Comparison of Doppler-determined elevated pulmonary arterial pressure with pressure measured at cardiac catheterization

doi:10.1016/0002-9149(86)90627-2

The American Journal of Cardiology

Volume 57, Issue 10, 1 April 1986, Pages 859-863

https://doi.org/10.1016/0002-9149(86)90627-2 Get rights and content

Abstract

This study assesses use of pulsed Doppler echocardiography to measure pulmonary artery (PA) pressure. PA flow at the right ventricular (RV) outflow tract was analyzed in 51 patients. Attention was focused on PA flow morphologic pattern, RV systolic intervals, time to peak flow and acceleration time index. Correlation was made with PA pressure and total pulmonary resistance. Three morphologic patterns of PA flow were found: type I indicates normal PA pressure (sensitivity 85%, specificity 100%) and types II and III indicate PA hypertension (sensitivity 100%, specificity 85%). The RV preejection/RV ejection ratio, time to peak flow and acceleration time index show a good correlation coefficient improved when a logarithmic function was applied. The best correlation was achieved with time to peak flow (r = −0.77 with PA pressure, r = −0.79 with total pulmonary resistance), and especially with acceleration time index (r = −0.84 with PA pressure, r = −0.87 with total pulmonary resistance). Analysis of pulmonary flow is a reliable new tool for evaluating PA pressure and is even better for evaluating total pulmonary resistance. Acceleration time index is the parameter that correlates best with these 2 variables.

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Cited by (97)

