| Validation of a cutoff value on echo Doppler analysis to replace right heart catheterization during pulmonary hypertension evaluation in heart transplant candidates. | |
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MedLine Citation:
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PMID: 20304186 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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BACKGROUND: Heart transplantation (OHT) has traditionally been contraindicated in the presence of severe pulmonary hypertension (PH), as detected by right heart catheterization. Noninvasive methods are still not reliably accurate to make this evaluation. OBJECTIVES: Determine the efficacy of echo Doppler analysis for the diagnosis of severe PH. METHODS: One hundred thirty patients (mean age = 42 +/- 15 years, 82 men) showed severe left ventricular dysfunction (mean ejection fraction = 29 +/- 12%; functional class III-IV). We excluded patients with atrial fibrillation, heart failure secondary to congenital disease, and valvulopathy. The pulmonary parameters defined as severe PH were: systolic pulmonary artery pressure (sPAP) >or= 60 mm Hg; a mean transpulmonary gradient >or= 15; or pulmonary vascular resistance >or= 5 Wood units. Patients underwent a right heart catheterization using a Swan-Ganz catheter to measure hemodynamic parameters and to noninvasively estimate right-sided pressures from spectral Doppler recordings of tricuspid regurgitation velocity (right ventricular systolic pressure [RVsP]). A Pearson correlation of sPAP was obtained with RVsP by; the sensitivity of RVsP for the diagnosis of PH was determined by a receiver operating characteristic (ROC) curve. RESULTS: A good correlation between sPAP and RVsP was obtained by Pearson correlation analysis (r = 0.64; 95% confidence interval [CI] 0.50-0.75; P < .001). The ROC curve analysis showed a sensitivity of 100%, a specificity of 37.2%, (95% CI 0.69-0.83, P < .0001) of a RVsP < 45 mm Hg (cutoff) on the exclusion of severe PH. CONCLUSIONS: The cutoff of RVsP < 45 mm Hg, on noninvasive echo Doppler evaluation of PH is an efficient method to replace invasive heart catheterization in OHT candidates. |
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Authors:
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F Bacal; A F de Freitas; L F Moreira; A I Fiorelli; S Mangini; A Abuhab; J de Lima Oliveira; R H B Santos; N A G Stolf; E A Bocchi |
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Publication Detail:
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Type: Journal Article |
Journal Detail:
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Title: Transplantation proceedings Volume: 42 ISSN: 1873-2623 ISO Abbreviation: Transplant. Proc. Publication Date: 2010 Mar |
Date Detail:
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Created Date: 2010-03-22 Completed Date: 2010-08-19 Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 0243532 Medline TA: Transplant Proc Country: United States |
Other Details:
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Languages: eng Pagination: 535-8 Citation Subset: IM |
Copyright Information:
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Copyright (c) 2010 Elsevier Inc. All rights reserved. |
Affiliation:
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Cardiology Department, Heart Failure Unit, Heart Institute (InCor), University of São Paulo Medical School, São Paulo, Brazil. fbacal@uol.com.br |
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| MeSH Terms | |
Descriptor/Qualifier:
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Adolescent Adult Aged Blood Pressure Child Echocardiography / methods Endosonography / methods* Female Heart Catheterization Heart Transplantation / contraindications, physiology* Heart Ventricles / physiopathology Hemodynamics Humans Hypertension, Pulmonary / ultrasonography* Male Middle Aged Reproducibility of Results Stroke Volume / physiology* Systole Tricuspid Valve Insufficiency / ultrasonography Vascular Resistance |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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