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European Journal of Echocardiography Advance Access originally published online on March 14, 2008
European Journal of Echocardiography 2008 9(4):547-554; doi:10.1093/ejechocard/jen121
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Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2008. For permissions please email: journals.permissions@oxfordjournals.org

Usefulness of right ventricular isovolumic relaxation time in predicting systolic pulmonary artery pressure

Nicolas Bréchot1,*, Laetitia Gambotti2, Stéphane Lafitte1 and Raymond Roudaut1

1 Department of Cardiology, University Hospital of Bordeaux-Pessac, Bordeaux-Pessac, France
2 Department of Public Health, University Hospital Pitié-Salpêtrière, Paris, France

Received 8 May 2007; accepted after revision 30 September 2007; online publish-ahead-of-print 14 March 2008.

* Corresponding author: U833-Collège de France 11 place Marcelin Berthelot 75005 Paris, France. Tel: +33 144271581; fax: +33 144271591. E-mail address: nicolasbrechot{at}wanadoo.fr


  Abstract

Aims: Systolic pulmonary artery pressure (sPAP) cannot always be assessed from Doppler-detected tricuspid regurgitation (TR), especially when sPAP is normal. The right ventricular isovolumic relaxation time (rIVRT) is related to sPAP, and assessment of rIVRT by tissular Doppler imaging (rIVRT') has recently been proposed as an alternative method for estimating sPAP in patients with pulmonary artery hypertension (PAH). We evaluated here its usefulness in everyday clinical practice.

Methods and results: We conducted a prospective Doppler vs. catheterization study in 26 patients. TR was undetectable in 6 patients (32%) with normal sPAP and in one patient (14%) from those with PAH. rIVRT' was recordable in all patients. We found a strong correlation between rIVRT' and sPAP (r = 0.87; P < 0.0001). rIVRT' had a high sensitivity in detecting PAH, and a rIVRT' of 40 ms or less excluded PAH with a negative predictive value of 100%. We also found that a prolonged rIVRT' is not specific to PAH and that the rIVRT'-evaluated sPAP did not agree well with the catheter-evaluated value.

Conclusion: Measurement of rIVRT' can help estimate sPAP in the absence of TR: A normal rIVRT' excludes PAH with a high negative predictive value. A prolonged rIVRT' is in favour of an elevated sPAP but cannot affirm it by itself.

Keywords: Doppler echocardiography; Right ventricular isovolumic relaxation time; Pulmonary artery pressure; Doppler tissular imaging; Cardiac catheterization; Prospective studies


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