Overestimation by echocardiography of the peak systolic pressure gradient between the right ventricle and right atrium due to tricuspid regurgitation and the usefulness of the early diastolic transpulmonary valve pressure gradient for estimating pulmonary artery pressure
We investigated the influence of tricuspid regurgitation (TR) severity on the echocardiographic peak systolic transtricuspid pressure gradient (TRPG) and evaluated the usefulness of the peak early diastolic transpulmonary valve pressure gradient (PRPG) for estimating pulmonary artery (PA) pressure....
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| Veröffentlicht in: | Heart and vessels 2017-07, Vol.32 (7), p.833-842 |
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| creator | Hioka, Takuma Kaga, Sanae Mikami, Taisei Okada, Kazunori Murayama, Michito Masauzi, Nobuo Nakabachi, Masahiro Nishino, Hisao Yokoyama, Shinobu Nishida, Mutsumi Iwano, Hiroyuki Sakakibara, Mamoru Yamada, Satoshi Tsutsui, Hiroyuki |
| description | We investigated the influence of tricuspid regurgitation (TR) severity on the echocardiographic peak systolic transtricuspid pressure gradient (TRPG) and evaluated the usefulness of the peak early diastolic transpulmonary valve pressure gradient (PRPG) for estimating pulmonary artery (PA) pressure. In 55 consecutive right heart-catheterized patients, we measured the peak systolic right ventricular (RV)–right atrial (RA) pressure gradient (RV-RA
CATH
), peak early diastolic PA-RV pressure gradient (PA-RV
CATH
), and mean PA pressure (MPAP
CATH
). Using echocardiography, we obtained the TRPG, PRPG, and an estimate of the mean PA pressure (EMPAP) as the sum of PRPG and the estimated RA pressure, and measured the vena contracta width of TR (VC
TR
). The difference between the TRPG and RV-RA
CATH
was significantly greater in the very severe TR group (VC
TR
> 11 mm) than in the mild, moderate, and severe TR groups, and significantly greater in the severe TR group (7 10 mmHg by TRPG was not seen in the mild or moderate TR groups, but was observed in the severe and very severe TR groups (22 and 83%, respectively). In the ROC analysis, EMPAP could distinguish patients with MPAP
CATH
≥ 25 mmHg with the area under the curve of 0.93, 100% sensitivity, and 87% specificity. In conclusion, TRPG frequently overestimated RV-RA
CATH
when VC
TR
was >11 mm and sometimes did when VC
TR
was >7 mm, where EMPAP using PRPG was useful for estimating PA pressure. |
| doi_str_mv | 10.1007/s00380-016-0929-4 |
| format | Article |
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CATH
), peak early diastolic PA-RV pressure gradient (PA-RV
CATH
), and mean PA pressure (MPAP
CATH
). Using echocardiography, we obtained the TRPG, PRPG, and an estimate of the mean PA pressure (EMPAP) as the sum of PRPG and the estimated RA pressure, and measured the vena contracta width of TR (VC
TR
). The difference between the TRPG and RV-RA
CATH
was significantly greater in the very severe TR group (VC
TR
> 11 mm) than in the mild, moderate, and severe TR groups, and significantly greater in the severe TR group (7 < VC
TR
≤ 11 mm) than in the mild TR group. The overestimation of the pressure gradient >10 mmHg by TRPG was not seen in the mild or moderate TR groups, but was observed in the severe and very severe TR groups (22 and 83%, respectively). In the ROC analysis, EMPAP could distinguish patients with MPAP
CATH
≥ 25 mmHg with the area under the curve of 0.93, 100% sensitivity, and 87% specificity. In conclusion, TRPG frequently overestimated RV-RA
CATH
when VC
TR
was >11 mm and sometimes did when VC
TR
