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A new, simple, and accurate method for non-invasive estimation of pulmonary arterial pressure
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  1. J Xu2,
  2. L-G Durand2,
  3. P Pibarot1,*
  1. 1Quebec Heart Institute/Laval Hospital, Laval University, Ste-Foy, Quebec, Canada
  2. 2Laboratory of Biomedical Engineering, Institut de recherches cliniques de Montréal, Université de Montréal, Montréal, Québec, Canada
  1. Correspondence to:
    Dr Philippe Pibarot, Quebec Heart Institute/Laval Hospital, Laval University, 2725 Chemin Sainte Foy, Sainte Foy, Quebec, Canada G1V 4G5;
    philippe.pibarot{at}med.ulaval.ca

Abstract

Objective: To develop and validate a new non-invasive method for the estimation of pulmonary arterial pressure (PAP) based on advanced signal processing of the second heart sound.

Design: Prospective comparative study.

Setting: Referral cardiology centre.

Patients: This method was first tested in 16 pigs with experimentally induced pulmonary hypertension and then in 23 patients undergoing pulmonary artery catheterisation.

Methods: The heart sounds were recorded at the surface of the thorax using a microphone connected to a personal computer. The splitting time interval between the aortic and the pulmonary components of the second heart sound was measured using a computer assisted spectral dechirping method and was normalised for heart rate.

Results: The systolic PAP varied between 14–73 mm Hg in pigs and between 20–70 mm Hg in patients. The normalised splitting interval was measurable in 97% of the recordings made in pigs and 91% of the recordings made in patients. There was a strong relation between the normalised splitting interval and the systolic PAP (pigs: r = 0.94, standard error of the estimate (SEE) = 5.3 mm Hg; patients: r = 0.84, SEE = 7.8 mm Hg) or the mean pulmonary pressure (pigs: r = 0.94, SEE = 4.1 mm Hg; patients: r = 0.85, SEE = 5.8 mm Hg).

Conclusions: This study shows that this new non-invasive method based on advanced signal processing of the second heart sound provides an accurate estimation of the PAP.

  • heart sounds
  • pulmonary hypertension
  • haemodynamics
  • signal processing
  • A2, aortic component of the second heart sound
  • HR, heart rate
  • NSI, normalised splitting interval
  • PAP, pulmonary arterial pressure
  • P2, pulmonary component of the second heart sound
  • S2, second heart sound
  • SEE, standard error of the estimate
  • SI, splitting interval
  • SNR, signal to noise ratio
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Footnotes

  • * Also the Laboratory of Biomedical Engineering

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