Noninvasive estimation of both systolic and diastolic pulmonary artery pressure from Doppler analysis of tricuspid regurgitant velocity spectrum in patients with chronic heart failure

Lanzarini, Luca; Fontana, Alessandra; Lucca, Elena; Campana, Carlo; Klersy, Catherine

doi:10.1067/mhj.2002.126350

Cited by 96 publications

(66 citation statements)

References 19 publications

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“…Measurement of TR at the opening of the pulmonary valve is used for estimating pulmonary artery diastolic pressure (PADP). (15) It is also possible to estimate pulmonary vascular resistance, which correlates with invasive hemodynamic measurement. (16) Atrial contraction and the subsequent increase in intracavitary pressure result in the formation of a characteristic wave, known as the A-wave.…”

Section: Echocardiographymentioning

confidence: 99%

O papel dos exames de imagem na avaliação da circulação pulmonar

et al. 2011

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O conhecimento sobre a estrutura e a função da circulação pulmonar evoluiu sensivelmente nas últimas décadas. A utilização de exames de imagem não invasivos para a avaliação da anatomia e da função dos vasos pulmonares e do coração ganhou ainda mais importância com o advento de tratamentos até então indisponíveis. Além do auxílio para o diagnóstico, as informações obtidas têm se mostrado fundamentais para o estabelecimento de prognósticos e como parâmetro de sucesso dos tratamentos. A presente revisão discute os diversos métodos que podem ser utilizados para a avaliação da circulação pulmonar por imagens existentes nos dias de hoje, desde técnicas amplamente disponíveis e de relativa baixa complexidade técnica, como a radiografia de tórax, até métodos complexos e promissores, como a tomografia de impedância elétrica

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Section: Echocardiographymentioning

confidence: 99%

O papel dos exames de imagem na avaliação da circulação pulmonar

et al. 2011

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“…11 We used continuous-wave Doppler sampling of the peak tricuspid-valve regurgitant jet velocity (TRV) to calculate the pulmonary arterial systolic pressure (sPAP), as described previously. [12][13][14] The echocardiographic acquisitions in transfusion-dependent patients were performed in the early posttransfusional period. Accordingly, patients were divided into 3 groups according to the European Society of Cardiology guidelines for the diagnosis of pulmonary hypertension (PH), with minor modification owing to the chronic anemia associated with β-thalassemia that may lead to overestimation of values 7 : Group A, sPAP ≤36 mm Hg or TRV ≤3.0 m/s (PH unlikely); Group B, sPAP ≥40 mm Hg or TRV ≥3.2 m/s (PH likely); and Group C, sPAP >36 and <40 mm Hg or TRV >3.0 and <3.2 m/s (PH possible).…”

Section: Study Design and Measurementsmentioning

confidence: 99%

Prevalence and Risk Factors for Pulmonary Arterial Hypertension in a Large Group of β-Thalassemia Patients Using Right Heart Catheterization

