Improving the echocardiographic assessment of pulmonary pressure using the tricuspid regurgitant signal—The “chin” vs the “beard”

Kyranis, S.; Latona, J.; Platts, D.; Kelly, Natalie; Savage, M.; Brown, M.; Hamilton-Craig, C.; Scalia, G.; Burstow, D.

doi:10.1111/echo.13893

Cited by 19 publications

(15 citation statements)

References 31 publications

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“…C, Shows 3 TRV signals, 1 of moderate quality (*) that is not completely filled in but can be measured by extrapolation and 2 others of poor quality (#) that are unreliable and should not be measured optimize gain settings, and to measure regurgitant jets at the dense outer edge of the velocity profile while avoiding measurement of fine linear signals, also called the "feathered edge" (Figure 2). [29][30][31] Because tricuspid regurgitation jets can be eccentric, nonstandard imaging planes might be necessary for visualization of tricuspid regurgitation and acquisition of TRV.…”

Section: Echocardiographic Signs Of Ph and Estimating Papmentioning

confidence: 99%

“…Although specific techniques of echocardiographic image acquisition and measurement are beyond the scope of this consensus statement, Doppler spectra should be well visualized and their shape and contour should comply with known hemodynamic principles. Care should be taken to align the cursor parallel to the direction of flow, optimize gain settings, and to measure regurgitant jets at the dense outer edge of the velocity profile while avoiding measurement of fine linear signals, also called the “feathered edge” (Figure ) . Because tricuspid regurgitation jets can be eccentric, nonstandard imaging planes might be necessary for visualization of tricuspid regurgitation and acquisition of TRV.…”

Section: Echocardiographic Assessment Of Phmentioning

confidence: 99%

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ACVIM consensus statement guidelines for the diagnosis, classification, treatment, and monitoring of pulmonary hypertension in dogs

Reinero

Visser

Kellihan

et al. 2020

Veterinary Internal Medicne

192

383

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Pulmonary hypertension (PH), defined by increased pressure within the pulmonary vasculature, is a hemodynamic and pathophysiologic state present in a wide variety of cardiovascular, respiratory, and systemic diseases. The purpose of this consensus statement is to provide a multidisciplinary approach to guidelines for the diagnosis, classification, treatment, and monitoring of PH in dogs. Comprehensive evaluation including consideration of signalment, clinical signs, echocardiographic parameters, and results of other diagnostic tests supports the diagnosis of PH and allows identification of associated underlying conditions. Dogs with PH can be classified into the following 6 groups: group 1, pulmonary arterial hypertension; group 2, left heart disease; group 3, respiratory disease/hypoxia; group 4, pulmonary emboli/pulmonary thrombi/pulmonary thromboemboli; group 5, parasitic disease (Dirofilaria and Angiostrongylus); and group 6, disorders that are multifactorial or with unclear mechanisms. The approach to treatment of PH focuses on strategies to decrease the risk of progression, complications, or both, recommendations to target underlying diseases or factors contributing to PH, and PH‐specific treatments. Dogs with PH should be monitored for improvement, static condition, or progression, and any identified underlying disorder should be addressed and monitored simultaneously.

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Section: Echocardiographic Signs Of Ph and Estimating Papmentioning

confidence: 99%

Section: Echocardiographic Assessment Of Phmentioning

confidence: 99%

ACVIM consensus statement guidelines for the diagnosis, classification, treatment, and monitoring of pulmonary hypertension in dogs

Reinero

Visser

Kellihan

et al. 2020

Veterinary Internal Medicne

192

383

View full text Add to dashboard Cite

show abstract

“…Measurement of an incomplete TR envelope will lead to underestimation. On the other hand, measuring the ''chin" rather than the ''beard" of the spectral Doppler display improves correlation with invasive measures (Figure 10) as measurement of the ''beard" leads to over-estimation [25].…”

Section: Important Clinical Applications Pulmonary Hypertensionmentioning

confidence: 99%

Echocardiographic Assessment of the Right Ventricle–State of the Art

Jones

Burns

Prior

2019

Heart, Lung and Circulation

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“…30,31 The maximum TR systolic jet velocity is measured with continuous wave (CW) doppler as seen in Figure 4. 30,34,35 Deviation beyond 15-20º from the Doppler jet will lead to underestimation of the regurgitant velocity and a subsequently underestimated systolic pulmonary artery pressure (sPAP). 30 –32…”

Section: Doppler Imagingmentioning

confidence: 99%

Transthoracic Right Heart Echocardiography for the Intensivist

Hockstein

Haycock

Wiepking

et al. 2021

J Intensive Care Med

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Background: The impact of critical illness on the right ventricle (RV) can be profound and RV dysfunction is associated with mortality. Intensivists are becoming more facile with bedside echocardiography, however, pedagogy has largely focused on left ventricular function. Here we review measurements of right heart function by way of echocardiographic modalities and list clinical scenarios where the RV dysfunction is a salient feature. Main: RV dysfunction is heterogeneously defined across many domains and its diagnosis is not always clinically apparent. The RV is affected by conditions commonly seen in the ICU such as acute respiratory distress syndrome, pulmonary embolism, RV ischemia, and pulmonary hypertension. Basic ultrasonographic modalities such as 2D imaging, M-mode, tissue Doppler, pulsed-wave Doppler, and continuous Doppler provide clinicians with metrics to assess RV function and response to therapy. Conclusion: The right ventricle is impacted by various critical illnesses with substantial mortality and mortality. Focused bedside echocardiographic exams with attention to the right heart may provide intensivists insight into RV function and provide guidance for patient management.

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Improving the echocardiographic assessment of pulmonary pressure using the tricuspid regurgitant signal—The “chin” vs the “beard”

Abstract: The accuracy of noninvasive measurement of right heart pressures is increased using the "chin" in estimation of both RVSP and PVR.

Cited by 19 publications

References 31 publications

ACVIM consensus statement guidelines for the diagnosis, classification, treatment, and monitoring of pulmonary hypertension in dogs

ACVIM consensus statement guidelines for the diagnosis, classification, treatment, and monitoring of pulmonary hypertension in dogs

Echocardiographic Assessment of the Right Ventricle–State of the Art

Transthoracic Right Heart Echocardiography for the Intensivist

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