Comparison of Doppler-determined elevated pulmonary arterial pressure with pressure measured at cardiac catheterization

Martín‐Durán, Rafael; Larman, Mariano; Trugeda, A; Prada, José Antonio Vázquez de; Ruano, Javier; Torres, Alfonso; Figueroa, Álvaro; Pajarón, A; Nistal, Francisco

doi:10.1016/0002-9149(86)90627-2

Cited by 110 publications

(76 citation statements)

References 16 publications

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“…Although many reports have evaluated AcT/RVET and PAP, those studies did not assess the process of recovery of RV morphology and function after treatment of APTE. [16][17][18][19][20] In the present study, PAP could not be evaluated by AcT/ RVET in patients with APTE, but our results showed that AcT/RVET could be a clinically useful index for evaluating the residual thrombus in patients with APTE after treatment following normalization of PAP. Such assessment is not only suitable for hospitalized patients, but could be also used in the outpatient clinic to assess the effect of anticoagulant therapy.…”

Section: Discussioncontrasting

confidence: 65%

“…[16][17][18][19][20][21] Although several possible mechanisms of these phenomena have been proposed, the major underlying mechanism has not yet been established. The proposed mechanisms include the waveform reflecting the ejection flow in peripheral pulmonary vessel in response to increased pressure, 16 turbulent flow caused by the presence of a dilated pulmonary artery (PA), 21 increased afterload because of reduced compliance of the PA, 18,19 and involvement of the RV ejection fraction. 20 In the present study, we found a negative correlation between mPAP, TPR and AcT/RVET during the acute phase of APTE.…”

Section: Discussionmentioning

confidence: 99%

“…19,27 In general, PVR is calculated as {(mPAP -pulmonary capillary wedge pressure (PCWP)) / CO} × 80 and TPR as (mPAP / CO) × 80. Unfortunately, we could not properly evaluate the relationship between AcT/RVET and PVR because PCWP was recorded in only 9 cases.…”

Section: Discussionmentioning

confidence: 99%

“…14,15 On the other hand, in patients with chronic cor pulmonale, several studies have demonstrated a close correlation between PAP and the ratio of acceleration time to RV ejection time (AcT/RVET) measured by pulsed Doppler Japanese Circulation Journal Vol.65, March 2001 UCG. [16][17][18][19][20] In the present study, we examined the serial changes in AcT/RVET in patients with APTE, from disease onset, and compared these findings with other simultaneously determined hemodynamic indices and PAG findings. In particular, we evaluated the relationship between AcT/ RVET and PAG findings after normalization of PAP.…”

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confidence: 99%

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Diagnostic Value of Pulsed Doppler Echocardiography in Acute Pulmonary Thromboembolism

Yoshinaga

Ikeda

Nishimura³

et al. 2001

Jpn Circ J

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cute pulmonary thromboembolism (APTE) is a lifethreatening condition that is often difficult to diagnose in routine clinical practice. It is usually confirmed by pulmonary angiography (PAG), 1 ventilation/ perfusion lung scintigraphy 2 or helical computed tomography (CT), 3 and the severity of APTE is often evaluated either by assessing the volume of the thrombus on PAG 1,4 or by measuring pulmonary artery pressure (PAP). It can also be evaluated non-invasively using electrocardiography (ECG) 5 or echocardiography (UCG). 6,7 On ECG, serial changes in negative T-waves are useful for evaluating the prognosis of APTE, 5 but the T wave can be influenced by a variety of factors, such as the severity and duration of the disease. UCG has been used to evaluate the right ventricular (RV) pressure overload in APTE, but although various UCG parameters, such as the pressure gradient calculated from tricuspid regurgitation (TR), 8,9 the RV end-diastolic dimension (RVDd) and RV function, have been used to evaluate the severity of APTE, the detection of a decrease in TR depends on the level of PAP. [11][12][13] Moreover, analysis of RV motion is actually required to precisely evaluate the RV dimensions or configuration. 14,15 On the other hand, in patients with chronic cor pulmonale, several studies have demonstrated a close correlation between PAP and the ratio of acceleration time to RV ejection time (AcT/RVET) measured by pulsed Doppler Japanese Circulation Journal Vol.65, March 2001 UCG. [16][17][18][19][20] In the present study, we examined the serial changes in AcT/RVET in patients with APTE, from disease onset, and compared these findings with other simultaneously determined hemodynamic indices and PAG findings. In particular, we evaluated the relationship between AcT/ RVET and PAG findings after normalization of PAP. Methods Subjects and MeasurementsBetween 1994 and 1998, 23 patients were diagnosed with APTE by angiography and 16 were prospectively enrolled in the present study. The inclusion criteria were: (i) the patient was free of pre-existing cardiopulmonary disease, and (ii) the patient responded favorably to thrombolysis within 14 days of the onset of symptoms. The remaining 7 cases were excluded from the study because they had a history of previous cardiopulmonary disease (including APTE), or had died within 1 week of thrombolysis, or had failed to respond to thrombolytic therapy (no change in PAG indices and PAP). UCG, PAG and measurement of PAP were performed in the patients before and after treatment. The mean age of the participating subjects was 66.7±8.2 years (range, 52-78), and included 1 male and 15 females. The ECG showed sinus rhythm on admission, except in 1 patient who had a right bundle branch block. Measurement of PAPCardiac catheterization was performed as follows: a 7F Swan-Ganz catheter (Edwards Critical-Care Division, Irvine, CA, USA) was inserted through the right internal jugular vein before PAG (if this proved to be difficult to perform, Jpn Circ J 2001; 65: 171 -176 (Received August 7...

