Pulmonary artery acceleration time provides an accurate estimate of systolic pulmonary arterial pressure during transthoracic echocardiography

Kibar Yared, Peter Noseworthy, Arthur E. Weyman, Elizabeth McCabe, Michael H. Picard, Aaron L. Baggish

Research output: Contribution to journalArticle

83 Citations (Scopus)

Abstract

Background: Transthoracic echocardiographic estimates of peak systolic pulmonary artery pressure are conventionally calculated from the maximal velocity of the tricuspid regurgitation (TR) jet. Unfortunately, there is insufficient TR to determine estimated peak systolic pulmonary artery pressure (EPSPAP) in a significant number of patients. To date, in the absence of TR, no noninvasive method of deriving EPSPAP has been developed. Methods: Five hundred clinically indicated transthoracic echocardiograms were reviewed over a period of 6 months. Patients with pulmonic stenosis were excluded. Pulsed-wave Doppler was used to measure pulmonary artery acceleration time (PAAT) and right ventricular ejection time. Continuous-wave Doppler was used to measure the peak velocity of TR (TRVmax), and EPSPAP was calculated as 4 × TRVmax2 + 10 mm Hg (to account for right atrial pressure). The relationship between PAAT and EPSPAP was then assessed. Results: Adequate imaging to measure PAAT was available in 99.6% of patients (498 of 500), but 25.3% (126 of 498) had insufficient TR to determine EPSPAP, and 1 patient had significant pulmonic stenosis. Therefore, 371 were included in the final analysis. Interobserver variability for PAAT was 0.97. There were strong inverse correlations between PAAT and TRVmax (r = -0.96), the right atrial/right ventricular pressure gradient (r = -0.95), and EPSPAP (r = -0.95). The regression equation describing the relationship between PAAT and EPSPAP was log10(EPSPAP) = -0.004 (PAAT) + 2.1 (P < .001). Conclusions: PAAT is routinely obtainable and correlates strongly with both TRVmax and EPSPAP in a large population of randomly selected patients undergoing transthoracic echocardiography. Characterization of the relationship between PAAT and EPSPAP permits PAAT to be used to estimate peak systolic pulmonary artery pressure independent of TR, thereby increasing the percentage of patients in whom transthoracic echocardiography can be used to quantify pulmonary artery pressure.

Original languageEnglish (US)
Pages (from-to)687-692
Number of pages6
JournalJournal of the American Society of Echocardiography
Volume24
Issue number6
DOIs
StatePublished - Jun 1 2011
Externally publishedYes

Fingerprint

Pulmonary Artery
Echocardiography
Arterial Pressure
Lung
Pressure
Tricuspid Valve Insufficiency
Pulmonary Valve Stenosis
Atrial Pressure
Observer Variation
Ventricular Pressure

Keywords

  • Pulmonary artery acceleration time
  • Pulmonary artery pressure
  • Right ventricular systolic pressure
  • Transthoracic echocardiography

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine

Cite this

Pulmonary artery acceleration time provides an accurate estimate of systolic pulmonary arterial pressure during transthoracic echocardiography. / Yared, Kibar; Noseworthy, Peter; Weyman, Arthur E.; McCabe, Elizabeth; Picard, Michael H.; Baggish, Aaron L.

In: Journal of the American Society of Echocardiography, Vol. 24, No. 6, 01.06.2011, p. 687-692.

Research output: Contribution to journalArticle

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T1 - Pulmonary artery acceleration time provides an accurate estimate of systolic pulmonary arterial pressure during transthoracic echocardiography

AU - Yared, Kibar

AU - Noseworthy, Peter

AU - Weyman, Arthur E.

AU - McCabe, Elizabeth

AU - Picard, Michael H.

AU - Baggish, Aaron L.

