Noninvasive assessment of pulmonary vascular resistance by doppler echocardiography

Amr E. Abbas, Laura M. Franey, Thomas Marwick, Micha T. Maeder, David M. Kaye, Antonios P. Vlahos, Walter Serra, Karim Al-Azizi, Nelson B. Schiller, Steven J. Lester

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81 Scopus citations

Abstract

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.

Original languageEnglish (US)
Pages (from-to)1170-1177
Number of pages8
JournalJournal of the American Society of Echocardiography
Volume26
Issue number10
DOIs
StatePublished - Oct 1 2013

Keywords

  • Doppler echocardiography
  • Pulmonary hypertension
  • Pulmonary vascular resistance

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine

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  • Cite this

    Abbas, A. E., Franey, L. M., Marwick, T., Maeder, M. T., Kaye, D. M., Vlahos, A. P., Serra, W., Al-Azizi, K., Schiller, N. B., & Lester, S. J. (2013). Noninvasive assessment of pulmonary vascular resistance by doppler echocardiography. Journal of the American Society of Echocardiography, 26(10), 1170-1177. https://doi.org/10.1016/j.echo.2013.06.003