Impact of severe tricuspid regurgitation on accuracy of systolic pulmonary arterial pressure measured by Doppler echocardiography: Analysis in an unselected patient population

Abstract

Pulmonary arterial pressure is an important index in cardiovascular disorders, especially for pulmonary hypertension (PH). Doppler echocardiography (DE) is widely used as a noninvasive method to assess pulmonary arterial pressure. However, recent studies have found several hemodynamic factors that affect its accuracy in estimating systolic pulmonary arterial pressure (sPAP). But the effect of tricuspid regurgitation (TR) has not been investigated. Therefore, our study is aimed to determine whether the severity of TR will affect the accuracy of sPAP measured by DE in an unselected patient population. We retrospectively studied 177 patients who underwent DE and right heart catheterization (RHC) examinations. Patients were categorized into 3 groups according to the severity of TR (mild, moderate, and severe). The discrepancy in sPAP measured by DE and RHC was calculated and compared in each group. Determinants of discordant results between two methods were also evaluated. Age, gender, interval between DE and RHC, sequence of DE and RHC were similar among groups (all P>.05). Differences in sPAP, RAP, and tricuspid regurgitation pressure gradient (TR-PG) were similar in group 1 and 2 (all P>.05), while all significantly higher in group 3 (all P<.05). The difference in sPAP between DE and RHC was affected independently by severe TR and severe PH (both P<.05). Severe TR and severe PH affect the accuracy of sPAP measured by DE. Modification of echocardiographic sPAP measurements by taking into consideration of these factors may lead to reduced systemic errors.

Detection of Pulmonary Hypertension with Systolic Pressure Estimated by Doppler Echocardiography

“…Finally, one of the advantages of the present study was that the time interval between echocardiography and RHC was smaller than the previous studies. 10,18,33) Although we performed echocardiography within 24 hours of RHC, they were within 48 hours 10) and 5 days, 18,33) respectively, in these previous studies. Study limitations: This study has several limitations.…”

“…Other investigators demonstrated a poor correlation in patients with certain medical conditions. [31][32][33] Fei, et al 33) indicated that the accuracy of the systolic PAP measured by DE was affected by severe TR and severe PH. In our study, we documented sPAP overestimation and underestimation in Table III.…”

“…This interval is shorter than that in previous studies. 10,18,33) Finally, there was no data on the echocardiographic assessment of the right heart, except for TR velocity and inferior vena cava diameter. Considering that we only examined the relationship between TRPG, sPA-PECHO, and invasive PAP in the present study, complete echocardiographic data were not acquired.…”

“…A previous study reported that severe TR was one of the independent factors for the inaccurate estimation of systolic PAP. 33) Further investigations that combine TR and right heart echocardiographic parameters are needed.…”

Echocardiographic evaluation of the right ventricular dimension and systolic function in dogs with pulmonary hypertension

“…Possible reasons for this discrepancy are different reference intervals for TAPSE, different sample population size, different underlying etiology of PH, and possibly different clinical severity among dogs with severe PH. Moreover, severe TR can influence the Doppler estimation of pulmonary arterial pressure and is a significant confounding factor when applying TAPSE to assess RV function . As is known, TAPSE increases with TR severity irrespectively of RV function.…”