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Echocardiographic assessment of raised pulmonary vascular resistance: application to diagnosis and follow-up of pulmonary hypertension
Citation
Dahiya, A and Vollbon, W and Jellis, C and Prior, D and Wahi, S and Marwick, TH, Echocardiographic assessment of raised pulmonary vascular resistance: application to diagnosis and follow-up of pulmonary hypertension, Heart, 96, (24) pp. 2005-2009. ISSN 1355-6037 (2010) [Refereed Article]
Copyright Statement
Copyright 2010 BMJ Publishing Group Ltd and the British Cardiovascular Society
DOI: doi:10.1136/hrt.2010.204834
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 X10/ (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 Blande-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.
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 X10/ (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 Blande-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.
Item Details
| Item Type: | Refereed Article |
|---|---|
| Research Division: | Medical and Health Sciences |
| Research Group: | Cardiorespiratory Medicine and Haematology |
| Research Field: | Cardiology (incl. Cardiovascular Diseases) |
| Objective Division: | Health |
| Objective Group: | Clinical Health (Organs, Diseases and Abnormal Conditions) |
| Objective Field: | Cardiovascular System and Diseases |
| Author: | Marwick, TH (Professor Tom Marwick) |
| ID Code: | 90862 |
| Year Published: | 2010 |
| Web of Science® Times Cited: | 20 |
| Deposited By: | Menzies Institute for Medical Research |
| Deposited On: | 2014-04-29 |
| Last Modified: | 2014-12-17 |
| Downloads: | 0 |
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