Echocardiographic estimation of pulmonary pressures

Abstract

Cardiac ultrasound plays a pivotal role in assessing pulmonary artery pressures. Estimation of right atrial pressure can be derived from the dimensions and respiratory variation of the inferior vena cava and Doppler modalities provide an accurate and comprehensive evaluation of right ventricular and pulmonary artery pressures. Peak pulmonary artery pressure can be calculated from continuous wave Doppler sampling of the tricuspid regurgitant jet, while pulsed wave Doppler sampling of the pulmonary regurgitant jet allows evaluation of mean and diastolic pulmonary artery pressures. In patients with tricuspid regurgitation that is either absent or not adequately detectable by Doppler method, Doppler right ventricular outflow tract investigation can be helpful. Recent data indicate that analysis of right ventricular function using myocardial Doppler echocardiography may also provide new insights for the non-invasive estimation of pulmonary artery pressures. In particular, right ventricular isovolumic relaxation time measured by myocardial Doppler echocardiography at the tricuspid annulus may provide an alternative method for estimating pulmonary artery pressure, especially in patients with tricuspid regurgitation not detectable or spectral Doppler not properly interpretable.

Pulmonary Artery Acceleration Time Provides an Accurate Estimate of Systolic Pulmonary Arterial Pressure during Transthoracic Echocardiography

“…[6][7][8][9][10][11][12][13][14][15][16][17][18] The most widely accepted transthoracic method for the estimation of pulmonary artery pressures relies on the measurement of TR Vmax . However, TR is frequently not sufficient to perform this measurement, as demonstrated by the fact that 25% of patients in our randomly selected clinical cohort had insufficient TR for EPSPAP determination.…”

Diagnostic accuracy of echocardiography for pulmonary hypertension: a systematic review and meta-analysis

“…The corresponding systolic continuous wave spectral Doppler can be obtained using an apical four-chamber view and/or a parasternal short axis view at the level of the tricuspid valve. Careful adjustment of the transducer position and the use of colour flow Doppler are critical in order to reduce the Doppler angle and to obtain the maximal regurgitant flow velocity 10. The sPAP is then calculated from the modified Bernoulli equation (4 v 2 ) and added to the RAP.…”

“…The modest correlation of sPAP from echocardiography versus sPAP from right heart catheterisation and the modest diagnostic accuracy of echocardiography for pulmonary hypertension in our review can be explained by several potential limitations of Doppler echocardiography for estimating pulmonary pressure. First, the alignment of the ultrasound beam to the tricuspid regurgitant jet should ideally be parallel in order to obtain the maximum velocity 10. Second, there should be no distal obstruction (ie, right ventricular outlet obstruction, pulmonic valve stenosis and supravalvular stenosis) 5.…”

The Effect of Cilostazol on Right Heart Function and Pulmonary Pressure

“…RV systolic pressure was then estimated by adding the transtricuspid pressure gradient to the right atrial pressure (RAP) . RAP was then estimated using the diameter and collapse of the inferior vena cava during spontaneous respiration, as previously described .…”