Echocardiographic Estimation of Pulmonary Vascular Resistance in Chronic Thromboembolic Pulmonary Hypertension: Utility of Right Heart Doppler Measurements

Abstract

TRV/VTI(RVOT) is only marginally useful for estimating PVR in CTEPH (r = 0.74). Moreover, the regression equation in CTEPH differs significantly from previous studies in pulmonary hypertension. Reasons for this may include the markedly elevated PVR levels in this population and specific effects on VTI(RVOT) from CTEPH.

Tricuspid annular plane systolic excursion in chronic thromboembolic pulmonary hypertension before and after pulmonary thromboendarterectomy

“…TAPSE correlated somewhat better with PVR ( r =−.6) than did RVFAC ( r =−.3) prior to PTE, but these r values suggest only a limited clinical utility for these echo parameters. Previous studies have shown that other echocardiographic parameters correlate reasonably well with PVR in CTEPH (including TR velocity/velocity–time integral RVOT [ r =.74], right ventricular Tei index [ r =.78], and tricuspid annular systolic velocity (S') [ r =−.71]) . The echocardiographic method of Abbas for estimating PVR (TR velocity divided by RV outflow tract velocity time integral) also has an r value of .74 when compared with RHC‐derived PVR in a population with CTEPH …”

“…Next, calculation of CO via the thermodilution method (especially in the setting of tricuspid regurgitation) can lead to errors. Severe tricuspid regurgitation occurs in only ~10% of CTEPH patients, however, and the thermodilution method remains the accepted standard measurement for CO in patients with CTEPH.…”

“…4,5 With pulmonary thromboendarterectomy (PTE), however, there is reduction in afterload with improved mPAP, PVR, and CO. 3,6 Although the standard for assessing the success of PTE in CTEPH is through right heart catheterization (RHC), 7 an accurate, less invasive approach would be helpful. There are echocardiographic measures that reasonably estimate right atrial (RA) pressure, peak PAP, and PVR, [8][9][10][11] but RV function has been shown to be prognostic in left-sided heart failure and pulmonary hypertension. 12,13 Prior animal studies have shown that RV output is inversely related to resistance.…”

Evaluation of two-dimensional strain echocardiography for quantifying right ventricular function in patients with pulmonary arterial hypertension

“…Moreover, the aforementioned studies used ultrasound estimation to evaluate RV function and hemodynamics, while RHC was used for evaluation in the current study. It has been reported in a meta-analysis that conventional ultrasound cannot accurately evaluate the extent of PAH or systolic function (13)(14)(15), due to the irregular shape of the RV and technical limitations of ultrasound in measuring area change rate and ejection fraction.…”

Application of Neonatologist Performed Echocardiography in the assessment and management of persistent pulmonary hypertension of the newborn

“…PVR can be estimated by calculating the TRV:VTI [RVOT] ratio, which is the ratio between TRV and the VTI of blood flow through the RVOT using pulsed-wave Doppler in the parasternal short axis. 33 – 35 The obtained VTI in the RVOT will be markedly changed in the presence of high PVR due to an earlier and enhanced reflection of the pressure wave. Higher PVR will lead to a decrease in VTI [RVOT] .…”