Quantitative assessment of pulmonary hypertension in patients with tricuspid regurgitation using continuous wave doppler ultrasound

Abstract

Doppler ultrasound examination was performed in 69 patients with a variety of cardiopulmonary disorders who were undergoing bedside right heart catheterization. Patients were classified into two groups on the basis of hemodynamic findings. Group I consisted of 20 patients whose pulmonary artery systolic pressure was less than 35 mm Hg and Group II consisted of 49 patients whose pulmonary artery systolic pressure was 35 mm Hg or greater. Tricuspid regurgitation was detected by Doppler ultrasound in 2 of 20 Group I patients and 39 of 49 Group II patients (p less than 0.001). Twenty-six of 27 patients with pulmonary artery systolic pressure greater than 50 mm Hg had Doppler evidence of tricuspid regurgitation. In patients with tricuspid regurgitation, continuous wave Doppler ultrasound was used to measure the velocity of the regurgitant jet, and by applying the Bernoulli equation, the peak pressure gradient between the right ventricle and right atrium was calculated. There was a close correlation between the Doppler gradient and the pulmonary artery systolic pressure measured by cardiac catheterization (r = 0.97, standard error of the estimate = 4.9 mm Hg). Estimating the right atrial pressure clinically and adding it to the Doppler-determined right ventricular to right atrial pressure gradient was not necessary to achieve accurate results. These findings indicate that tricuspid regurgitation can be identified by Doppler ultrasound in a large proportion of patients with pulmonary hypertension, especially when the pulmonary artery pressure exceeds 50 mm Hg. Calculation of the right ventricular to right atrial pressure gradient in these patients provides an accurate noninvasive estimate of pulmonary artery systolic pressure.

On the parameters affecting the sensitivity of MR measures of pressure with microbubbles

“…From Fig. 4, it is clear that ⌬ must improve to 34 ppm for R 2 Bubb to reach 5 s Ϫ1 . Since there are no naturally occurring gases that can provide a sufficient ⌬ , novel ways of increasing the susceptibility difference between the bubble and the surrounding fluid must be derived.…”

“…It is possible to infer the pressure in the left ventricle with a sphygmomanometer. To date, there have been numerous attempts to develop a similar noninvasive means of measuring pressure in the right ventricle (RV) (2)(3)(4). Such efforts have been made with the intent of replacing widely used catheterization procedures and the associated physical discomfort and risk of infection in patients (5).…”

“…When microbubbles are added to blood, the decay of magnetization is due to dissipative relaxation mechanisms (R 2 Diss , such as dipoledipole coupling) as well as diffusion through local field variations set up by both the deoxygenated red blood cells (R 2 RBC ) (11) and bubbles (R 2 Bubb ). This means that we could expect…”

“…To effectively measure small pressure variations, R 2 Bubb should dominate the other two decay constants in Eq. [1].…”

“…[1]. Since the R 2 Diss was approximately 4 s Ϫ1 while R 2 RBC at a refocusing interval ( 180 ) of 6 ms and field strength of 1.5T for an oxygenation saturation of 70% O 2 in the pulmonary trunk was ϳ 1.2 s Ϫ1 , we could anticipate that for the bubbles to dominate the relaxation process, R 2 Bubb should be at least 5 s Ϫ1 for 180 of 6 ms. In addition, the measurement of R * 2 and R 2 could be significantly affected by cardiac motion, breathing, flow dephasing, and partial volume effects.…”