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 Jay Lester

Research output: Contribution to journalArticle

76 Citations (Scopus)

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 2013

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Tricuspid Valve Insufficiency
Doppler Echocardiography
Vascular Resistance
Linear Models
Regression Analysis
Validation Studies

Keywords

  • Doppler echocardiography
  • Pulmonary hypertension
  • Pulmonary vascular resistance

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine

Cite this

Noninvasive assessment of pulmonary vascular resistance by doppler echocardiography. / Abbas, Amr E.; Franey, Laura M.; Marwick, Thomas; Maeder, Micha T.; Kaye, David M.; Vlahos, Antonios P.; Serra, Walter; Al-Azizi, Karim; Schiller, Nelson B.; Lester, Steven Jay.

In: Journal of the American Society of Echocardiography, Vol. 26, No. 10, 10.2013, p. 1170-1177.

Research output: Contribution to journalArticle

Abbas, AE, Franey, LM, Marwick, T, Maeder, MT, Kaye, DM, Vlahos, AP, Serra, W, Al-Azizi, K, Schiller, NB & Lester, SJ 2013, 'Noninvasive assessment of pulmonary vascular resistance by doppler echocardiography', Journal of the American Society of Echocardiography, vol. 26, no. 10, pp. 1170-1177. https://doi.org/10.1016/j.echo.2013.06.003
Abbas, Amr E. ; Franey, Laura M. ; Marwick, Thomas ; Maeder, Micha T. ; Kaye, David M. ; Vlahos, Antonios P. ; Serra, Walter ; Al-Azizi, Karim ; Schiller, Nelson B. ; Lester, Steven Jay. / Noninvasive assessment of pulmonary vascular resistance by doppler echocardiography. In: Journal of the American Society of Echocardiography. 2013 ; Vol. 26, No. 10. pp. 1170-1177.
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title = "Noninvasive assessment of pulmonary vascular resistance by doppler echocardiography",
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.",
keywords = "Doppler echocardiography, Pulmonary hypertension, Pulmonary vascular resistance",
author = "Abbas, {Amr E.} and Franey, {Laura M.} and Thomas Marwick and Maeder, {Micha T.} and Kaye, {David M.} and Vlahos, {Antonios P.} and Walter Serra and Karim Al-Azizi and Schiller, {Nelson B.} and Lester, {Steven Jay}",
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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 Jay

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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