Impact of Severe Tricuspid Regurgitation on Accuracy of Echocardiographic Pulmonary Artery Systolic Pressure Estimation

Özpelit, Ebru; Akdeniz, Bahri; Özpelit, Emre; Taş, Sedat; Alpaslan, Erkan; Bozkurt, Selen; Arslan, Abdulla; Badak, Özer

doi:10.1111/echo.12912

Cited by 22 publications

(21 citation statements)

References 24 publications

(56 reference statements)

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“…However, many studies in humans have reported inaccuracies when pulmonary artery systolic pressure with TRPG is assessed by Doppler echocardiography rather than right heart catheterization, reporting both underestimation and overestimation . In addition, severe TR may affect the estimation of pulmonary artery systolic pressure by Doppler echocardiography …”

Section: Discussionmentioning

confidence: 99%

Echocardiographic Evaluation of the Right Atrial Area Index in Dogs with Pulmonary Hypertension

Vezzosi

Domenech

Iacona

et al. 2018

Veterinary Internal Medicne

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BackgroundRight atrial area (RAA) is a prognostic factor in human patients with pulmonary arterial hypertension (PAH). Reference intervals for RAA have been described in healthy dogs.ObjectivesTo evaluate RAA indexed to the body surface area in dogs with PAH as an indicator of right atrial size, PAH severity and right‐sided congestive heart failure (R‐CHF).AnimalsA total of 119 client‐owned dogs, 48 dogs with PAH and 71 control dogs.MethodsProspective observational study. Pulmonary arterial hypertension was classified according to the tricuspid regurgitation pressure gradient (TRPG) as mild (36–50 mmHg), moderate (51–75 mmHg), or severe (>75 mmHg). The RAA index was calculated as the RAA divided by body surface area.ResultsThe RAA index was higher in dogs with moderate PAH (13.3 cm2/m2; range, 3.4–24.7 cm2/m2) and severe PAH (12.1 cm2/m2; range, 5.4–21.8 cm2/m2) than in those with mild PAH (6.7 cm2/m2; range, 4.8–10.7 cm2/m2) or in controls (7.3 cm2/m2; range, 4.2–10.2 cm2/m2; P < 0.001). The RAA index was higher (P < 0.0001) in dogs with R‐CHF (17.5 cm2/m2; range, 12.7–24.7 cm2/m2) compared to those without R‐CHF (7.6 cm2/m2; range, 4.4–19.4 cm2/m2). The most accurate cutoff value of the RAA index to identify R‐CHF was >12.3 cm2/m2 (sensitivity, 100%; specificity, 89.5%). In dogs with PAH, severity of tricuspid regurgitation (TR) was the only independent predictor of RAA index based on multivariate analysis (P < 0.02).Conclusions and Clinical ImportanceThe RAA index can be used to evaluate right atrial size in dogs and may be more effective than TRPG in predicting R‐CHF in dogs with PAH. The severity of TR is the main determinant of the RAA index in dogs with PAH.

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Section: Discussionmentioning

confidence: 99%

Echocardiographic Evaluation of the Right Atrial Area Index in Dogs with Pulmonary Hypertension

Vezzosi

Domenech

Iacona

et al. 2018

Veterinary Internal Medicne

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“…Possible explanation is that the larger regurgitant volume, the more congestion in inferior vena cava, which leads to an overestimation of RAP. Ozpelit et al . also mentioned that RAP was the main reason for an overestimated sPAP in patients with severe TR, but they thought the maximal velocity of TR jet did not affect sPAP.…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2017

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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.

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“…As recommended by ESC and ASE guidelines, 16,17 the LAV index, rather than the LA area index, was selected as the measurement of LA size to be included in the multivariate analysis. Because the SPAP is not always available and may be erroneous, 19 The multivariate analysis (Table 2) showed that the presence of larger RA than LA and SmRV were significant predictors of mortality and that the results were affected by SPAP and CVP. Larger RA than LA had a low sensitivity 20%, but high specificity 94%, for mortality with a negative and positive predictive value of 36% and 88%, respectively.…”

Section: Discussionmentioning

confidence: 99%

“…As recommended by ESC and ASE guidelines, the LAV index, rather than the LA area index, was selected as the measurement of LA size to be included in the multivariate analysis. Because the SPAP is not always available and may be erroneous, a multivariate analysis without SPAP and CVP was also performed. Spearman's rank correlation coefficient ( r ) was used for bivariate correlation.…”

Section: Methodsmentioning

confidence: 99%

Larger right atrium than left atrium is associated with all‐cause mortality in elderly patients with heart failure

et al. 2017

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Impact of Severe Tricuspid Regurgitation on Accuracy of Echocardiographic Pulmonary Artery Systolic Pressure Estimation

Abstract: The results of the study show that in patients with PAH, the presence of severe TR is associated with an overestimated PASP measurement on echocardiography.

Cited by 22 publications

References 24 publications

Echocardiographic Evaluation of the Right Atrial Area Index in Dogs with Pulmonary Hypertension

Echocardiographic Evaluation of the Right Atrial Area Index in Dogs with Pulmonary Hypertension

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

Larger right atrium than left atrium is associated with all‐cause mortality in elderly patients with heart failure

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