TY - JOUR
T1 - Noninvasive assessment of pulmonary vascular resistance by doppler echocardiography
AU - Abbas, Amr E.
AU - Franey, Laura M.
AU - Marwick, Thomas
AU - Maeder, Micha T.
AU - Kaye, David M.
AU - Vlahos, Antonios P.
AU - Serra, Walter
AU - Al-Azizi, Karim
AU - Schiller, Nelson B.
AU - Lester, Steven J.
PY - 2013/10
Y1 - 2013/10
N2 - Background The ratio of tricuspid regurgitation velocity (TRV) to the time-velocity integral of the right ventricular outflow tract (TVI RVOT) has been studied as a reliable measure to distinguish elevated from normal pulmonary vascular resistance (PVR). The equation TRV/TVI RVOT × 10 + 0.16 (PVRecho) has been shown to provide a good noninvasive estimate of PVR. However, its role in patients with significantly elevated PVR (> 6 Wood units [WU]) has not been conclusively evaluated. The aim of this study was to establish the validity of the TRV/TVIRVOT ratio as a correlate of PVR. The role of TRV/TVI RVOT was also compared with that of a new ratio, TRV 2/TVIRVOT, in patients with markedly elevated PVR (>6 WU). Methods Data from five validation studies using TRV/TVIRVOT as an estimate of PVR were compared with invasive PVR measurements (PVR cath). Multiple linear regression analyses were generated between PVRcath and both TRV/TVIRVOT and TRV2/TVI RVOT. Both PVRecho and a new derived regression equation based on TRV2/TVIRVOT: 5.19 × TRV 2/TVIRVOT - 0.4 (PVRecho2) were compared with PVRcath using Bland-Altman analysis. Logistic models were generated, and cutoff values for both TRV/TVIRVOT and TRV2/TVI RVOT were obtained to predict PVR > 6 WU. Results One hundred fifty patients remained in the final analysis. Linear regression analysis between PVRcath and TRV/TVIRVOT revealed a good correlation (r = 0.76, P <.0001, Z = 0.92). There was a better correlation between PVRcath and TRV2/TVIRVOT (r = 0.79, P <.0001, Z = -0.01) in the entire cohort as well as in patients with PVR > 6 WU. Moreover, PVRecho2 compared better with PVRcath than PVRecho using Bland-Altman analysis in the entire cohort and in patients with PVR > 6 WU. TRV2/TVIRVOT and TRV/TVI RVOT both predicted PVR > 6 WU with good sensitivity and specificity. Conclusions TRV/TVIRVOT is a reliable method to identify patients with elevated PVR. In patients with TRV/TVIRVOT > 0.275, PVR is likely > 6 WU, and PVRecho2 derived from TRV 2/TVIRVOT provides an improved noninvasive estimate of PVR compared with PVRecho.
AB - Background The ratio of tricuspid regurgitation velocity (TRV) to the time-velocity integral of the right ventricular outflow tract (TVI RVOT) has been studied as a reliable measure to distinguish elevated from normal pulmonary vascular resistance (PVR). The equation TRV/TVI RVOT × 10 + 0.16 (PVRecho) has been shown to provide a good noninvasive estimate of PVR. However, its role in patients with significantly elevated PVR (> 6 Wood units [WU]) has not been conclusively evaluated. The aim of this study was to establish the validity of the TRV/TVIRVOT ratio as a correlate of PVR. The role of TRV/TVI RVOT was also compared with that of a new ratio, TRV 2/TVIRVOT, in patients with markedly elevated PVR (>6 WU). Methods Data from five validation studies using TRV/TVIRVOT as an estimate of PVR were compared with invasive PVR measurements (PVR cath). Multiple linear regression analyses were generated between PVRcath and both TRV/TVIRVOT and TRV2/TVI RVOT. Both PVRecho and a new derived regression equation based on TRV2/TVIRVOT: 5.19 × TRV 2/TVIRVOT - 0.4 (PVRecho2) were compared with PVRcath using Bland-Altman analysis. Logistic models were generated, and cutoff values for both TRV/TVIRVOT and TRV2/TVI RVOT were obtained to predict PVR > 6 WU. Results One hundred fifty patients remained in the final analysis. Linear regression analysis between PVRcath and TRV/TVIRVOT revealed a good correlation (r = 0.76, P <.0001, Z = 0.92). There was a better correlation between PVRcath and TRV2/TVIRVOT (r = 0.79, P <.0001, Z = -0.01) in the entire cohort as well as in patients with PVR > 6 WU. Moreover, PVRecho2 compared better with PVRcath than PVRecho using Bland-Altman analysis in the entire cohort and in patients with PVR > 6 WU. TRV2/TVIRVOT and TRV/TVI RVOT both predicted PVR > 6 WU with good sensitivity and specificity. Conclusions TRV/TVIRVOT is a reliable method to identify patients with elevated PVR. In patients with TRV/TVIRVOT > 0.275, PVR is likely > 6 WU, and PVRecho2 derived from TRV 2/TVIRVOT provides an improved noninvasive estimate of PVR compared with PVRecho.
KW - Doppler echocardiography
KW - Pulmonary hypertension
KW - Pulmonary vascular resistance
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U2 - 10.1016/j.echo.2013.06.003
DO - 10.1016/j.echo.2013.06.003
M3 - Article
C2 - 23860092
AN - SCOPUS:84884532661
SN - 0894-7317
VL - 26
SP - 1170
EP - 1177
JO - Journal of the American Society of Echocardiography
JF - Journal of the American Society of Echocardiography
IS - 10
ER -