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European Journal of Echocardiography 2007 8(2):128-136; doi:10.1016/j.euje.2006.02.005
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Copyright © 2006, The European Society of Cardiology

The use of the right ventricular diameter and tricuspid annular tissue Doppler velocity parameter to predict the presence of pulmonary hypertension

Anthony S. McLean*, Iris Ting, Stephen J. Huang and Sarah Wesley

Cardiovascular Ultrasound Laboratory, Department of Intensive Care Medicine, Nepean Hospital, University of Sydney, Great Western Highway, Penrith, NSW 2750, Australia

Received 19 September 2005; received in revised form 20 February 2006; accepted after revision 28 February 2006.

* Corresponding author. Tel.: +61 2 47342490; fax: +61 2 47343134. mcleana{at}med.usyd.edu.au


  Abstract

Aims Detecting the presence of pulmonary hypertension (PH) is important especially with unexplained dyspnoea and suspected thromboembolism. Although PH can be detected invasively by right ventricular (RV) catheterisation, accurate non-invasive assessment by echocardiography has many advantages. This however relies on the presence of tricuspid regurgitation (TR). We examined if the presence of PH can be predicted echocardiographically without relying on TR.

Methods and results Seventy-six consecutive patients with TR were recruited, and another 32 were used for prediction study. RV end-diastolic diameter (RVD) was measured in the apical view and tissue Doppler imaging (TDI) parameters were obtained from the lateral tricuspid annulus motion. Pulmonary artery systolic pressures (PASP) were estimated from TR. The RVD, and the TDI duration from start of isovolumic contraction to peak systole, Tpeak, correlated with PASP. However, the RVD/Tpeak ratio offered the best correlation and, at a cutoff of 22cm/s, predicted the presence of PH with 80% sensitivity and 83% specificity. The same results were obtained even if the study was confined to patients with or without RV dysfunction. The ratio displayed a good correlation with catheter-derived PASP in nine separate patients.

Conclusion While RVD and Tpeak can adequately detect the presence of PH, RVD/Tpeak acted as the best predictor for PH. The results apply regardless of the presence or absence of RV dysfunction.

Keywords: Echocardiography; Pulmonary hypertension; Pulmonary artery systolic pressure; Tissue Doppler; Right ventricular diameter


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