What echocardiographic findings differentiate acute pulmonary embolism and chronic pulmonary hypertension?
2023, American Journal of Emergency Medicine
Pulmonary embolism (PE) and pulmonary hypertension (PH) are potentially fatal disease states. Early diagnosis and goal-directed management improve outcomes and survival. Both conditions share several echocardiographic findings of right ventricular dysfunction. This can inadvertently lead to incorrect diagnosis, inappropriate and potentially harmful management, and delay in time-sensitive therapies. Fortunately, bedside echocardiography imparts a few critical distinctions.
This narrative review describes eight physiologically interdependent echocardiographic parameters that help distinguish acute PE and chronic PH. The manuscript details each finding along with associated pathophysiology and summarization of the literature evaluating diagnostic utility. This guide then provides pearls and pitfalls with high-quality media for the bedside evaluation.
The echocardiographic parameters suggesting acute or chronic right ventricular dysfunction (best used in combination) are: 1. Right heart thrombus (acute PE) 2. Right ventricular free wall thickness (acute ≤ 5 mm, chronic > 5 mm) 3. Tricuspid regurgitation pressure gradient (acute ≤ 46 mmHg, chronic > 46 mmHg, corresponding to tricuspid regurgitation maximal velocity ≤ 3.4 m/sec and > 3.4 m/sec, respectively) 4. Pulmonary artery acceleration time (acute ≤ 60-80 msec, chronic < 105 msec) 5. 60/60 sign (acute) 6. Pulmonary artery early-systolic notching (proximally-located, higher-risk PE) 7. McConnell’s sign (acute) 8. Right atrial enlargement (equal to left atrial size suggests acute, greater than left atrial size suggests chronic).
Emergency physicians must appreciate the echocardiographic findings and associated pathophysiology that help distinguish acute and chronic right ventricular dysfunction. In the proper clinical context, these findings can point towards PE or PH, thereby leading to earlier goal-directed management.
Doppler-derived echocardiographic evidence of pulmonary hypertension in cats with left-sided congestive heart failure
2019, Journal of Veterinary Cardiology
Pulmonary hypertension (PH) caused by left-sided congestive heart failure (L-CHF) is common in dogs and contributes to clinical signs and outcome. The aim of this study was to evaluate the prevalence of Doppler echocardiography–derived PH in a population of cats with L-CHF.
The study involved 131 cats with L-CHF and 56 control cats.
The study design is retrospective, observational study. Tricuspid regurgitation velocity, right atrial dimension, right ventricular (RV) dimension and function, RV wall thickness, pulmonary artery (PA) dimension, Doppler-derived systolic time intervals of PA flow, and presence of septal flattening were evaluated. Pulmonary hypertension was considered if tricuspid regurgitation velocity was >2.7 m/s.
Tricuspid regurgitation was present in 57/131 (44%) of cats with L-CHF and 24/56 (43%) in control cats based on color flow Doppler. Doppler-derived of PH was identified in 22/131 cats with L-CHF (17%). In 15/22 cats, PH was associated with cardiomyopathy, in 5/22 cases with congenital heart disease, and in 2/22 cases with other causes. Cats with Doppler-derived PH more often had chronic L-CHF, as opposed to acute L-CHF (p<0.05). All cats with Doppler-derived PH had subjectively-assessed right-sided heart enlargement, with larger right atrial and RV diameters (p<0.001), increased RV wall thickness (p<0.05), and higher prevalence of septal flattening (<0.001) and PA enlargement (p<0.05).
Pulmonary hypertension identified by Doppler echocardiography is not a common finding in cats with L-CHF. Right-sided heart enlargement, more frequently observed, may raise the suspicion of PH in cats with L-CHF.
Pulmonary Hypertension and Pulmonary Artery Acceleration Time: A Systematic Review and Meta-Analysis
2018, Journal of the American Society of Echocardiography
Measuring mean pulmonary artery pressure by right-heart catheterization is the gold standard for pulmonary hypertension (PH) diagnosis. However, its invasiveness and complication leads to its limited use. The aim of this study was to determine whether echocardiography-derived pulmonary artery acceleration time (PAAT) possesses adequate diagnostic performance for PH, using right-heart catheterization as a reference standard.
MEDLINE, Embase, PubMed, and the Cochrane Central Register of Controlled Trials were searched through July 2016 for studies evaluating PAAT for the diagnosis of PH. Methodologic quality was assessed using the Quality Assessment of Diagnostic Accuracy Studies tool. For each study, the sensitivity, specificity, and diagnostic odds ratio, along with 95% CIs, were calculated to determine the diagnostic accuracy of PAAT. Meta-regression was conducted to evaluate the impact of potential confounding factors.
Of 430 articles, 21 studies (1,280 patients) were identified, including three studies that used transesophageal echocardiography and 18 studies that used transthoracic echocardiography. The pooled sensitivity across studies was 0.84 (95% CI, 0.75–0.90), the pooled specificity was 0.84 (95% CI, 0.78–0.89), and the pooled diagnostic odds ratio was 28 (95% CI, 16–49). The arrhythmia ratio in the population did not affect the specificity of PAAT's diagnostic performance and increased the sensitivity of PH detection.
The results of this study suggest that PAAT is useful for PH detection.
Echocardiography allows for analysis of pulmonary arterial flow in mice with congenital diaphragmatic hernia
2018, Journal of Surgical Research
Congenital diaphragmatic hernia (CDH) is a structural birth defect associated with pulmonary hypoplasia and pulmonary arterial hypertension (PAH). We hypothesize that echocardiography provides a method to assess real-time right ventricle (RV) function, remodeling, and pulmonary artery (PA) flow.
Slit3 wild-type (WT) (n = 6) and knockout (KO) (n = 5) mice were analyzed at 2-3 months of age. Mice were anesthetized using isoflurane. Echocardiography was performed to analyze left and right ventricular wall thickness, internal diameter (ID), and function. Color Doppler was used to analyze flow in the PA and across the tricuspid valve.
There was significant RV dilation in the KO mice versus WT, with an average RVID of 1.99 mm versus 1.26 mm, respectively (P = 0.007). Flow in the PA of KO mice was altered compared to WT, with elevated PA velocity time indices, 30.68 mm versus 22.13 mm (P = 0.012), elevated PA peak velocities, 952.61 mm/s versus 628.73 mm/s (P = 0.003), and decreased pulmonary acceleration times, 8.94 ms versus 16.18 ms (P = 0.002), respectively. Pulmonary vascular resistance, calculated by measuring tricuspid regurgitation peak velocity and right ventricular outflow tract velocity time index, was increased in KO versus WT mice, 17.61 mm²/s versus 8.91 mm²/s (P = 0.003), respectively.
