A new method to estimate pulmonary vascular resistance using diastolic pulmonary artery-right ventricular pressure gradients derived from continuous-wave Doppler velocity measurements of pulmonary regurgitation

Abstract

Purpose: Pulmonary vascular resistance (PVR) is an important hemodynamic parameter in patients with heart failure, especially when the pulmonary arterial pressure is lower due to reduced stroke volume. Several echocardiographic methods to estimate PVR have been proposed, but their applications in patients with organic left-sided heart diseases have been limited. The aim of the present study was to examine the usefulness of our new method to estimate PVR (PVR PR ) based on the continuous-wave Doppler velocity measurements of pulmonary regurgitation in these patients. Methods:In 43 patients who underwent right heart catheterization, PVR PR was calculated as the difference between the Doppler-derived early-and end-diastolic pulmonary artery (PA)-right ventricular (RV) pressure gradients divided by the cardiac output measured in the left ventricular outflow tract by echocardiography.

A Simple and Novel Noninvasive Method of Estimating Markedly Elevated Pulmonary Vascular Resistance in Patients with Pre-capillary Pulmonary Hypertension

“…A number of echocardiographic methods have been proposed for the noninvasive estimation of PVR [1][2][9][10][11][12]. However, most methods acquired formulas containing various empirical constants, which would affect the accuracy of the estimating PVR results.…”

“…Compared to the method of Abbas et al [2] and Kaga et al [10], the new method also takes into account the contribution of RAP to estimate mPAP. Current guidelines have suggested that RAP predicts prognosis of PAH [7].…”

The Age of Non-Invasive Measurements: Echocardiographic Equations Methods to Determine Variables in the Pulmonary Vascular Reactivity Test

“…Unfortunately the work presented had a great limitation because it excluded all patients with moderate and severe tricuspid regurgitation representing the population that could be most favored. In successive years, emerged publications aimed at giving validity to this equation [32][33][34][35][36], discuss its content 16-18 or establishing different approaches and hemodynamic variables for the calculation of PVR [13][14][15][16]37,38].…”

“…Evaluation of patients candidates for cardiac and liver transplant [3][4][5][6][7], is a prognostic parameter for patients with congenital diseases [8], is considered a critical parameter for evaluating PH independent of etiology [9]. The PVR is calculated invasively by the relation of the pressure gradient and the flow transpulmonar [10], Abbas and collaborators [11,12] proposed to estimate the measurement echocardiographic of the PVR by the relation TRV/TVI rvot representing the method most used currently, among others proposed for its calculation [13][14][15][16][17][18]. On the other hand, the PVRT has very precise indications according to the European Society Cardiology guidelines [9] for the diagnosis, treatment and prognosis of the PH.…”

“…for patients with higher PVR who had a TRV/TVI rvot index ≥ 0.275, being this cut-off point for PVR>6 UW (ROC curve). Currently his two works have worldwide acceptance and recognition and PVR echo equation=RTV/TVI rvot × 10+0.16, is part of the list of hemodynamic variables validated and obtained by Doppler echocardiogram.In a more current work (2017), Kaga S, et al[16], proposed an equation based on the difference of the initial and final diastolic pressure gradient obtained by means of Pulmonary Regurgitation (PR) and CO: (early-diastolic PA-RV pressure gradient-end-diastolic PA-RV pressure gradient)/echocardiographic cardiac output. They analyzed the linear correlation between the Abbas equations (2003 and 2013) and the Scapellato equation with catheterization, obtaining MPAP was obtained by means of the equation proposed by Chemla D, et al[23]: MPAP=0.61 × SPAP+1.95 and the PVR with the relationship TRV/TVI rvot to evaluate its behavior in high values of PVR.…”