Document Detail


Echocardiography can identify patients with increased pulmonary vascular resistance by assessing pressure reflection in the pulmonary circulation.
MedLine Citation:
PMID:  20448141     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Pulmonary hypertension is a frequent finding in patients with cardiopulmonary disorders. It is important to recognize pulmonary hypertension due to increased pulmonary vascular resistance (PVR), as this affects treatment and prognosis. Patients with increased PVR have an increased pulmonary pressure reflection. We hypothesized that pressure reflection can be described by echocardiography and that variables related to pressure reflection can identify patients with increased PVR.
METHODS AND RESULTS: The study comprised 98 patients investigated within 24 hours of right heart catheterization and 20 control subjects. The pressure reflection variables were obtained by pulsed Doppler in the pulmonary artery and continuous Doppler of tricuspid regurgitation. We selected 3 variables related to pressure reflection: the interval from valve opening to peak velocity in the pulmonary artery (AcT, ms), the interval between pulmonary artery peak velocity and peak tricuspid velocity (tPV-PP, ms), and the right ventricular pressure increase after peak velocity in the pulmonary artery (augmented pressure, AP, mm Hg). The correlation between simultaneous catheter- and echocardiography-determined AP was strong (n=19, R=0.83). The AcT, tPV-PP, and AP in patients with a PVR of >3 Woods units (n=71) was (mean+/-SD) 77+/-16 ms, 119+/-36 ms, and 22+/-12 mm Hg, respectively, and differed from patients with a PVR of </=3 Woods units (n=27, P<0.0001), 111+/-32 ms, 39+/-54 ms, and 3+/-4 mm Hg, and from controls, 153+/-32 ms, -19+/-45 ms, and 0 mm Hg, respectively (P<0.0001). The AcT, tPV-PP, and AP values were not correlated with capillary wedge pressure (R=0.08-0.16). The areas under the receiver operator characteristic curve (95%CI) for AcT, tPV-PP, and AP were 0.87 (0.82 to 0.95), 0.94 (0.89 to 0.99), and 0.98 (0.95 to 1.0), respectively.
CONCLUSIONS: In this study, we describe a novel echocardiography method for assessing pressure reflection in the pulmonary circulation. This method can be used to identify patients with pulmonary hypertension due to increased PVR.
Authors:
Odd Bech-Hanssen; Fredrik Lindgren; Nedim Selimovic; Bengt Rundqvist
Publication Detail:
Type:  Journal Article     Date:  2010-05-06
Journal Detail:
Title:  Circulation. Cardiovascular imaging     Volume:  3     ISSN:  1942-0080     ISO Abbreviation:  Circ Cardiovasc Imaging     Publication Date:  2010 Jul 
Date Detail:
Created Date:  2010-07-21     Completed Date:  2010-08-12     Revised Date:  2011-09-06    
Medline Journal Info:
Nlm Unique ID:  101479935     Medline TA:  Circ Cardiovasc Imaging     Country:  United States    
Other Details:
Languages:  eng     Pagination:  424-32     Citation Subset:  IM    
Affiliation:
Departments of Cardiology and Clinical Physiology, Sahlgrenska University Hospital, Göteborg, Sweden. odd.bech-hanssen@klinfys.gu.se
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MeSH Terms
Descriptor/Qualifier:
Adult
Aged
Analysis of Variance
Case-Control Studies
Echocardiography, Doppler / methods*
Female
Hemodynamics
Humans
Hypertension, Pulmonary / physiopathology,  ultrasonography*
Male
Middle Aged
ROC Curve
Statistics, Nonparametric
Tricuspid Valve Insufficiency / physiopathology,  ultrasonography
Vascular Resistance

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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