Echocardiographic assessment of pulmonary hypertension: standard operating procedure

Howard, Luke; Grapsa, Julia; Dawson, David M.; Bellamy, Michael; Chambers, John; Masani, Navroz; Nihoyannopoulos, Petros; Gibbs, J. Simon R.

doi:10.1183/09059180.00003912

Cited by 158 publications

(170 citation statements)

References 54 publications

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“…4, 5 The measurement of MPAPPR becomes more difficult with the anatomical modifications of right ventricular (RV) structure in patients with severe PH. Chemla et al reported that MPAP can be reliably calculated from SPAP estimated from the peak flow velocity of TR (SPAPTR) using the formula: MPAP=0.61×SPAPTR+2 mmHg.…”

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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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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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“…The absence or failure to get alignment of TR jet mandates the use of PR Doppler profile, if present, to estimate the MPAP and DPAP. The MPAP can be obtained from the PR velocity at the beginning of regurgitation as MPAP = 4 × [Beginning velocity of pulmonary regurgitation jet (Vpr)] 2 + Pra, and the DPAP from the end diastolic velocity of PR as DPAP = 4 × (End Vpr) 2 + right atrial pressure (Pra), where Pra is end diastolic pressure in right atrium, 23 which has the similar limitations that PR is not always present in all the patients. The dependency on the presence of TR and PR in the above-mentioned methods made the use of pulmonary flow contour analysis in estimating MPAP, which is available in all patients even in populations without any cardiopulmonary disease.…”

Section: Discussionmentioning

confidence: 99%

“…Since the RVET has negative correlation with the HR, thereby, indirectly affecting the PAT, Howard et al 23 suggested a correction in PAT value according to the patient's HR, when HR >100 or <70, which is done by multiplying the PAT by 75 and dividing by the patient's HR.…”

Section: Jopementioning

confidence: 99%

Derivation and Validation of Formula relating Pulmonary Acceleration Time and Mean Pulmonary Artery Pressure in Indian Population

Ganesan¹

2017

Journal of Perioperative Echocardiography

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Background: Pulmonary acceleration time (PAT) forms a valuable echocardiographic parameter in deriving the mean pulmonary artery pressure (MPAP). The present study aims to derive and validate a formula relating MPAP and PAT in an Indian population. Materials and methods:Preoperative echocardiography was performed in 22 adult cardiac surgery patients undergoing coronary artery bypass grafting (CABG) and/or mitral valve replacement. The PAT, PAT/right ventricular ejection time (RVET), PAT corrected for heart rate [(HR) HRcPAT], and tricuspid regurgitation (TR) peak velocity were correlated with MPAP measured from pulmonary artery (PA) catheter, and a new formula relating MPAP and PAT was derived and subsequently validated in another cohort of 21 patients. Results:The PAT, HRcPAT, and PAT/RVET correlated well (r 2 = 0.69, 0.68 and 0.47 respectively, p < 0.0001), while TR velocity correlated poorly with MPAP (r 2 = 0.20, p = 0.046). The cutoff values of PAT and HRcPAT for diagnosing pulmonary artery hypertension (PAH) (MPAP = 25 mm Hg) were 74 and 99 respectively, with 92% sensitivity and 100% specificity. The derived formula (MPAP = 62.4 − 0.3 PAT) correlated well with the standard formula (79−0.45 PAT) on applying in the validation cohort (Bland-Altman plot, bias <10%). In subgroup analysis, patients with severe PAH (MPAP = 50 mm Hg) showed better correlation than patients with less than severe PAH (r 2 =0.633, p=0.038 and r 2 = 0.46, p = 0.108 respectively). Similarly, the formula for deriving pulmonary vascular resistance index (PVRI) from PAT [(PVRI = 14.9−0.09 pulmonary artery acceleration time (PAAT)] correlated well with the existing formula (PVRI = 9 − 0.07 PAAT). The inter-and intraobserver variabilities were not significant. Conclusion:The indexed formula is better in predicting MPAP from PAT in Indian population, particularly in patients with severe PAH (MPAP = 50 mm Hg) and the cutoffs of PAT and HRcPAT in predicting PAH (MPAP = 25 mm Hg) in an Indian population are 74 and 99 msec respectively.

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“…7 On the basis of these three parameters (dilation, hypertrophy and contractility), an experienced echo cardiographer will be able to make a good qualitative assessment of RV function and will be able to grade it as mild,moderate or severe impairment. 8 A good evaluation of pulmonary haemodynamics can be performed with Doppler echocardiography using in association, several measurements,for example: maximal velocity of TR,pulmonary blood flow velocity and new indices of right ventricular dysfunction. 9 The triad of decreased RV systolic function, increasing RV sizeand septal bowing form the fundamental basis for the echocardiographic recognition of PAH, with or without demonstration of an increase in Doppler estimated PA systolic pressure.…”

Section: Discussionmentioning

confidence: 99%

Evaluation of Right Ventricular Dysfunction and Pulmonary Artery Hypertension Secondary to Copd Severity by Electrocardiogram and Echocardiography

Jain¹,

Pasari²,

Bajpai³

et al. 2015

jemds

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Patient with COPD carry increased risk of morbidity and mortality due to pulmonary artery hypertension, corpulmonale, cardiac arrhythmias, congestive heart failure and pulmonary embolism. Echocardiography provides a rapid, noninvasive, portable, and accurate method to evaluate the cardiac changes secondary to severe COPD. AIM: To evaluate right ventricular dysfunction and pulmonary artery hypertension secondary to COPD severity as per GOLD guidelines by Electrocardiogram and Echocardiography. MATERIAL AND METHODS: A total 80 of patients of COPD were selected and graded as per GOLD guidelines by spirometry and evaluated by ECG and Echocardiography. RESULT: ECG and Echocardiographic evaluation reveal a direct correlation between cardiac changes and COPD severity. Presence of P pulmonale was seen in 16/34 (47%) in moderate COPD patients, 20/26 (76.9%) in severe COPD patients and 11/12 (91.6%) in very severe COPD patients. The frequencies of Pulmonary artery Hypertension in mild,moderate,severe,and very severe COPD were 1/8 (12.5%), 14/34(41.1%), 18/36 (50%) and 8/12 (66%) respectively. Moderate to severe pulmonary artery hypertension was more commonly seen in COPD Grade 3 and Grade 4 patient as comparison to COPD grade 2 patients. Corpulmonale was observed in 5/12(41.7%) in very severe COPD, 4/26(15.3) in severe COPD and 1/34(2.9%) in moderate COPD patient. CONCLUSION: Prevalence of Pulmonary Artery Hypertension and Corpulmonale has a linear relationship with severity of COPD patients. Severe PAH and corpulmonale is a major complication commonly found in severe and very severe COPD patients. Echocardiography helps in early detection of cardiac changes secondary to severe and very severe COPD cases providing time for early interventions.

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Echocardiographic assessment of pulmonary hypertension: standard operating procedure

Cited by 158 publications

References 54 publications

Mean Pulmonary Artery Pressure Using Echocardiography in Chronic Thromboembolic Pulmonary Hypertension

Mean Pulmonary Artery Pressure Using Echocardiography in Chronic Thromboembolic Pulmonary Hypertension

Derivation and Validation of Formula relating Pulmonary Acceleration Time and Mean Pulmonary Artery Pressure in Indian Population

Evaluation of Right Ventricular Dysfunction and Pulmonary Artery Hypertension Secondary to Copd Severity by Electrocardiogram and Echocardiography

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