Echocardiographic assessment of pulmonary vascular resistance in pulmonary arterial hypertension

Cardiovascular Ultrasound

Research

Thérèse Lognoné¹  Rémi Sabatier¹  Eric Saloux¹  Fabien Labombarda¹  Arnaud Pellissier¹  Sophie Gomes¹  Vincent Roule¹  Paul Milliez¹  Gilles Grollier¹  Emmanuel Bergot² 

[1] Department of Cardiology, University Hospital of Caen, 14033, Caen Cedex, France;Department of Pneumology, University Hospital of Caen, 14033, Caen Cedex, France;

关键词: Pulmonary Hypertension;    Pulmonary Arterial Hypertension;    Pulmonary Vascular Resistance;    Pulmonary Capillary Wedge Pressure;    Pulmonary Artery Systolic Pressure;   

DOI  :  10.1186/1476-7120-8-21

 received in 2010-03-18, accepted in 2010-06-07,  发布年份 2010

来源: Springer

【 摘 要 】

BackgroundEchocardiographic ratio of peak tricuspid regurgitant velocity to the right ventricular outflow tract time-velocity integral (TRV/TVI rvot) was presented as a reliable non-invasive method of estimating pulmonary vascular resistance (PVR). Studies using this technique in patients with moderate to high PVR are scarce. Left ventricular outflow tract time-velocity integral (TVI lvot) can be easier to measure than TVI rvot, especially in patients with severe pulmonary hypertension (PH) with significant anatomical modifications of the right structures.AimsWe wanted to determine whether the TRV/TVI rvot and TRV/TVI lvot ratios would form a reliable non-invasive tool to estimate PVR in a cohort of patients with moderate to severe pulmonary vascular disease.MethodsDoppler echocardiographic examination and right heart catheterisation were performed in 37 patients. Invasive PVR was compared with TRV/TVI rvot and TRV/TVI lvot ratios using regression analysis. Two equations were modelled and the results compared with invasive measurements using the Bland-Altman analysis. Using receiver-operating characteristics curve analysis, a cut-off value for the two ratios was generated.ResultsCorrelation coefficients between invasive PVR and TRV/TVI rvot then TRV/TVI lvot were respectively 0.76 and 0.74. Two new equations were found but the Bland-Altman analysis showed wide standard deviations (respectively 3.8 and 3.9 Wood units). A TRV/TVI rvot then TRV/TVI lvot ratio cut-off value of 0.14 had a sensitivity of 93% and a specificity of 57% for the first and a sensitivity of 87% and a specificity of 57% for the second to determine PVR > 2 Wood units.ConclusionEchocardiography is useful for the screening of patients with pulmonary hypertension and PVR > 2 WU. It remains disappointing for accurate assessment of high PVR. TVI lvot may be an alternative to TVI rvot for patients for whom accurate TVI rvot measurement is not possible.

【 授权许可】

CC BY   
© Roule et al; licensee BioMed Central Ltd. 2010