Noninvasive Assessment of Pulmonary Vascular Resistance Using Doppler Tissue Imaging of the Tricuspid Annulus

Gurudevan, Swaminatha V.; Malouf, Philip J.; Kahn, Andrew M.; Auger, William R.; Waltman, Thomas J.; Madani, Michael; DeMaria, Anthony N.; Blanchard, Daniel G.

doi:10.1016/j.echo.2007.02.004

« Previous Next »Journal of the American Society of Echocardiography
Volume 20, Issue 10 , Pages 1167-1171, October 2007

Noninvasive Assessment of Pulmonary Vascular Resistance Using Doppler Tissue Imaging of the Tricuspid Annulus

Swaminatha V. Gurudevan, MD
- Division of Cardiology, University of California Irvine School of Medicine, Irvine, California
Philip J. Malouf, MD
- Division of Cardiology, University of California San Diego Medical Center and School of Medicine, San Diego, California
Andrew M. Kahn, MD, PhD
- Division of Cardiology, University of California San Diego Medical Center and School of Medicine, San Diego, California
William R. Auger, MD
- Division of Cardiology, University of California San Diego Medical Center and School of Medicine, San Diego, California
Thomas J. Waltman, MD, FACC
- Division of Cardiothoracic Surgery, University of California San Diego Medical Center and School of Medicine, San Diego, California.
Michael Madani, MD
- Division of Pulmonary Medicine, University of California San Diego Medical Center and School of Medicine, San Diego, California
Anthony N. DeMaria, MD, MACC
- Division of Cardiology, University of California San Diego Medical Center and School of Medicine, San Diego, California
Daniel G. Blanchard, MD, FACC
- Division of Cardiology, University of California San Diego Medical Center and School of Medicine, San Diego, California
- Reprint requests: Daniel G. Blanchard, MD, FACC, Division of Cardiology, University of California San Diego, 9350 Campus Point Dr, 1D, La Jolla, CA 92037.

published online 14 June 2007.

Background

Pulmonary artery pressure (PAP) and pulmonary vascular resistance (PVR) are important hemodynamic parameters in patients with advanced cardiopulmonary disease. We undertook this study to determine whether Doppler tissue imaging of the tricuspid annulus could be used to assess PAP and PVR noninvasively.

Methods

We studied 50 consecutive patients with suspected chronic thromboembolic pulmonary hypertension referred to our center for evaluation. We performed preoperative transthoracic echocardiography with Doppler tissue imaging of the tricuspid annulus. All patients then underwent cardiac catheterization with invasive determination of cardiac output, PAP, and PVR.

Results

The systolic velocity of the tricuspid annulus (tS_m) had an inverse relationship with catheterization-derived mean PAP, with a correlation coefficient of −0.493 (P = .0003). The inverse correlation of tS_m with catheterization-derived PVR was more striking, with a correlation coefficient of −0.710 (P < .0001). Based on the data, we derived the following logarithmic regression equation: PVR = 3698 − 1227 × ln(tS_m).

Conclusions

Doppler tissue imaging of the lateral tricuspid annulus is a useful clinical tool that can provide a noninvasive estimate of PVR in patients with chronic thromboembolic pulmonary hypertension. In this population, decreasing values of tS_m predicted progressively higher measurements of PVR.