Noninvasive Estimation of Pulmonary Vascular Resistance in Pulmonary Hypertension

Rajagopalan, Navin; Simon, Marc A.; Suffoletto, Matthew S.; Shah, Hemal; Edelman, Kathy; Mathier, Michael A.; López‐Candales, Angel

doi:10.1111/j.1540-8175.2008.00837.x

Cited by 91 publications

(104 citation statements)

References 16 publications

(18 reference statements)

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“…As previously described, all the equations became less accurate when the PVR increased. 33, 34 Our results confirmed than estimation of PVR is not adequately established with ECHO. 23 When this value is important to guide therapy, the calculation must be determined using RHC.…”

Section: Doutreleau S Et Alsupporting

confidence: 78%

Right Heart Hemodynamics in Pulmonary Hypertension　– An Echocardiography and Catheterization Study –

Doutreleau

Canuet

Enache

et al. 2016

Circ J

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Section: Doutreleau S Et Alsupporting

confidence: 78%

Right Heart Hemodynamics in Pulmonary Hypertension　– An Echocardiography and Catheterization Study –

Doutreleau

Canuet

Enache

et al. 2016

Circ J

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“…[33][34][35][36] These indirect measures have not been validated with sufficient patient numbers, and questions about accuracy persist. Consequently, catheterization-derived measurement of PVR is still required.…”

Section: Estimates Of Pap and Pvrmentioning

confidence: 99%

Pediatric Pulmonary Hypertension

Abman¹,

Hansmann²,

Archer³

et al. 2015

Circulation

948

405

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Abstract-Pulmonary hypertension is associated with diverse cardiac, pulmonary, and systemic diseases in neonates, infants, and older children and contributes to significant morbidity and mortality. However, current approaches to caring for pediatric patients with pulmonary hypertension have been limited by the lack of consensus guidelines from experts in the field. In a joint effort from the American Heart Association and American Thoracic Society, a panel of experienced clinicians and clinician-scientists was assembled to review the current literature and to make recommendations on the diagnosis, evaluation, and treatment of pediatric pulmonary hypertension. This publication presents the results of extensive literature reviews, discussions, and formal scoring of recommendations for the care of children with pulmonary hypertension. Key Words: AHA Scientific Statements ◼ bronchopulmonary dysplasia ◼ congenital diaphragmatic hernia ◼ congenital heart disease ◼ genetics ◼ persistent pulmonary hypertension of the newborn ◼ sickle cell disease © 2015 by the American Heart Association, Inc., and the American Thoracic Society.Circulation is available at http://circ.ahajournals.org DOI: 10.1161/CIR.0000000000000329 †Deceased. The American Heart Association and the American Thoracic Society make every effort to avoid any actual or potential conflicts of interest that may arise as a result of an outside relationship or a personal, professional, or business interest of a member of the writing panel. Specifically, all members of the writing group are required to complete and submit a Disclosure Questionnaire showing all such relationships that might be perceived as real or potential conflicts of interest.This document was approved by the American Heart Association Science Advisory and Coordinating Committee on May 12, 2015, the American Heart Association Executive Committee on July 22, 2015, and the American Thoracic Society on July 24, 2015.The online-only Data Supplement is available with this article at http://circ.ahajournals.org/lookup/suppl/doi:10.1161/CIR.0000000000000329/-/DC1. The American Heart Association requests that this document be cited as follows: Abman SH, Hansmann G, Archer SL, Ivy DD, Adatia I, Chung WK, Hanna BD, Rosenzweig EB, Raj JU, Cornfield D, Stenmark KR, Steinhorn R, Thébaud B, Fineman JR, Kuehne T, Feinstein JA, Friedberg MK, Earing M, Barst RJ, Keller RL, Kinsella JP, Mullen M, Deterding R, Kulik T, Mallory G, Humpl T, Wessel DL; on behalf of the American Heart Association Council on Cardiopulmonary, Critical Care, Perioperative and Resuscitation, Council on Clinical Cardiology, Council on Cardiovascular Disease in the Young, Council on Cardiovascular Radiology and Intervention, Council on Cardiovascular Surgery and Anesthesia, and the American Thoracic Society. Pediatric pulmonary hypertension: guidelines from the American Heart Association and American Thoracic Society. Circulation. 2015;132:2037-2099 Copies: This document is available on the World Wide Web site of the American Heart Associat...

