Estimation of the Systolic Pulmonary Arterial Pressure Using Contrast-Enhanced Continuous-Wave Doppler in Patients with Trivial Tricuspid Regurgitation.

Abstract

Noninvasive estimation of pulmonary arterial pressure is important for hemodynamic monitoring of patients with heart disease. In patients with tricuspid regurgitation (TR), the peak velocity of TR on continuous-wave (CW) Doppler can be used to estimate the systolic pulmonary arterial pressure (PAPs) using the simplified Bernoulli equation. We evaluated a new technique of contrast-enhanced CW Doppler for calculating PAPs in patients with trivial TR. Forty-one patients without visible TR detected by color Doppler, pulsed Doppler or CW Doppler were evaluated. Age ranged from 19 to 73 (55 +/- 12) years old. Tricuspid flow signals were recorded on CW Doppler after intravenous administration of indocyanin green (ICG) or Albunex. PAPs was calculated as; PAPs = 4 x VTR2 + 10 mmHg, where VTR is the peak velocity of TR. PAPs calculated using contrast-enhanced CW Doppler was compared with PAPs measured by the following cardiac catheterization. 1) TR signals were recorded using the contrast-enhanced CW Doppler technique in 39 of 41 patients (95%) after intravenous administration of contrast agents. 2) The error of estimate of PAPs using the contrast-enhanced CW Doppler technique was -2.4 +/- 7.5 mmHg, and the percent error was -10.7 +/- 32.4% in all patients. In 20 of 39 patients (51%), the error of estimate was within +/- 5 mmHg. 3) PAPs was overestimated by 12.2 +/- 6.1 mmHg in patients with good contrast enhancement of TR signals. The contrast-enhanced CW Doppler technique is useful for estimating PAPs noninvasively in patients with trivial TR. It is better to assume the right atrial pressure as 3-5 mmHg, not 10 mmHg, in patients with good enhancement of trivial TR. Physiological TR may be enhanced by contrast agents in these patients.

O papel dos exames de imagem na avaliação da circulação pulmonar

“…Materials such as 5% glucose microbubbles, sonicated human albumin, and indocyanine green increase echo intensity without affecting V TR . One group of authors (12) observed that, in a small patient sample (comprising 39 patients, most of whom had left heart disease), the estimation of PASP with the use of contrast resulted lower than the estimation of PASP with the use of right heart catheterization, the standard error for the latter being ± 5 mmHg in 51% of the patients and ± 10 mmHg in 82%.…”

The usefulness of contrast during exercise echocardiography for the assessment of systolic pulmonary pressure

“…Therefore, utilization of air-blood-saline contrast has been implemented for the improvement of Doppler signal in several clinical contexts. It is now recommended in the evaluation of patients with pulmonary hypertension [ 6 - 8 ].…”

Echocardiographic Estimation of Systemic Systolic Blood Pressure in Dogs with Mild Mitral Regurgitation

“…This technique allows accurate estimation of systolic pulmonary arterial pressure in human beings with tricuspid regurgitation, as well as pressure estimation in human patients with AS and mitral stenosis. [21][22][23][24][25][26][27][28][29][30] Doppler echocardiography accurately estimates left atrial pressure (LAP) in people with congestive heart failure and MR when brachial artery systolic blood pressure is used as an estimate of sLVP. [31][32][33] Similarly, if one assumes a normal systolic LAP (sLAP) in a dog with MR, the peak mitral regurgitant jet velocity obtained by Doppler echocardiography can be used to calculate peak sLVP.…”