PY - 2011/6/1

Y1 - 2011/6/1

N2 - Background: Transthoracic echocardiographic estimates of peak systolic pulmonary artery pressure are conventionally calculated from the maximal velocity of the tricuspid regurgitation (TR) jet. Unfortunately, there is insufficient TR to determine estimated peak systolic pulmonary artery pressure (EPSPAP) in a significant number of patients. To date, in the absence of TR, no noninvasive method of deriving EPSPAP has been developed. Methods: Five hundred clinically indicated transthoracic echocardiograms were reviewed over a period of 6 months. Patients with pulmonic stenosis were excluded. Pulsed-wave Doppler was used to measure pulmonary artery acceleration time (PAAT) and right ventricular ejection time. Continuous-wave Doppler was used to measure the peak velocity of TR (TRVmax), and EPSPAP was calculated as 4 × TRVmax2 + 10 mm Hg (to account for right atrial pressure). The relationship between PAAT and EPSPAP was then assessed. Results: Adequate imaging to measure PAAT was available in 99.6% of patients (498 of 500), but 25.3% (126 of 498) had insufficient TR to determine EPSPAP, and 1 patient had significant pulmonic stenosis. Therefore, 371 were included in the final analysis. Interobserver variability for PAAT was 0.97. There were strong inverse correlations between PAAT and TRVmax (r = -0.96), the right atrial/right ventricular pressure gradient (r = -0.95), and EPSPAP (r = -0.95). The regression equation describing the relationship between PAAT and EPSPAP was log10(EPSPAP) = -0.004 (PAAT) + 2.1 (P < .001). Conclusions: PAAT is routinely obtainable and correlates strongly with both TRVmax and EPSPAP in a large population of randomly selected patients undergoing transthoracic echocardiography. Characterization of the relationship between PAAT and EPSPAP permits PAAT to be used to estimate peak systolic pulmonary artery pressure independent of TR, thereby increasing the percentage of patients in whom transthoracic echocardiography can be used to quantify pulmonary artery pressure.

AB - Background: Transthoracic echocardiographic estimates of peak systolic pulmonary artery pressure are conventionally calculated from the maximal velocity of the tricuspid regurgitation (TR) jet. Unfortunately, there is insufficient TR to determine estimated peak systolic pulmonary artery pressure (EPSPAP) in a significant number of patients. To date, in the absence of TR, no noninvasive method of deriving EPSPAP has been developed. Methods: Five hundred clinically indicated transthoracic echocardiograms were reviewed over a period of 6 months. Patients with pulmonic stenosis were excluded. Pulsed-wave Doppler was used to measure pulmonary artery acceleration time (PAAT) and right ventricular ejection time. Continuous-wave Doppler was used to measure the peak velocity of TR (TRVmax), and EPSPAP was calculated as 4 × TRVmax2 + 10 mm Hg (to account for right atrial pressure). The relationship between PAAT and EPSPAP was then assessed. Results: Adequate imaging to measure PAAT was available in 99.6% of patients (498 of 500), but 25.3% (126 of 498) had insufficient TR to determine EPSPAP, and 1 patient had significant pulmonic stenosis. Therefore, 371 were included in the final analysis. Interobserver variability for PAAT was 0.97. There were strong inverse correlations between PAAT and TRVmax (r = -0.96), the right atrial/right ventricular pressure gradient (r = -0.95), and EPSPAP (r = -0.95). The regression equation describing the relationship between PAAT and EPSPAP was log10(EPSPAP) = -0.004 (PAAT) + 2.1 (P < .001). Conclusions: PAAT is routinely obtainable and correlates strongly with both TRVmax and EPSPAP in a large population of randomly selected patients undergoing transthoracic echocardiography. Characterization of the relationship between PAAT and EPSPAP permits PAAT to be used to estimate peak systolic pulmonary artery pressure independent of TR, thereby increasing the percentage of patients in whom transthoracic echocardiography can be used to quantify pulmonary artery pressure.

KW - Pulmonary artery acceleration time

KW - Pulmonary artery pressure

KW - Right ventricular systolic pressure

KW - Transthoracic echocardiography

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