An Alternative Echocardiographic Method to Estimate Mean Pulmonary Artery Pressure: Diagnostic and Clinical Implications

Aduen, Javier F.; Castelló, Ramón; Lozano, Marcelo M.; Hepler, George N.; Keller, Cesar A.; Álvarez, Francisco; Safford, Robert E.; Crook, Julia E.; Heckman, Michael G.; Burger, Charles D.

doi:10.1016/j.echo.2009.04.007

Cited by 99 publications

(85 citation statements)

References 29 publications

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“…Mean PAP (MPAP) is an important parameter in the diagnosis, assessment of severity, and response to therapy in patients with PH. 2 Although right heart catheterization (RHC) is the gold standard for assessing pulmonary hemodynamics in patients with PH, it is invasive and costly. 3 Systolic PAP (SPAP) is estimated from the peak flow velocity of tricuspid regurgitation (TR) on echocardiography and is used for patient screening and follow-up.…”

mentioning

confidence: 99%

Mean Pulmonary Artery Pressure Using Echocardiography in Chronic Thromboembolic Pulmonary Hypertension

Kasai

Matsumura

Sugiura

et al. 2016

Circ J

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Background: Mean pulmonary arterial pressure (MPAP) is an important pulmonary hemodynamic parameter used in the management of patients with chronic thromboembolic pulmonary hypertension (CTEPH). We compared echocardiography-derived estimates of MPAP with right heart catheterization (RHC) to identify reliable noninvasive methods of estimating MPAP-derived RHC (MPAPRHC) in these patients. Methods and Results:Echocardiography and RHC were performed in 56 patients with CTEPH (60.5±12.0 years; 44 females). We measured the tricuspid regurgitation (TR) pressure gradient (TRPG) using echocardiography. The mean systolic right ventricular (RV)-right atrial (RA) gradient was calculated by tracing the TR time velocity flow. Systolic and mean pulmonary artery pressures (SPAPTR and MPAPTR) estimated from TRPG and mean systolic RV-RA gradient were calculated by adding RA pressure based on the inferior vena cava. MPAPChemla was calculated using Chemla's formula: 0.61×SPAPTR+2 mmHg. MPAPRHC and pulmonary vascular resistance were 35.9±11.3 mmHg and 6.6±3.6 Wood units, respectively. The mean difference from MPAPRHC and limits of agreement were −1.5 mmHg and −19.6 to 16.5 mmHg for MPAPTR, and −4.6 mmHg and −24.5 to 15.2 mmHg for MPAPChemla. Accuracy within 10 mmHg and 5 mmHg of MPAPRHC was 80.4% and 46.4% for MPAPTR, and 71.4% and 48.2% for MPAPChemla, respectively.Conclusions: MPAPTR and MPAPChemla are reliable estimates for MPAPRHC in patients with CTEPH. (Circ J 2016; 80: 1259 -1264

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confidence: 99%

Mean Pulmonary Artery Pressure Using Echocardiography in Chronic Thromboembolic Pulmonary Hypertension

Kasai

Matsumura

Sugiura

et al. 2016

Circ J

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“…24 In particular, PAT <90 ms can identify PVR ≥3 WU with 84% sensitivity and 85% specificity. 29 From the above discussion, a PAT < 90 ms or ratio V TR / RVOT VTI >0.175 suggest the possibility of elevated PVR, and in turn, PH.…”

Section: A B D Cmentioning

confidence: 99%

“…28 A third method for the estimation of MPAP is from the mean systolic gradient between RA and RV from the formula, MPAP = RAP + V TR mean gradient. 29 While measuring MPAP from PAT, the RV function should be evaluated because poor RV function in itself reduces the RV ejection time (RVET) and, thereby, PAT leading to overestimation of MPAP, which can corrected by using PAT corrected for RVET.…”

Section: Estimation Of Mpap and Dpapmentioning

confidence: 99%

Transesophageal Echocardiographic Approach to a Patient with Suspected Pulmonary Hypertension in the Intraoperative Period

Kumar¹,

Puri²

2017

Journal of Perioperative Echocardiography

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Pulmonary hypertension (PH) defined by a mean pulmonary artery pressure (MPAP) >25 mm Hg at rest is confirmed by right heart catheterization (RHC). With the rapid development of surgical methods and cardiopulmonary bypass strategies, many children and adults are undergoing surgical correction for their cardiac pathologies. Presence of PH in these patients contributes to a major morbidity and poses a great challenge for the operative team during its surgical and postoperative management. With the universal use of transesophageal echocardiography (TEE) in almost all cardiac surgeries, the etiology, severity of PH, and its effect on cardiac structures and function can be evaluated in patients suspected of having PH. Since there is no established algorithm for the intraoperative TEE evaluation of such patients, we proposed an algorithm for the evaluation of PH in patients suspected of having raised pulmonary pressure using TEE in the intraoperative period.

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“…Although validated surrogate endpoints in assessing response to therapy remain a source of ongoing discussion, measurements such as spirometry, ECHO, six minute walk distance, WHO functional class have been validated to monitor disease course, but remain imperfect. (Hoeper 2005;Snow 2007;Aduen 2009) If there were some benefit, it is unfortunate that it will remain inconclusive. Cases 1 and 3 had subjective improvement; however, there clinical scenario was complex as outlined above.…”

Section: Wwwintechopencommentioning

confidence: 99%

Autologous Stem Cell Infusion for Treatment of Pulmonary Disease

Patel¹,

Burger²

2012

New Advances in Stem Cell Transplantation

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An Alternative Echocardiographic Method to Estimate Mean Pulmonary Artery Pressure: Diagnostic and Clinical Implications

Cited by 99 publications

References 29 publications

Mean Pulmonary Artery Pressure Using Echocardiography in Chronic Thromboembolic Pulmonary Hypertension

Mean Pulmonary Artery Pressure Using Echocardiography in Chronic Thromboembolic Pulmonary Hypertension

Transesophageal Echocardiographic Approach to a Patient with Suspected Pulmonary Hypertension in the Intraoperative Period

Autologous Stem Cell Infusion for Treatment of Pulmonary Disease

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