et al. 2014

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Distinction of the various forms of β-thalassemia relies on clinical grounds. Patients with β-thalassemia major present to medical attention in early childhood with severe anemia requiring life-long transfusion and iron chelation therapy for survival.2 Conversely, patients with β-thalassemia intermedia present later in childhood with milder anemia and remain largely transfusion-independent.3 Such variation in phenotype has been attributed to several environmental and genetic factors that alter the α/β-chain imbalance and subsequent ineffective erythropoiesis and peripheral hemolysis, the hallmarks of disease process in β-thalassemia. 4 Clinical Perspective on p 345Among the sequelae associated with a diagnosis of β-thalassemia, pulmonary arterial hypertension (PAH) has received great attention in recent years.5 PrevalenceBackground-Pulmonary arterial hypertension (PAH) remains a concern in patients with β-thalassemia major (TM) and intermedia (TI); however, studies evaluating its prevalence and risk factors using systematic confirmation on right heart catheterization are lacking. Methods and Results-This was a multicenter cross-sectional study of 1309 Italian β-thalassemia patients (mean age 36.4±9.3 years; 46% men; 74.6% TM, 25.4% TI). Patients with a tricuspid-valve regurgitant jet velocity ≥3.2 m/s (3.6%) on transthoracic echocardiography further underwent right heart catheterization to confirm the diagnosis of PAH (mean pulmonary arterial pressure ≥25 mm Hg and pulmonary capillary wedge pressure ≤15mm Hg). The confirmed PAH prevalence on right heart catheterization was 2.1% (95% confidence interval [CI], 1.4-3.0) and was higher in TI (4.8%; 95% CI, 3.0-7.7) than TM (1.1%; 95% CI, 0.6-2.0). The positive predictive value for the tricuspid-valve regurgitant jet velocity ≥3.2 m/s threshold for the diagnosis of pulmonary hypertension was 93.9%. Considerable functional limitation and decrease in the 6-minute walk distance were noted in patients with confirmed PAH. On multivariate logistic regression analysis, independent risk factors for confirmed PAH were age (odds ratio, 1.102 per 1-year increase; 95% CI, 1.06-1.15) and splenectomy (odds ratio, 9.31; 95% CI, 2.57-33.7). Conclusions-The prevalence of PAH in β-thalassemia patients as confirmed on right heart catheterization was 2.1%, with an ≈5-fold higher prevalence in TI than TM. Advanced age and splenectomy are risk factors for PAH in this patient population. Clinical Trial Registration-URL: http://www.ClinicalTrials.gov. Unique identifier: NCT01496963.(Circulation. 2014;129:338-345.)

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“…These noninvasive estimates of PAP have been demonstrated to be strongly correlated with invasively measured PAP values in humans. [6][7][8][9] However, noninvasive assessment of PAP by the Doppler method has several limitations. Firstly, the threshold defining Doppler-derived evidence of PAH is not clearly identified in the dog.…”

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confidence: 99%

Diagnostic Value of Echo-Doppler and Tissue Doppler Imaging in Dogs with Pulmonary Arterial Hypertension

Serres¹,

Chetboul²,

Gouni³

et al. 2007

J Vet Int Med

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Background: Diagnosis of pulmonary arterial hypertension (PAH) relies on Doppler measurement of pulmonic and tricuspid regurgitation (TR). However, these are not always detectable.Hypothesis: Tissue Doppler imaging (TDI), a novel noninvasive ultrasound technique, provides indirect but sensitive and specific assessment of elevated systolic pulmonary artery pressure (SPAP) in dogs.Animals: One hundred and five dogs with TR. Methods: Prospective observational study. Dogs were categorized as presenting normal (group 1, n 5 45), mildly increased (group 2, n 5 19), or moderately to severely increased (group 3, n 5 41) SPAP, based on TR peak velocities (,2.5, 2.5-3.0, and .3.0 m/s, respectively). Ten quantitative echo-Doppler-and TDI-derived variables were assessed, including the main pulmonary arterial diameter to aortic diameter ratio, pulmonary flow acceleration time, and acceleration-to-ejection time ratio, the Tei index of right ventricular function, and 6 longitudinal basal right ventricular TDI variables.Results: A significant correlation was observed between SPAP and each of the 10 tested variables (P , .05). Conventional echo-Doppler variables were less discriminating than the TDI for predicting increased SPAP. The combined systolic and diastolic right TDI index had the highest sensitivity and specificity (89% and 93% respectively, for a cutoff of 11.8 cm/s) and could discriminate between dogs in group 1 from dogs in group 2.Conclusions and Clinical Importance: TDI provided effective predictors of systolic PAH and demonstrated that both alterations in right-sided systolic and diastolic myocardial function can occur with mild increases in SPAP.

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Noninvasive estimation of both systolic and diastolic pulmonary artery pressure from Doppler analysis of tricuspid regurgitant velocity spectrum in patients with chronic heart failure

Cited by 96 publications

References 19 publications

O papel dos exames de imagem na avaliação da circulação pulmonar

O papel dos exames de imagem na avaliação da circulação pulmonar

Prevalence and Risk Factors for Pulmonary Arterial Hypertension in a Large Group of β-Thalassemia Patients Using Right Heart Catheterization

Diagnostic Value of Echo-Doppler and Tissue Doppler Imaging in Dogs with Pulmonary Arterial Hypertension

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