Noninvasive determination of pulmonary arterial systolic pressure by continuous wave Doppler

doi:10.1016/0167-5273(87)90249-X

International Journal of Cardiology

Volume 16, Issue 2, August 1987, Pages 177-184

https://doi.org/10.1016/0167-5273(87)90249-X Get rights and content

Abstract

We evaluated the accuracy of continuous wave Doppler for estimating pulmonary arterial systolic pressure in patients with tricuspid regurgitation. Of 44 patients with a variety of cardiac disorders, 39 (89%) had Doppler-detected tricuspid regurgitation. Adequate spectral profiles of the flow signals were obtained in 34 of them (87%), representing 77% of the entire group. Continuous wave Doppler ultrasound was used to measure the maximum velocity of the regurgitant jet, and by applying the modified Bernoulli equation, the systolic pressure gradient between the right ventricle and the right atrium was calculated. Pulmonary arterial systolic pressure was estimated by adding the transtricuspid gradient of the mean right atrial pressure, and correlated well with catheterization values (r = 0.96). The correlation coefficient was not significantly modified if mean right atrial pressures were excluded in the calculations (r = 0.91). Continuous wave Doppler constitutes a sensitive method for the detection of tricuspid regurgitation. The method using the tricuspid gradient provides an accurate estimation of pulmonary arterial systolic pressure. Combined with other available methods (pulsed wave Doppler), this noninvasive technique can yield information comparable with that obtained at catheterization.

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Cited by (30)

