Noninvasive assessment of pulmonary hypertension from right ventricular isovolumic contraction time

Mills, Peter; Amara, I. B.; McLaurin, Lambert P.; Craige, Ernest

doi:10.1016/0002-9149(80)90069-7

Cited by 9 publications

(7 citation statements)

References 10 publications

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“…In the patients with normal pulmonary artery pressure (mean pressure < 20 mm Hg, 16 patients), ejection flow reached a peak level at midsystole (137 + 24 msec, mean + SD), producing a domelike contour of the flow velocity pattern during systole. In contrast, the flow velocity pattern in patients with pulmonary hypertension (mean pressure ¢ 20 mm Hg,17 patients) was demonstrated to accelerate rapidly and to reach a peak level sooner (97 + 20 msec, p < .01); in 10 of the pulmonary hypertensive patients a secondary slower rise in flow velocity was observed during a deceleration, resulting in the midsystolic notching. The time to peak flow (acceleration time, AcT) and right ventricular ejection time (RVET) were measured from the flow velocity pattern.…”

mentioning

confidence: 99%

Noninvasive evaluation of pulmonary hypertension by a pulsed Doppler technique.

Kitabatake¹,

Inoue²,

Asao³

et al. 1983

Circulation

725

384

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We used a pulsed Doppler technique to examine the flow velocity pattern in the right ventricular outflow tract in 33 adults. In the patients with normal pulmonary artery pressure (mean pressure < 20 mm Hg, 16 patients), ejection flow reached a peak level at midsystole (137 + 24 msec, mean + SD), producing a domelike contour of the flow velocity pattern during systole. In contrast, the flow velocity pattern in patients with pulmonary hypertension (mean pressure ¢ 20 mm Hg,17 patients) was demonstrated to accelerate rapidly and to reach a peak level sooner (97 + 20 msec, p < .01); in 10 of the pulmonary hypertensive patients a secondary slower rise in flow velocity was observed during a deceleration, resulting in the midsystolic notching. The time to peak flow (acceleration time, AcT) and right ventricular ejection time (RVET) were measured from the flow velocity pattern. Either AcT or AcT/RVET decreased with increase in mean pulmonary artery pressure, and a very high correlation (r = -.90) was found between AcT/RVET and log,0 (mean pulmonary artery pressure). The use of this technique permitted the noninvasive estimation of the pulmonary artery pressure. Circulation 68, No. 2, 302-309, 1983. NONINVASIVE evaluation of pulmonary hypertension has been an important clinical problem for many years. The presence of pulmonary hypertension has been assessed by abnormalities in heart sounds,' in electrocardiographic tracings, or in chest x-rays,2 but to date, the accurate measurement of the pulmonary artery pressure requires the use of cardiac catheterization procedures. The development of echocardiographic techniques has allowed the investigation of pulmonic valve motion,3 which represents some characteristic abnormalities associated with pulmonary hypertension, such as rapid opening slope in systole,j5 attenuation or absence of the "a" dip,' prolongation of the ratio of right ventricular preejection period (RPEP) to right ventricular ejection time (RVET),57 and midsystolic semiclosure of pulmonic valve.)6 A recent experimental study8 emphasized that these abnormalities of the pulmonic valve motion were determined by abnormal flow changes in the pulmonary artery. However, flow characteristics with regard to pulmonary artery pressure either in the pulmonary artery or in the right ventricular outflow tract have not been successfully studied in man. Our objectives were to study the blood flow characteristics in the right ventricular outflow tract in patients with pulmonary hypertension by a pulsed Doppler technique9-I and to develop an index that would permit quantitative evaluation of pulmonary hypertension by noninvasive methods. Materials and methodsPatient selection. Thirty-eight patients admitted for diagnostic catheterization were examined by a pulsed Doppler technique. Five patients were excluded in whom Doppler recordings of flow velocity in the right ventricular outflow tract were not satisfactorily obtained because of poor penetration of ultrasound through the chest wall. Doppler examination was perfor...

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confidence: 99%

Noninvasive evaluation of pulmonary hypertension by a pulsed Doppler technique.

Kitabatake¹,

Inoue²,

Asao³

et al. 1983

Circulation

725

384

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“…Recently, Tei et al [3,4,13] have proposed an LV Doppler index combining systolic and diastolic performance for assessment of global LV function, which correlates with systolic peak +dP/dt, diastolic peak -dP/dt, and the time constant of relaxation [4]. An RV Doppler index was also proposed for assessment of RV global function [5,6,14]; however, this index may also reflect RV afterload because pulmonary artery pressure influences on RV ICT and RV IRT [7][8][9][10]. RV dysfunction and RV afterload increase often accompany with LV dysfunction; therefore, we analyzed the RV Doppler index in addition to the LV Doppler index in patients with dilated cardiomyopathy.…”

