Usefulness of the Continuous-Wave Doppler-Derived Pulmonary Arterial–Right Ventricular Pressure Gradient Just before Atrial Contraction for the Estimation of Pulmonary Arterial Diastolic and Wedge Pressures

Abstract

In our new echocardiographic method, pulmonary regurgitant velocity immediately before right atrial (RA) contraction is used to estimate pulmonary artery diastolic pressure (PADP) and mean PA wedge pressure (MPAWP). Our aim here was to compare the usefulness of this new method with that of the conventional method, which uses pulmonary regurgitant velocity at end diastole. We studied 55 consecutive patients who underwent echocardiography and right-sided heart catheterization. The pulmonary regurgitant velocities just before RA contraction and at end diastole were measured to obtain echocardiographic estimates of PADP (EPADP and EPADP, respectively) by adding the pressure gradients to the echocardiographically estimated RA pressure. Compared with EPADP, EPADP correlated better with PADP (r = 0.87) and MPAWP (r = 0.80), and direct fixed biases were detected for EPADP but not for EPADP. The area under the receiver operating characteristic curve distinguishing patients with MPAWP ≥18 mm Hg was greater for EPADP (0.97) than for E/e' (0.94) and E/A (0.83). EPADP is thus useful in estimating PADP and MPAWP in patients with heart disease.

Prognostic value of an echocardiographic index reflecting right ventricular operating stiffness in patients with heart failure

“…We recently proposed a completely noninvasive index of RV operating stiffness, i.e., PRPGDAC/TAPMAC, which is derived by using the echocardiographic PR velocity waveform and the tricuspid annular movement during atrial contraction. The PR waveform reflects the diastolic pressure difference between PA and RV, thus, PRPGDAC would have reflected the RV pressure increase during the atrial contraction [26]. The tricuspid annular movement reflects RV volume change because RV longitudinal shortening has been recognized as an important factor determining RV contraction [27].…”