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Section: Discussioncontrasting

confidence: 65%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

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Diagnostic Value of Pulsed Doppler Echocardiography in Acute Pulmonary Thromboembolism

Yoshinaga

Ikeda

Nishimura³

et al. 2001

Jpn Circ J

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“…Back in the 1980s, it was shown that in adult patients with PAAT values <100 ms, there is a linear inverse relationship between the PAAT and the mean PAP (mPAP). [1][2][3][4][5] However, an increased heart rate (HR) is suspected to shorten the PAAT. In adults, the PAAT was shown to correlate strongly with mPAP 1 and can be measured in adults and in children.…”

mentioning

confidence: 99%

Normal Reference Values and z Scores of the Pulmonary Artery Acceleration Time in Children and Its Importance for the Assessment of Pulmonary Hypertension

Koestenberger

Grangl

Avian

et al. 2017

Circ: Cardiovascular Imaging

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Background-Pulsed-wave Doppler determination of the pulmonary artery acceleration time (PAAT) as a surrogate for pulmonary artery pressure was found to be of clinical value for assessment of pulmonary hypertension (PH) with studies to date exclusively performed in adults. This study aims to provide representative, normal reference values for PAAT in children of all ages. Moreover, we validated abnormal PAAT values in 54 children with PH. Methods and Results-We conducted a prospective echocardiographic study in 756 healthy children (aged 1 day to 18 years) and in 54 children with PH. Possible associations of age, body length, body weight, body surface area, and heart rate on PAAT were investigated. The PAAT correlated positively with age (r=0.848), body length (r=0.871), body surface area (r=0.856), and body weight (r=0.825) and negatively with heart rate (r=−0.906). PAAT increased with age (neonates: median: 81 ms, range: 53-104; 18th year of life: median: 151 ms, range: 107-187). Receiver operating characteristic analysis for detecting PH patients using age-specific z scores showed an excellent performance of PAAT (P<0.001; area under the curve, 0.98; 95% confidence interval, 0.97-0.99) with a best cutoff score according to Youden index of -1.565 (sensitivity: 92%, specificity: 96%). PAAT values of PH patients negatively correlated (ρ=−0.497) with pulmonary vascular resistance. Conclusions-The PAAT normal reference values and z scores we provide here will be useful to identify children with a shortened PAAT. Abnormal PAAT values with scores <−2 were predictive of PH. (Circ Cardiovasc Imaging.

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Pulmonary hypertension in patients with myelofibrosis secondary to myeloproliferative diseases

et al. 1999

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We examined the clinical characteristics of six patients with myelofibrosis secondary to myeloproliferative diseases whose clinical courses were complicated by pulmonary hypertension to determine possible causal links between the two disorders. Six patients (four male, two female), with diagnoses of myeloproliferative disease, myelofibrosis (one with polycythemia vera, three with agnogenic myeloid metaplasia, one with unclassified myeloproliferative syndrome, one with essential thrombocytosis), and pulmonary hypertension are presented. Measurement of the pulmonary artery pressure was performed by Doppler echocardiography in all patients and by right sided heart catheterization in four patients. The range of resting pulmonary artery systolic pressure was 35 to 47 mmHg above the mean right atrium by echocardiography. One patient had autopsy evidence of pulmonary myeloid metaplasia and interstitial fibrosis; another had acute leukemic infiltration of the lung parenchyma. All patients had thrombocytosis; symptomatology in one patient with marked thrombocytosis improved with plateletpheresis. Two patients suffered systemic thrombosis. All patients had severe hepatomegaly. Two patients had evidence of left ventricular dysfunction. The interval between the development of dyspnea and death was less than seven months in five of the patients. A causal link between pulmonary hypertension and myelofibrosis secondary to myeloproliferative diseases is suggested for each patient. Hematopoietic infiltration of the pulmonary parenchyma, portal hypertension, thrombocytosis, hypercoagulability, and left ventricular failure may account in part for the development of pulmonary hypertension in these patients. Patients with myelofibrosis and dyspnea should have Doppler echocardiography to evaluate pulmonary artery pressures.

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Comparison of Doppler-determined elevated pulmonary arterial pressure with pressure measured at cardiac catheterization

Cited by 110 publications

References 16 publications

Diagnostic Value of Pulsed Doppler Echocardiography in Acute Pulmonary Thromboembolism

Diagnostic Value of Pulsed Doppler Echocardiography in Acute Pulmonary Thromboembolism

Normal Reference Values and z Scores of the Pulmonary Artery Acceleration Time in Children and Its Importance for the Assessment of Pulmonary Hypertension

Pulmonary hypertension in patients with myelofibrosis secondary to myeloproliferative diseases

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