived pattern of the systolic flow velocity curve (SFVC) in the right ventricular (RV) outflow tract is also believed to reflect the level of Ppa [5±9]. Using SFVC is appealing because, in contrast to TVPG, it can be recorded in almost every patient, including those with lung hyperinflation [10]. Coexistence of short acceleration time (tacc) and midsystolic deceleration (tmsd; which has a "notched" pattern) is considered diagnostic of severe pulmonary hypertension [5]. However, such patterns have also been observed in the setting of acute pulmonary embolism [11] and similar changes have been induced experimentally by proximal constriction of the proximal pulmonary arteries in dogs [12]. In both these situations, marked SFVC changes were found in the presence of acute but relatively mild elevation of Ppa limited by the per...

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“…In addition, mid-systolic deceleration of right ventricular ejection into the pulmonary artery, whenever present, occurred earlier with higher Ppa [6]. Reports suggested excellent correlations between AcT and Ppa, particularly when measured simultaneously [7], and offered regression equations for noninvasive pressure calculations.…”

Section: Diagnostic Value Of Echocardiography and Its Role In Screenimentioning

confidence: 99%

The role of echocardiography in the diagnosis and management of patients with pulmonary hypertension

Habib¹,

Torbicki²

2010

Eur Respir Rev

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Pulmonary hypertension (PH) is defined as an increased mean pulmonary artery pressure (Ppa) .25 mmHg at rest as assessed by right heart catheterisation (RHC). However, this technique is invasive and noninvasive alternatives are desirable for early diagnosis of PH. Although estimation of systolic pulmonary arterial pressure is easily obtained using Doppler echocardiography, cases of under-and over-estimations are not rare and direct measurement of Ppa is not possible using this method. Therefore, echocardiography should be considered as a tool for assessment of the likelihood rather than the definite presence or absence of PH. Transthoracic echocardiography may be useful for noninvasive screening of patients at risk of PH. On the basis of an echocardiographic assessment, patients showing signs suggestive of PH can be referred for a confirmatory RHC. A number of variables measured during echocardiography reflect the morphological and functional consequences of PH and have prognostic value. The presence of pericardial effusion, reduced tricuspid annular plane excursion and right atrial enlargement are associated with a poorer prognosis. Echocardiography is also an important procedure for monitoring the response of patients to therapy, and is recommended 3-4 months after initiation of, or a change in, therapy. Echocardiographic assessment as part of a goal-oriented approach to therapy is essential for the effective management of PH patients.

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Early partial systolic closure of the pulmonic valve relates to severity of pulmonary hypertension

Cited by 34 publications

References 16 publications

Magnetic Resonance–Derived 3-Dimensional Blood Flow Patterns in the Main Pulmonary Artery as a Marker of Pulmonary Hypertension and a Measure of Elevated Mean Pulmonary Arterial Pressure

Magnetic Resonance–Derived 3-Dimensional Blood Flow Patterns in the Main Pulmonary Artery as a Marker of Pulmonary Hypertension and a Measure of Elevated Mean Pulmonary Arterial Pressure

Proximal pulmonary emboli modify right ventricular ejection pattern

The role of echocardiography in the diagnosis and management of patients with pulmonary hypertension

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