Pulmonary hypertension registry of Kerala, India (PRO-KERALA) — Clinical characteristics and practice patterns
2018, International Journal of Cardiology
Citation Excerpt :
In PRO-KERALA, we used a broader echocardiography defined entry criteria instead of the resource-intensive cardiac catheterization based definition. Even though direct invasive measurement of PA pressure is the gold standard for the diagnosis of PH, Doppler echocardiography-based estimates have shown good correlation with direct measurements [11] [12] [13]. Additionally, echocardiography-based registries in the LMICs were found to be useful in describing patient characteristics as in the PAPUCO registry of sub-Saharan Africa [4] [14].
Epidemiological data on pulmonary hypertension (PH) are scarce from developing countries including India.
We established a multi-center registry of PH, the PRO-KERALA registry, in Kerala, India. Fifty hospitals enrolled consecutive adult (>18 years) patients for one year. Echocardiographic criteria (right ventricular systolic pressure – RVSP > 50 mmHg) or invasively obtained mean pulmonary artery pressure > 25 mmHg was the criteria for entry.
There were 2003 patients (52% Women, mean age 56 ± 16.1 years) enrolled. The mean RVSP was 68.2 (SD = 17.9) mmHg. Majority of the study participants (59%) belonged to group 2 of the WHO Nice Classification 2013 (PH secondary to left heart disease). One-fifth (21.2%) belonged to group 1, while 13.3%, 3.8% and 2.4% of the study population belonged to groups 3, 4 and 5 respectively.
More than a quarter (27%) reported PH due to left heart disease with valvular disease etiology; while 20.7% had coronary artery disease. The other common etiological factors were chronic obstructive pulmonary disease (10.6%), congenital heart disease (14.6%), idiopathic pulmonary hypertension (5.8%), and chronic thromboembolic pulmonary hypertension (3.8%). Only one of two patients with pulmonary artery hypertension was receiving PH specific therapies. The use of combination therapy was negligible and PH-specific therapies were prescribed off-label to a small proportion of patients too.
PRO-KERALA is the first PH registry from South Asia and the second largest globally. Left heart diseases attribute to three fifths of patients with PH. Utilization rates of PH specific drug therapies are remarkably lower than the Western population.
Assessment of pulmonary arterial pressure during exercise in collagen vascular disease: Echocardiography vs right-sided heart catheterization
2010, Chest
This study compared the results of exercise Doppler echocardiography (EDE) with right-sided heart catheterization (RHC) and evaluated the combination of EDE and cardiopulmonary exercise testing (CPET) as a screening method for early pulmonary vasculopathy in patients with connective tissue disease.
Patients (N = 52) with connective tissue disease (predominantly systemic sclerosis) and without known pulmonary arterial hypertension underwent both EDE and CPET. If systolic pulmonary arterial pressure (SPAP) was >40 mm Hg during exercise or peak oxygen uptake (
o₂) was <75% predicted, RHC was suggested.
EDE showed an SPAP > 40 mm Hg during exercise in 26/52 patients. Additionally, CPET showed a peak
o₂ <75% predicted in 10/26 patients with SPAP ≤ 40 mm Hg upon exercise. Accordingly, RHC was suggested to 36 patients. RHC was performed in 28 of these patients, revealing SPAP > 40 mm Hg in 25 patients (n = 1 at rest, n = 24 during exercise). SPAP values assessed by EDE showed no significant difference vs RHC at rest, 25 W, 50 W, and maximal exercise (difference [95% CI]: 0.3 [−2.7; 3.2], −1.3 [−7.1; 4.4], 0.9 [−7.7; 5.9], and −5.6 [−13.5; 2.2] mm Hg). Eight patients with exercise SPAP > 40 mm Hg had an exercise pulmonary arterial wedge pressure > 20 mm Hg, suggesting exercise-induced left ventricular diastolic dysfunction not detectable by EDE.
EDE appears to be a reasonable noninvasive method to detect SPAP increase during exercise in connective tissue disease. In combination with CPET, it may be a useful screening tool for early pulmonary vasculopathy, although RHC remains the gold standard for hemodynamic assessment.
clinicaltrials.gov; Identifier: NCT00609349 (Early Recognition of Pulmonary Arterial Hypertension)
Systolic pulmonary artery pressure and serum uric acid levels in patients with hyperthyroidism
2003, Archives of Medical Research
The aim of this study was to investigate systolic pulmonary artery pressure (SPAP) and serum uric acid (SUA) levels in patients with hyperthyroidism and after euthyroid state was reached.
Twenty five (10 male, 15 female, mean age 49.8 ± 11.6 years) consecutive patients with hyperthyroidism (18 due to toxic nodular goiter, seven to Graves' disease) and 25 (eight male, 17 female, mean age 48.7 ± 8.7 years) healthy controls were included in the study. Thyroid hormones, SUA, glucose, urea, creatinine, and transthoracic echocardiography were performed in all patients. All tests were repeated after treatment of hyperthyroidism.
Mean SPAP and SUA levels in patients with hyperthyroidism were significantly higher than in controls (30.4 ± 8.5 vs. 22 ± 3.7 mmHg, p <0.0001, and 5.1 ± 1.1 vs. 4.3 ± 0.5 mg/dL, p = 0.004, respectively). Elevated SPAP and SUA levels in patients with hyperthyroidism decreased significantly after treatment to levels comparable with controls (24.4 ± 5.4 mmHg, p = 0.001 and 4.6 ± 0.9 mg/dL, p = 0.002, respectively). Correlation between SPAP and SUA levels, however, was not significant in hyperthyroid population and after euthyroid stage was reached (r = 0.34, p = 0.097, and r = 0.256, p = 0.216, respectively), possibly due to relatively low number of patients (overall correlation of SPAPs and SUAs was r = 0.4, p <0.0001).
Hyperthyroidism should be included in differential diagnosis of pulmonary arterial hypertension. However, further investigations are needed to determine the exact mechanism between hyperthyroidism and pulmonary hypertension.
Pulmonary artery distensibility and blood flow patterns: A magnetic resonance study of normal subjects and of patients with pulmonary arterial hypertension
1989, American Heart Journal
Pulmonary artery distensibility was studied with spin-echo magnetic resonance imaging in 20 normal subjects of variable age and in four patients with pulmonary arterial hypertension. The distensibility was found to be significantly lower (8%) in patients with pulmonary arterial hypertension than it was in normal subjects (23%). No age-related difference occurred. Magnetic resonance velocity mapping of the pulmonary artery blood flow was performed in 26 normal subjects—11 had mapping in the mid pulmonary artery, 15 had mapping in the distal pulmonary artery, and mapping in the four patients with pulmonary arterial hypertension was in the mid pulmonary artery. The pulmonary artery flow volume was compared with aortic flow and left ventricular stroke volume and a very good correlation was found. A retrograde flow of 2% occurred in the normal subjects serving to close the pulmonic valve. Antegrade plug flow occurred in most normal subjects but varied among individuals. There were also other variations in the flow pattern among normal individuals. All patients with pulmonary arterial hypertension had a markedly irregular ante- and retrograde flow and a large retrograde flow (average 26%). Magnetic resonance imaging offers a noninvasive way to evaluate pulmonary arterial hypertension as well as to quantitate pulmonary and aortic flows in, for example, left-to-right shunts.
Noninvasive right ventricular work in patients with atrial septal defects: a proof-of-concept study
2023, Cardiovascular Ultrasound
Accuracy of Transthoracic Echocardiogram as a Screening Method in the Clinical Practice of Pulmonary Hypertension Investigation
2023, Arquivos Brasileiros de Cardiologia

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Original studyNoninvasive determination of pulmonary arterial systolic pressure by continuous wave Doppler

Abstract

Am J Cardiol

J Am Coll Cardiol

J Am Coll Cardiol

Noninvasive estimation of right ventricular systolic pressure by Doppler ultrasound in patients with tricuspid regurgitation

Circulation

Doppler ultrasound in cardiology: physical principles and clinical application

Original study
Noninvasive determination of pulmonary arterial systolic pressure by continuous wave Doppler