TY - JOUR
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.
N1 - Copyright:
Copyright 2011 Elsevier B.V., All rights reserved.
PY - 2011/6
Y1 - 2011/6
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
UR - http://www.scopus.com/inward/record.url?scp=79956345322&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=79956345322&partnerID=8YFLogxK
U2 - 10.1016/j.echo.2011.03.008
DO - 10.1016/j.echo.2011.03.008
M3 - Article
C2 - 21511434
AN - SCOPUS:79956345322
SN - 0894-7317
VL - 24
SP - 687
EP - 692
JO - Journal of the American Society of Echocardiography
JF - Journal of the American Society of Echocardiography
IS - 6
ER -