Noninvasive Estimation of Pulmonary Artery Diastolic Pressure in Patients With Tricuspid Regurgitation by Doppler Echocardiography

Stephen, Bibiana; Dalal, Prateek; Berger, Marvin; Schweitzer, Paul; Hecht, Susan R.

doi:10.1378/chest.116.1.73

Cited by 63 publications

(45 citation statements)

References 20 publications

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“…Further, some studies have reported that the pulmonary arterial diastolic pressure correlates with PAP-SG (r = 0.92). 19) When comparing PAP measurements determined by TTE to those determined by S-G catheterization, values may vary by as much as 3 to 38 mmHg. 15,20,21) For example, in one study, TTE underestimated PAP by an average of 11 mmHg 15) and by more than 20 mmHg in 31% of patients.…”

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confidence: 99%

Utility of Echocardiography Versus BNP Level for the Prediction of Pulmonary Arterial Pressure in Patients With Pulmonary Arterial Hypertension

et al. 2010

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SummaryRecent advances in the treatment of pulmonary arterial hypertension provide a rational basis for earlier, noninvasive diagnosis of pulmonary arterial hypertension. However, the reliability of transthoracic echocardiography, plasma BNP levels, and other parameters for the diagnosis of pulmonary arterial hypertension remains unclear. Thus, the purpose of this study was to determine the utility of these modes of investigation for the prediction of pulmonary arterial pressure as compared with the current gold standard, Swan-Ganz catheterization.Among 46 PAH patients, 37 had connective tissue diseases, while the remainder had primary pulmonary arterial hypertension, chronic pulmonary thromboembolism, and interstitial pneumonitis. Systolic pulmonary arterial pressure calculated by transthoracic echocardiography was significantly correlated with systolic pulmonary arterial pressure measured using a Swan-Ganz catheter (r = 0.51, P < 0.01). Plasma BNP concentration did not correlate with systolic pulmonary arterial pressure (r = 0.10, NS) in the overall patient population. However, when we excluded left ventricular heart failure and left ventricular hypertrophy, BNP concentration was correlated with systolic pulmonary arterial pressure (r = 0.508, P < 0.05). Among other variables tested, ECG electrical axis was correlated with pulmonary arterial pressure (r = 0.46, P < 0.05) but uric acid, lactate dehydrogenase, %DLCO, enhanced IIp sound, and pulmonary artery enlargement on chest x-ray did not correlate with pulmonary arterial pressure.These data suggest that echocardiography is the noninvasive modality of choice for the assessment of pulmonary arterial hypertension. Plasma BNP level also predicts pulmonary arterial pressure, when left ventricular heart failure and cardiac hypertrophy are excluded. (Int Heart J 2010; 51: 343-347)

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confidence: 99%

Utility of Echocardiography Versus BNP Level for the Prediction of Pulmonary Arterial Pressure in Patients With Pulmonary Arterial Hypertension

et al. 2010

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“…Second, technical difficulties associated with pulmonary artery systolic pressure estimation in older subjects with more severe lung disease reduced the prognostic impact of this variable. Finally, intra-and inter-observer variability associated with pulmonary artery systolic pressure estimation using Doppler ultrasonography may have had an impact on the accuracy of this procedure, 18 and, although all measurements were performed by the same experienced echocardiographer, this may be considered a possible source of bias. Despite these limitations, the clinical relevance of the present findings should be highlighted.…”

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confidence: 99%

Clinical Outcomes and Prognostic Factors in a Cohort of Adults With Cystic Fibrosis: A 7-Year Follow-Up Study

et al. 2015

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“…Although the validity of TRJV measurements was subject to early studies in the general population [12,13] as well as in various chronic medical conditions [14][15][16], fewer studies, and none specifically in SCD, have assessed their test-retest agreement or reproducibility [17][18][19]. On an individual level, our results have important implications for the routine use of TRJV measurements as a screening tool to estimate pulmonary artery systolic pressures and the reliance on a strict peak TRJV definition of 2.5 m/sec for determining treatment eligibility in this population.…”

Section: Discussionmentioning

confidence: 99%

“…Subjects with poor Doppler windows were excluded in Stephen et al's study, which demonstrated low inter-and intra-observer variability associated with using TRJV to estimate tricuspid valve gradient [17]. Also, results from studies of aortic and mitral valve regurgitation [20,21] cannot be extrapolated to TRJV measurements since the acoustic windows used for assessing flow across these valves rely on different transducer positions.…”

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confidence: 99%

Reproducibility of tricuspid regurgitant jet velocity measurements in children and young adults with sickle cell disease undergoing screening for pulmonary hypertension

et al. 2010

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The reproducibility of tricuspid regurgitant jet velocity (TRJV) measurements by Doppler echocardiography has not been subjected to systematic evaluation among individuals with sickle cell disease (SCD) undergoing screening for pulmonary hypertension. We examined sources of disagreement associated with peak TRJV in children and young adults with SCD. Peak TRJV was independently measured and interpreted a week apart by separate sonographers and readers, respectively, in 30 subjects (mean age, 15.8 ± 3.3 years) who provided 120 observations. We assessed intra-/inter-reader, intra-/inter-sonographer, sonographerreader, and within subject agreement using Intraclass Correlation Coefficient (ICC) and Cohen's kappa (j). Agreement was examined graphically using Bland-Altman plots. Although sonographers could estimate and measure peak TRJV in all subjects, readers designated tricuspid regurgitation nonquantifiable in 10-17% of their final interpretations. Intra-reader agreement was highest (ICC 5 0.93 [95% CI 0.86, 0.97], P 5 0.0001) and within subject agreement lowest (ICC 5 0.36 [95% CI 0.02, 0.64], P 5 0.021) for single TRJV measurements. Similarly, intra-reader agreement was highest (j 5 0.74 [95% CI 0.53, 0.95], P 5 0.0001) and within subject lowest (j 5 0.14 [95% CI 20.17, 0.46], P 5 0.38) when sonographers and readers categorized TRJV measurements. On Bland-Altman plots, absolute differences in observations increased with higher mean TRJV readings for intra-/inter-reader agreement. Peak TRJV measurements in individual children and young adults with SCD are affected by several sources of disagreement, underscoring the need for methodological improvements that ensure reproducibility of this screening modality for making clinical decisions in this population. Am. J. Hematol. 85:741-745, 2010. V

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Noninvasive Estimation of Pulmonary Artery Diastolic Pressure in Patients With Tricuspid Regurgitation by Doppler Echocardiography

Cited by 63 publications

References 20 publications

Utility of Echocardiography Versus BNP Level for the Prediction of Pulmonary Arterial Pressure in Patients With Pulmonary Arterial Hypertension

Utility of Echocardiography Versus BNP Level for the Prediction of Pulmonary Arterial Pressure in Patients With Pulmonary Arterial Hypertension

Clinical Outcomes and Prognostic Factors in a Cohort of Adults With Cystic Fibrosis: A 7-Year Follow-Up Study

Reproducibility of tricuspid regurgitant jet velocity measurements in children and young adults with sickle cell disease undergoing screening for pulmonary hypertension

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