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Echocardiographic assessment of raised pulmonary vascular resistance: application to diagnosis and follow-up of pulmonary hypertension
  1. Arun Dahiya1,2,
  2. William Vollbon1,2,
  3. Christine Jellis1,3,
  4. David Prior3,
  5. Sudhir Wahi1,2,
  6. Thomas Marwick1,2,4
  1. 1School of Medicine, The University of Queensland, Australia
  2. 2Princess Alexandra Hospital, Brisbane, Australia
  3. 3St Vincent's Hospital, Melbourne, Australia
  4. 4Cleveland Clinic, Cleveland, Ohio, USA
  1. Correspondence to Dr T Marwick, Cardiovascular Imaging, J1-5, Cleveland Clinic, 9500 Euclid Av, Cleveland, OH 44122, USA; marwict{at}ccf.org

Abstract

Objective To optimise an echocardiographic estimation of pulmonary vascular resistance (PVRe) for diagnosis and follow-up of pulmonary hypertension (PHT).

Design Cross-sectional study.

Setting Tertiary referral centre.

Patients Patients undergoing right heart catheterisation and echocardiography for assessment of suspected PHT.

Methods PVRe ([tricuspid regurgitation velocity ×10/(right ventricular outflow tract velocity-time integral+0.16) and invasive PVRi ((mean pulmonary artery systolic pressure-wedge pressure)/cardiac output) were compared in 72 patients. Other echo data included right ventricular systolic pressure (RVSP), estimated right atrial pressure, and E/e' ratio. Difference between PVRe and PVRi at various levels of PVR was sought using Bland–Altman analysis. Corrected PVRc ((RVSP−E/e')/RVOTVTI) (RVOT, RV outflow time; VTI, velocity time integral) was developed in the training group and tested in a separate validation group of 42 patients with established PHT.

Results PVRe>2.0 had high sensitivity (93%) and specificity (91%) for recognition of PVRi>2.0, and PVRc provided similar sensitivities and specificities. PVRe and PVRi correlated well (r=0.77, p<0.01), but PVRe underestimated marked elevation of PVRi—a trend avoided by PVRc. PVRc and PVRe were tested against PVRi in a separate validation group (n=42). The mean difference between PVRe and PVRi exceeded that between PVRc and PVRi (2.8±2.7 vs 0.8±3.0 Wood units; p<0.001). A drop in PVRi by at least one SD occurred in 10 patients over 6 months; this was detected in one patient by PVRe and eight patients by PVRc (p=0.002).

Conclusion PVRe distinguishes normal from abnormal PVRi but underestimates high PVRi. PVRc identifies the severity of PHT and may be used to assess treatment response.

  • Pulmonary vascular resistance
  • pulmonary artery pressure
  • pulmonary hypertension
  • echo-Doppler
  • catheterisation
  • pulmonary arterial hypertension (PAH)

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Footnotes

  • Competing interests None.

  • Ethics approval This study was conducted with the approval of the Princess Alexandra Hospital.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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