Noninvasive Assessment of Pulmonary Vascular Resistance by Doppler Echocardiography
| Autor: | Karim Al-Azizi, Amr E. Abbas, Walter Serra, David M. Kaye, Laura M. Franey, Steven J. Lester, Nelson B. Schiller, Micha T. Maeder, Antonios P. Vlahos, Thomas H. Marwick |
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| Rok vydání: | 2013 |
| Předmět: |
medicine.medical_specialty
medicine.diagnostic_test business.industry Wood units Doppler echocardiography medicine.disease Pulmonary hypertension Surgery medicine.anatomical_structure Internal medicine medicine Vascular resistance Cardiology Ventricular outflow tract Radiology Nuclear Medicine and imaging In patient Cardiology and Cardiovascular Medicine business Pulmonary wedge pressure |
| Zdroj: | Journal of the American Society of Echocardiography. 26:1170-1177 |
| ISSN: | 0894-7317 |
| DOI: | 10.1016/j.echo.2013.06.003 |
| Popis: | Background The ratio of tricuspid regurgitation velocity (TRV) to the time-velocity integral of the right ventricular outflow tract (TVI RVOT ) has been studied as a reliable measure to distinguish elevated from normal pulmonary vascular resistance (PVR). The equation TRV/TVI RVOT × 10 + 0.16 (PVR echo ) has been shown to provide a good noninvasive estimate of PVR. However, its role in patients with significantly elevated PVR (> 6 Wood units [WU]) has not been conclusively evaluated. The aim of this study was to establish the validity of the TRV/TVI RVOT ratio as a correlate of PVR. The role of TRV/TVI RVOT was also compared with that of a new ratio, TRV 2 /TVI RVOT , in patients with markedly elevated PVR (>6 WU). Methods Data from five validation studies using TRV/TVI RVOT as an estimate of PVR were compared with invasive PVR measurements (PVR cath ). Multiple linear regression analyses were generated between PVR cath and both TRV/TVI RVOT and TRV 2 /TVI RVOT . Both PVR echo and a new derived regression equation based on TRV 2 /TVI RVOT : 5.19 × TRV 2 /TVI RVOT - 0.4 (PVR echo2 ) were compared with PVR cath using Bland-Altman analysis. Logistic models were generated, and cutoff values for both TRV/TVI RVOT and TRV 2 /TVI RVOT were obtained to predict PVR > 6 WU. Results One hundred fifty patients remained in the final analysis. Linear regression analysis between PVR cath and TRV/TVI RVOT revealed a good correlation ( r = 0.76, P Z = 0.92). There was a better correlation between PVR cath and TRV 2 /TVI RVOT ( r = 0.79, P Z = −0.01) in the entire cohort as well as in patients with PVR > 6 WU. Moreover, PVR echo2 compared better with PVR cath than PVR echo using Bland-Altman analysis in the entire cohort and in patients with PVR > 6 WU. TRV 2 /TVI RVOT and TRV/TVI RVOT both predicted PVR > 6 WU with good sensitivity and specificity. Conclusions TRV/TVI RVOT is a reliable method to identify patients with elevated PVR. In patients with TRV/TVI RVOT > 0.275, PVR is likely > 6 WU, and PVR echo2 derived from TRV 2 /TVI RVOT provides an improved noninvasive estimate of PVR compared with PVR echo . |
| Databáze: | OpenAIRE |
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