Slit3 KO mice with CDH show evidence of PAH and resultant RV dilation. Using direct cardiac puncture, elevated RV systolic pressures have been demonstrated in KO mice as evidence of PAH. Echocardiography allows direct analysis of the PA and real-time RV function without sacrifice of the mouse. This mode of evaluation allows longitudinal study in mice with PAH and CDH.
Intrapulmonary arteriovenous anastomoses in dogs with severe Angiostrongylus vasorum infection: Clinical, radiographic, and echocardiographic evaluation
2016, Journal of Veterinary Cardiology
Citation Excerpt :
The RV variables studied were peak velocity of pulmonary artery flow and systolic flow profile, and RV systolic time intervals (i.e. pre-ejection period, acceleration time [AT], ejection time [ET], pre-ejection period/ET ratio, and AT index [AT/ET ratio]) acquired from the right parasternal short-axis view at the level of the heart base with the pulsed wave Doppler sample volume in the midstream between the opened pulmonic valve leaflets where a clear laminar flow pattern was recorded. Systolic flow profiles were defined as type I, normal flow profile, symmetric envelope, equal acceleration and deceleration times; type II, peak velocity occurring early in systole with a longer deceleration time; type III, rapid acceleration with notching during deceleration [25]. Tricuspid annular plane systolic excursion (TAPSE) was measured from M-mode recordings of the lateral tricuspid valve annulus from a left parasternal apical four-chamber view optimized for the RV, as previously described [26].
In both humans and dogs the pulmonary vasculature is able to recruit large-diameter anatomical intrapulmonary arteriovenous anastomoses (IPAVAs). In healthy people the opening of these anastomoses affects the degree of exercise-induced increase in pulmonary arterial pressure. The presence of these IPAVAs can be demonstrated using saline contrast echocardiography.
The aims of the present study were to characterize severely affected, naturally infected dogs with Angiostrongylus vasorum, to evaluate if these dogs can open IPAVAs, and to assess if the recruitment of such anastomoses affects the severity of pulmonary hypertension (PH).
Eight client-owned dogs with severe A. vasorum infection were recruited.
Dogs with A. vasorum infection that presented with severe dyspnea and/or syncope were prospectively screened by echocardiography for the presence of PH and IPAVAs. Only severely affected dogs, based on a combination of clinical, radiographic and echocardiographic abnormalities, were enrolled.
Opening of IPAVAs could be demonstrated in three dogs with no to moderate PH, and could not be demonstrated in five dogs with severe PH. In two dogs thoracic radiographs showed only mild interstitial changes, while computer tomography and postmortem examination revealed severe pulmonary interstitial and vascular disease.
These results suggest that dogs may open IPAVAs and that opening of such anastomoses may play a regulatory role in the development of PH. There may be a marked discrepancy between radiographic changes and disease severity in A. vasorum.
Accuracy of Doppler echocardiographic estimates of pulmonary artery pressures in a canine model of pulmonary hypertension
2015, Journal of Veterinary Cardiology
Citation Excerpt :
In recent reports, in humans with PH, the correlation between peak TR pressure gradient as an estimate of sPAP and invasively measured PAPRHC is moderate to poor with a high degree of variability.11,17–21 Other echocardiographic criteria that have been identified as possible predictors of PH in people and dogs include systolic time intervals, pulse-wave Doppler assessment of pulmonary outflow velocity profile, tricuspid annular plane systolic excursion and tissue Doppler imaging.1,4,7,15,22–29 These measurements add information to the echocardiographic assessment of PH patients, but the relatively straightforward analysis of PAP through assessment of TR and PR jets remains clinically popular even though the limitations of this type of assessment are widely acknowledged.
To compare noninvasive estimates of pulmonary artery pressure (PAP) obtained via echocardiography (ECHO) to invasive measurements of PAP obtained during right heart catheterization (RHC) across a range of PAP. To examine the accuracy of estimating right atrial pressure via ECHO (RAP_ECHO) compared to RAP measured by RHC (RAP_RHC), and determine if adding RAP_ECHO improves the accuracy of noninvasive PAP estimations.
14 healthy female beagle dogs.
Comparison of ECHO and RHC measures of PAP, both at normal PAP and increased PAP generated by microbead embolization.
Noninvasive estimates of PAP were moderately but significantly correlated (r of 0.68–0.78; p < 0.0006) with invasive measurements of PAP. Wide variance was noted for all estimations, with increased variance at higher PAP. The addition of RAP_ECHO improved correlation and bias in all cases. RAP_RHC was significantly correlated with RAP_ECHO (r = 0.38; p = 0.04) as estimated by the ellipse area method. Median RAP_RHC was significantly different between 3 subjective assessments of right atrial size (p = 0.037).
Spectral Doppler assessments of tricuspid and pulmonic regurgitation are imperfect methods for predicting PAP as measured by catheterization despite an overall moderate correlation between invasive and noninvasive values. Noninvasive measurements may be better utilized as part of a comprehensive assessment of PAP in canine patients. RAP_RHC appears best estimated based on subjective assessment of RA size. Including estimated RAP_ECHO in estimates of PAP improves the correlation and relatedness between noninvasive and invasive measures of PAP, but notable variability in accuracy of estimations persists.

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Comparison of Doppler-determined elevated pulmonary arterial pressure with pressure measured at cardiac catheterization

Abstract

Am J Med

Circulation

Circulation

Echocardiographic evaluation of pulmonary hypertension

Circulation

Echocardiographic patterns of pulmonary valve motion with pulmonary hypertension

Circulation

Measurements of right and left ventricular systolic time intervals by echocardiography

Circulation

Assessment of the pulmonary vascular bed echocardiographic right ventricular systolic time intervals

Circulation

Non invasive estimation of pulmonary artery systolic pressure with Doppler ultrasound

Br Heart J

Noninvasive evaluation of pulmonary hypertension by a pulsed Doppler technique

Circulation

Cardiac catheterization and angiography

Cardiac catheterization and angiography

Cardiac catheterization and angiography