Discordant Doppler Right Heart Catheterization Pulmonary Artery Systolic Pressures: Importance of Pulmonary Capillary Wedge Pressure

Abstract

Pulmonary capillary wedge pressure appears to be a significant covariate in the correlation between D and RHC PASP.

Impact of Severe Tricuspid Regurgitation on Accuracy of Echocardiographic Pulmonary Artery Systolic Pressure Estimation

“…12 Doppler echocardiography was considered inaccurate in 57.4% of PASP estimates. 15 In this study, high PCWP and high RAP were found to be associated with discrepant results in univariate analysis. Similar findings were reported in Fisher's prospective study.…”

“…Recently, another trial focusing on reasons for discrepant PASP DE and PASP RHC did not confirm their findings, and they found both overand underestimation at the higher end of the pulmonary artery spectrum. 15 In this study, high PCWP and high RAP were found to be associated with discrepant results in univariate analysis. However, multivariate analysis showed that the only hemodynamic factor contributing to the true estimation of PASP was PCWP.…”

“…2,[11][12][13][14][15][16][17][18] Inadequate TR jet Doppler signal is the most common source of inappropriate PASP DE estimation. Our hypothesis was that the hemodynamic consequences of severe TR on atrioventricular interaction may be a confounding factor for PASP DE measurement as PASP DE estimation relies on pressure difference between RV and RA.…”

“…Overall weighted correlation coefficient was around 0.7 in these reports. 2,[11][12][13][14][15][16][17][18] Inadequate TR jet Doppler signal is the most common source of inappropriate PASP DE estimation. Nonsimultaneous nature of the studies, noncoaxial interrogation of the tricuspid regurgitation jet, measurement of the tricuspid valve closure artifact, RR irregularity, contamination of the Doppler signal by aortic stenosis, and measurement of postextrasystolic potentiation and unrecognized distal obstructions in right heart are other potential error sources for PASP DE estimation.…”

Pulmonary Hypertension in a Large Cohort with Hereditary Hemorrhagic Telangiectasia

“…This prevented patients with clinically diagnosed HHT in whom genetic testing could not detect a disease-causing mutation from being falsely classified as HHTnegative. Subjects without a reliable peak tricuspid regurgitation velocity (TRV) measurement on TTCE were excluded [24,25] .…”