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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

View larger version (130K): [in a new window]   Figure 1 Images showing peak tricuspid regurgitant velocity (TRV) and right ventricular outflow time-velocity integral (TVIRVOT) in a patient with normal pulmonary vascular resistance (PVR). (A) TRV is 2.86 m/s. (B) TVIRVOT is 20.8 cm. The ratio of TRV/TVIRVOT = 2.86/20.8 = 0.1375. . This patient’s invasive PVR measurement was within 0.4 WU of the echocardiographic value (PVRCATH = 1.3 WU). PVRECHO = PVR in WU calculated based on the linear regression equation in which a value for PVR in WU was modeled based on TRV/TVIRVOT. PVRCATH = invasive PVR.

View larger version (121K): [in a new window]   Figure 2 Images showing TRV and TVIRVOT in a patient with elevated PVR. (A) TRV is 3.64 m/s. (B) TVIRVOT shows a clear deceleration of pulmonary flow before the pulmonic valve closure click and is calculated at 6.5 cm. The ratio of TRV/TVIRVOT = 3.64/6.5 = 0.56. . This patient’s invasive PVR measurement is also within 0.4 WU of the echocardiographic value (PVRCATH = 6.0 WU). Abbreviations as in Figure 1.

View larger version (27K): [in a new window]   Figure 3 Linear regression analysis between PVRCATH and TRV/TVIRVOT. The circle highlights the PVR cutoff value of 2 WU (r = 0.929, 95% confidence interval 0.87 to 0.96). Abbreviations as in Figure 1.

View larger version (17K): [in a new window]   Figure 4 Linear regression analysis between PVRCATH and TRV/TVIRVOT. The correlation remained robust among all groups of patients. Patients with normal left atrial pressure (LAP) and right atrial pressure (RAP) (open squares), elevated LAP and RAP (solid squares), elevated LAP and normal RAP (solid triangles), and elevated RAP and normal LAP (open triangles) were evenly distributed among the study population. Abbreviations as in Figure 1.

View larger version (17K): [in a new window]   Figure 5 Bland-Altman analysis showing the limits of agreement between PVRECHO and PVRCATH. Abbreviations as in Figure 1.

View larger version (11K): [in a new window]   Figure 6 Receiver-operating characteristics curve. A TRV/TVIRVOT cutoff value of 0.175 provided the best-balanced sensitivity (77%) and specificity (81%) to determine patients with a PVR value >2 WU. (Area under the curve = 0.916.) Abbreviations as in Figure 1.