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CLINICAL STUDY: PULMONARY HYPERTENSION

A simple method for noninvasive estimation of pulmonary vascular resistance

Amr E. Abbas, MD^*, F. David Fortuin, MD^*, Nelson B. Schiller, MD, FACC, Christopher P. Appleton, MD, FACC^*, Carlos A. Moreno, BS^* and Steven J. Lester, MD, FACC^*,*

^* Division of Cardiovascular Diseases, Mayo Clinic, Scottsdale, Arizona, USA
Division of Cardiology, University of California, San Francisco, California, USA

Manuscript received June 20, 2002; revised manuscript received October 15, 2002, accepted November 11, 2002.

^* Reprint requests and correspondence: Dr. Steven J. Lester, Division of Cardiovascular Diseases, Mayo Clinic, 13400 East Shea Boulevard, Scottsdale, Arizona 85259, USA.
lester.steven{at}mayo.edu

OBJECTIVES: We sought to test whether the ratio of peak tricuspid regurgitant velocity (TRV, ms) to the right ventricular outflow tract time-velocity integral (TVI_RVOT, cm) obtained by Doppler echocardiography (TRV/TVI_RVOT) provides a clinically reliable method to determine pulmonary vascular resistance (PVR).

BACKGROUND: Pulmonary vascular resistance is an important hemodynamic variable used in the management of patients with cardiovascular and pulmonary disease. Right-heart catheterization, with its associated disadvantages, is required to determine PVR. However, a reliable noninvasive method is unavailable.

METHODS: Simultaneous Doppler echocardiographic examination and right-heart catheterization were performed in 44 patients. The ratio of TRV/TVI_RVOT was then correlated with invasive PVR measurements using regression analysis. An equation was modeled to calculate PVR in Wood units (WU) using echocardiography, and the results were compared with invasive PVR measurements using the Bland-Altman analysis. Using receiver-operating characteristics curve analysis, a cutoff value for the Doppler equation was generated to determine PVR >2WU.

RESULTS: As calculated by Doppler echocardiography, TRV/TVI_RVOT correlated well (r = 0.929, 95% confidence interval 0.87 to 0.96) with invasive PVR measurements. The Bland-Altman analysis between PVR obtained invasively and that by echocardiography, using the equation: , showed satisfactory limits of agreement (mean 0 ± 0.41). A TRV/TVI_RVOT cutoff value of 0.175 had a sensitivity of 77% and a specificity of 81% to determine PVR >2WU.

CONCLUSIONS: Doppler echocardiography may provide a reliable, noninvasive method to determine PVR.

Abbreviations and Acronyms   CI   confidence interval   ICC   intraclass correlation coefficient   MPAP   mean pulmonary artery pressure   PASP   pulmonary artery systolic pressure   PCWP   pulmonary capillary wedge pressure   PVR   pulmonary vascular resistance   PVRCATH   invasive pulmonary vascular resistance   PVRECHO   pulmonary vascular resistance calculated by echocardiography   Qp   transpulmonary flow   p   transpulmonary pressure gradient   RAP   right atrial pressure   TRV   peak tricuspid regurgitant velocity   TVIRVOT   right ventricular outflow tract time-velocity integral   WU   Wood units

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