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“…However, when the Abbas formula was applied to patients with a PVR >8 Wood units, the relationship was no longer significant. 40 Recently, Opotowsky et al 41 showed a very strong correlation between invasively measured PVR and estimated PVR using a model based on the ratio of Doppler-estimated systolic PAP to RVOT velocity time integral and the presence of RVOT Doppler midsystolic notching on echocardiogram. Interestingly, the Opotowsky method had a superior receiver-operating characteristic curve for discrimination of PVR >3 Wood units compared with the Abbas method.…”

Section: Discussionmentioning

confidence: 99%

Pulmonary Pulse Wave Transit Time is Associated with Right Ventricular–Pulmonary Artery Coupling in Pulmonary Arterial Hypertension

et al. 2016

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Pulmonary pulse wave transit time (pPTT), defined as the time for the systolic pressure pulse wave to travel from the pulmonary valve to the pulmonary veins, has been reported to be reduced in pulmonary arterial hypertension (PAH); however, the underlying mechanism of reduced pPTT is unknown. Here, we investigate the hypothesis that abbreviated pPTT in PAH results from impaired right ventricular-pulmonary artery (RV-PA) coupling. We quantified pPTT using pulsed-wave Doppler ultrasound from 10 healthy age-and sexmatched controls and 36 patients with PAH. pPTT was reduced in patients with PAH compared with controls. Univariate analysis revealed the following significant predictors of reduced pPTT: age, right ventricular fractional area change (RV FAC), tricuspid annular plane excursion (TAPSE), pulmonary arterial pressures (PAP), diastolic pulmonary gradient, transpulmonary gradient, pulmonary vascular resistance, and RV-PA coupling (defined as RV FAC/mean PAP or TAPSE/mean PAP). Although the correlations between pPTT and invasive markers of pulmonary vascular disease were modest, RV FAC (r = 0.64, P < 0.0001), TAPSE (r = 0.67, P < 0.0001), and RV-PA coupling (RV FAC/mean PAP: r = 0.72, P < 0.0001; TAPSE/mean PAP: r = 0.74, P < 0.0001) had the strongest relationships with pPTT. On multivariable analysis, only RV FAC, TAPSE, and RV-PA coupling were independent predictors of pPTT. We conclude that shortening of pPTT in patients with PAH results from altered RV-PA coupling, probably occurring as a result of reduced pulmonary arterial compliance. Thus, pPTT allows noninvasive determination of the status of both the pulmonary vasculature and the response of the RV in patients with PAH, thereby allowing monitoring of disease progression and regression.Keywords: pulse wave velocity, right ventricular-pulmonary artery coupling, echocardiography. Pulmonary arterial hypertension (PAH) is a lethal disease, characterized by pathological pulmonary vascular remodeling, that leads to elevated pulmonary arterial pressure (PAP) and pulmonary vascular resistance (PVR), decreased pulmonary arterial compliance, and eventual right ventricular failure and death.1,2 Growing evidence suggests that pulmonary arterial compliance plays a critical role in the pathogenesis of PAH and right ventricular failure. 3 Decreased pulmonary arterial compliance causes premature reflection of waves from the distal pulmonary vasculature, leading to increased pulsatile right ventricular afterload and altered right ventricular-pulmonary artery (RV-PA) coupling. 3-5 Both loss of pulmonary arterial compliance and impaired RV-PA coupling are clinically important, because they are associated with increased mortality in patients with pulmonary hypertension. 6-11Pulse wave velocity, defined as the velocity of pressure waves traveling through the arterial system, correlates inversely with arterial compliance in the systemic circulation.12 With decreasing compliance, pulse wave velocity increases, and the time taken by the pressure wave to travel between...

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Noninvasive Estimation of Pulmonary Vascular Resistance in Pulmonary Hypertension

Abstract: Background: Determination of pulmonary vascular resistance (PVR) in patients with

Cited by 91 publications

References 16 publications

Right Heart Hemodynamics in Pulmonary Hypertension　– An Echocardiography and Catheterization Study –

Right Heart Hemodynamics in Pulmonary Hypertension　– An Echocardiography and Catheterization Study –

Pediatric Pulmonary Hypertension

Pulmonary Pulse Wave Transit Time is Associated with Right Ventricular–Pulmonary Artery Coupling in Pulmonary Arterial Hypertension

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Noninvasive Estimation of Pulmonary Vascular Resistance in Pulmonary Hypertension

Abstract: Background: Determination of pulmonary vascular resistance (PVR) in patients with

Cited by 91 publications

References 16 publications

Right Heart Hemodynamics in Pulmonary Hypertension – An Echocardiography and Catheterization Study –

Right Heart Hemodynamics in Pulmonary Hypertension – An Echocardiography and Catheterization Study –

Pediatric Pulmonary Hypertension

Pulmonary Pulse Wave Transit Time is Associated with Right Ventricular–Pulmonary Artery Coupling in Pulmonary Arterial Hypertension

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Resources

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Right Heart Hemodynamics in Pulmonary Hypertension　– An Echocardiography and Catheterization Study –

Right Heart Hemodynamics in Pulmonary Hypertension　– An Echocardiography and Catheterization Study –