Section: Discussionmentioning

confidence: 99%

“…A right ventricular (RV) Doppler index, similarly obtained from the RV Doppler time intervals, predicts survival in patients with primary pulmonary hypertension [5,6]. Because RV ICT and RV IRT depend on pulmonary artery pressure [7][8][9][10], the RV Doppler index may also increase with elevation of pulmonary artery pressure induced by congestive heart failure. However, little is known about the association between cardiac pressure data and Doppler indices.…”

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confidence: 85%

Validity of the right ventricular Doppler index for assessment of severity of congestive heart failure in patients with dilated cardiomyopathy

et al. 1999

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This study was designed to clarify the validity of Doppler indices for assessment of the severity of congestive heart failure in patients with dilated cardiomyopathy. Left ventricular (LV) and right ventricular (RV) Doppler indices, defined as the sum of isovolumic contraction time and relaxation time divided by the ejection time, were obtained in 30 normal subjects and 35 patients with ischemic or idiopathic dilated cardiomyopathy. We analyzed the correlation between New York Heart Association (NYHA) functional class, right-sided cardiac pressure, and the Doppler indices. Patients with dilated cardiomyopathy revealed significantly higher LV and RV Doppler indices than normal subjects; however, the LV Doppler index did not correlate significantly with NYHA functional class or right-sided cardiac pressure. On the other hand, the RV Doppler index correlated significantly with NYHA functional class (rs = 0.83, P < 0.001), pulmonary capillary wedge pressure (r = 0.80, P < 0.001), pulmonary artery systolic pressure (r = 0.81, P < 0.001) and pulmonary artery diastolic pressure (r = 0.77, P < 0.001). Both RV isovolumic contraction and relaxation time also correlated significantly with right-sided cardiac pressure. In 12 patients who improved from NYHA III-IV to I-II after treatment, the RV Doppler index decreased from 0.84 +/- 0.25 to 0.33 +/- 0.10 (P < 0.001), while the LV Doppler index did not change significantly (0.72 +/- 0.27 to 0.68 +/- 0.23, P = 0.53). These results suggest that the RV Doppler index is useful for assessment of the severity of congestive heart failure in patients with dilated cardiomyopathy.

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“…PVR and other hemodynamic variables have important prognostic implications in the assessment of patients with pulmonary hypertension. [1][2][3][4][5][6][7] Assessment of PVR is of great importance in the management of chronic heart failure, and it is an essential component of the evaluation of orthotopic heart transplant recipients. 8 Currently, this information is obtained only via invasive cardiac catheterization.…”

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confidence: 99%

“…While right heart catheterization would still be necessary to diagnose pulmonary hypertension, using echocardiography to measure PVR would have the advantage of being able to follow patients serially and to assess their response to treatment noninvasively. [1][2][3][4][5][6][7] Recent studies have demonstrated that strain imaging provides an objective means to quantify global and regional left and right ventricular (RV) functions. In particular, RV myocardial strain has been shown to accurately quantify the RV function in patients with pulmonary hypertension.…”

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confidence: 99%

Utility of Right Ventricular Strain Imaging in Predicting Pulmonary Vascular Resistance in Patients With Pulmonary Hypertension

Naderi

Haghighi

Amin

et al. 2012

Congestive Heart Failure

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Pulmonary vascular resistance (PVR) has important prognostic implications in the assessment of patients with pulmonary hypertension. Using echocardiography to measure PVR would have the advantage of being able to follow patients serially and to assess their response to treatment noninvasively. The authors sought to assess whether right ventricular strain rate imaging (SRI) can predict PVR in patients with pulmonary hypertension. The study population consisted of 46 patients referred for right heart catheterization. The inclusion criteria was mean pulmonary artery pressure ≥25 mm Hg in right heart catheterization in patients with pulmonary hypertension including chronic systolic heart failure. Echocardiography was performed to obtain SRI just before right heart catheterization. Mean values of peak systolic longitudinal strain and strain rate obtained from basal and mid‐right ventricular free wall were calculated. The control group consisted of 35 healthy adults matched for age and sex. The most significant correlations were between basal right ventricular strain and strain rate (SR) and mean pulmonary arterial pressure (r=0.63, P=.000), transpulmonary gradient (r=0.6, P=.001), and PVR (r=0.5, P=.003). SR was independently correlated with PVR (PVR=26.9−16.9×basal right ventricular SR; r=0.53, P=.003). The present study shows that basal right ventricular free wall strain and SR could be independently correlated with PVR in patients with pulmonary hypertension.

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Noninvasive assessment of pulmonary hypertension from right ventricular isovolumic contraction time

Cited by 9 publications

References 10 publications

Noninvasive evaluation of pulmonary hypertension by a pulsed Doppler technique.

Noninvasive evaluation of pulmonary hypertension by a pulsed Doppler technique.

Validity of the right ventricular Doppler index for assessment of severity of congestive heart failure in patients with dilated cardiomyopathy

Utility of Right Ventricular Strain Imaging in Predicting Pulmonary Vascular Resistance in Patients With Pulmonary Hypertension

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