Inaccuracy of Doppler Echocardiographic Estimates of Pulmonary Artery Pressures in Patients With Pulmonary Hypertension

Rich, Jonathan D.; Shah, Sanjiv J.; Swamy, Rajiv; Kamp, Anna; Rich, Stuart

doi:10.1378/chest.10-1269

Cited by 326 publications

(260 citation statements)

References 30 publications

(30 reference statements)

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“…Although well-established, DE as a technique has a number of limitations, such as the need for correct angulation between the Doppler beam and the flow jet and dependence on the geometry of the restriction [4,6].…”

Section: Introductionmentioning

confidence: 99%

Volumetric velocity measurements in restricted geometries using spiral sampling: a phantom study

Nilsson

Revstedt

Heiberg

et al. 2014

Magn Reson Mater Phy

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Object:To evaluate the accuracy of maximum velocity measurements using volumetric phase contrast imaging with spiral readouts in a stenotic flow phantom. Materials and Methods:In a phantom model, maximum velocity, flow, pressure gradient and streamline visualizations were evaluated using volumetric phase contrast MRI with velocity encoding in one (extending on current clinical practice) and three directions (for characterization of the flow field) using spiral readouts.Results of maximum velocity and pressure drop were compared to CFD simulations (Computational Fluid Dynamics), as well as corresponding low-TE Cartesian data. Flow was compared to 2D throughplane PC upstream from the restriction. Results:Results obtained with 3D throughplane PC as well as 4D PC at shortest TE using spiral readout showed excellent agreements with the maximum velocity values obtained with CFD (<1% for both methods), while larger deviations were seen using Cartesian readouts (-2% and 13%, respectively).Peak pressure drop calculated from 3D throughplane PC and 4D PC spiral sequences was 14% and 13% overestimated compared to CFD. Conclusion:Identification of the maximum velocity location as well as accurate velocity quantification can be obtained in stenotic regions using short-TE spiral volumetric PC imaging.3

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Section: Introductionmentioning

confidence: 99%

Volumetric velocity measurements in restricted geometries using spiral sampling: a phantom study

Nilsson

Revstedt

Heiberg

et al. 2014

Magn Reson Mater Phy

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“…Unfortunately, identification of PH in SCD frequently requires invasive RHC for confirmation, and current noninvasive tests of detecting PH lack optimal sensitivity and specificity (5).…”

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confidence: 99%

A Novel Molecular Signature for Elevated Tricuspid Regurgitation Velocity in Sickle Cell Disease

Desai¹,

Zhou²,

Ahmad

et al. 2012

Am J Respir Crit Care Med

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Rationale: An increased tricuspid regurgitation jet velocity (TRV . 2.5 m/s) and pulmonary hypertension defined by right heart catheterization both independently confer increased mortality in sickle cell disease (SCD). Objectives: We explored the usefulness of peripheral blood mononuclear cell-derived gene signatures as biomarkers for an elevated TRV in SCD. Methods: Twenty-seven patients with SCD underwent echocardiography and peripheral blood mononuclear cell isolation for expression profiling and 112 patients with SCD were genotyped for single-nucleotide polymorphisms. Measurements and Main Results: Genome-wide gene and miRNA expression profiles were correlated against TRV, yielding 631 transcripts and 12 miRNAs. Support vector machine analysis identified a 10-gene signature including GALNT13 (encoding polypeptide N-acetylgalactosaminyltransferase 13) that discriminates patients with and without increased TRV with 100% accuracy. This finding was then validated in a cohort of patients with SCD without (n ¼ 10) and with pulmonary hypertension (n ¼ 10, 90% accuracy). Increased TRV-related miRNAs revealed strong in silico binding predictions of miR-301a to GALNT13 corroborated by microarray analyses demonstrating an inverse correlation between their expression. A genetic association study comparing patients with an elevated (n ¼ 49) versus normal (n ¼ 63) TRV revealed five significant single-nucleotide polymorphisms within GALNT13 (P , 0.005), four trans-acting (P , 2.1 3 10 27) and one cis-acting (P ¼ 0.6 3 10 24 ) expression quantitative trait locus upstream of the adenosine-A2B receptor gene (ADORA2B). Conclusions: These studies validate the clinical usefulness of genomic signatures as potential biomarkers and highlight ADORA2B and GALNT13 as potential candidate genes in SCD-associated elevated TRV.

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“…The MPAP can be derived from SPAP, which, in turn, is derived from the peak TR velocity provided there is no RVOTO or ventricular septal defect, using the formula [SPAP = RV systolic pressure = 4 × (TR max velocity) 2 + RAP], where RAP is right atrial pressure measured indirectly from the diameter and collapsibility of the inferior vena cava with inspiration or central venous catheter. 9 Although few studies questioned the reliability of this Doppler-based method of estimating SPAP, 17,[19][20][21][22] two recent retrospective studies involving 1,695 and 310 patients proved the significance of this formula in determining the SPAP accurately. 28,29 In the study by Syyed et al, 30 they derived a formula for measuring MPAP from SPAP as MPAP = 0.65 (SPAP) + 0.55 mm Hg.…”

Section: Discussionmentioning

confidence: 99%

“…pressure has been questioned. [17][18][19][20][21][22] In Doppler the SPAP, diastolic PA pressure (DPAP), and MPAP can be measured from peak TR velocity, end-diastolic pulmonary regurgitation (PR) velocity, and PAT respectively. .…”

Section: Introductionmentioning

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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Inaccuracy of Doppler Echocardiographic Estimates of Pulmonary Artery Pressures in Patients With Pulmonary Hypertension

Cited by 326 publications

References 30 publications

Volumetric velocity measurements in restricted geometries using spiral sampling: a phantom study

Volumetric velocity measurements in restricted geometries using spiral sampling: a phantom study

A Novel Molecular Signature for Elevated Tricuspid Regurgitation Velocity in Sickle Cell Disease

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

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