was >7 mm, where EMPAP using PRPG was useful for estimating PA pressure.</description><identifier>ISSN: 0910-8327</identifier><identifier>EISSN: 1615-2573</identifier><identifier>DOI: 10.1007/s00380-016-0929-4</identifier><identifier>PMID: 27999948</identifier><language>eng</language><publisher>Tokyo: Springer Japan</publisher><subject>Aged ; Aged, 80 and over ; Atrium ; Biomedical Engineering and Bioengineering ; Blood Pressure ; Cardiac Catheterization ; Cardiac Surgery ; Cardiology ; Echocardiography ; Echocardiography, Doppler, Color ; Electrocardiography ; Estimation ; Female ; Heart ; Heart - physiopathology ; Humans ; Japan ; Linear Models ; Male ; Medicine ; Medicine & Public Health ; Middle Aged ; Original Article ; Patients ; Pulmonary arteries ; Pulmonary artery ; Pulmonary Artery - physiopathology ; Pulmonary Valve Insufficiency - diagnostic imaging ; Regurgitation ; ROC Curve ; Systole ; Systolic pressure ; Tricuspid Valve Insufficiency - diagnostic imaging ; Ultrasonic imaging ; Vascular Surgery ; Ventricle</subject><ispartof>Heart and vessels, 2017-07, Vol.32 (7), p.833-842</ispartof><rights>Springer Japan 2016</rights><rights>Heart and Vessels is a copyright of Springer, 2017.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c549t-6d73dc2968d970c64cd5b1c9c421d5cbbd54228b54930a29221135c52029fdb13</citedby><cites>FETCH-LOGICAL-c549t-6d73dc2968d970c64cd5b1c9c421d5cbbd54228b54930a29221135c52029fdb13</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1007/s00380-016-0929-4$$EPDF$$P50$$Gspringer$$H</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1007/s00380-016-0929-4$$EHTML$$P50$$Gspringer$$H</linktohtml><link.rule.ids>314,776,780,27901,27902,41464,42533,51294</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/27999948$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Hioka, Takuma</creatorcontrib><creatorcontrib>Kaga, Sanae</creatorcontrib><creatorcontrib>Mikami, Taisei</creatorcontrib><creatorcontrib>Okada, Kazunori</creatorcontrib><creatorcontrib>Murayama, Michito</creatorcontrib><creatorcontrib>Masauzi, Nobuo</creatorcontrib><creatorcontrib>Nakabachi, Masahiro</creatorcontrib><creatorcontrib>Nishino, Hisao</creatorcontrib><creatorcontrib>Yokoyama, Shinobu</creatorcontrib><creatorcontrib>Nishida, Mutsumi</creatorcontrib><creatorcontrib>Iwano, Hiroyuki</creatorcontrib><creatorcontrib>Sakakibara, Mamoru</creatorcontrib><creatorcontrib>Yamada, Satoshi</creatorcontrib><creatorcontrib>Tsutsui, Hiroyuki</creatorcontrib><title>Overestimation by echocardiography of the peak systolic pressure gradient between the right ventricle and right atrium due to tricuspid regurgitation and the usefulness of the early diastolic transpulmonary valve pressure gradient for estimating pulmonary artery pressure</title><title>Heart and vessels</title><addtitle>Heart Vessels</addtitle><addtitle>Heart Vessels</addtitle><description>We investigated the influence of tricuspid regurgitation (TR) severity on the echocardiographic peak systolic transtricuspid pressure gradient (TRPG) and evaluated the usefulness of the peak early diastolic transpulmonary valve pressure gradient (PRPG) for estimating pulmonary artery (PA) pressure. In 55 consecutive right heart-catheterized patients, we measured the peak systolic right ventricular (RV)–right atrial (RA) pressure gradient (RV-RA
CATH
), peak early diastolic PA-RV pressure gradient (PA-RV
CATH
), and mean PA pressure (MPAP
CATH
). Using echocardiography, we obtained the TRPG, PRPG, and an estimate of the mean PA pressure (EMPAP) as the sum of PRPG and the estimated RA pressure, and measured the vena contracta width of TR (VC
TR
). The difference between the TRPG and RV-RA
CATH
was significantly greater in the very severe TR group (VC
TR
> 11 mm) than in the mild, moderate, and severe TR groups, and significantly greater in the severe TR group (7 < VC
TR
≤ 11 mm) than in the mild TR group. The overestimation of the pressure gradient >10 mmHg by TRPG was not seen in the mild or moderate TR groups, but was observed in the severe and very severe TR groups (22 and 83%, respectively). In the ROC analysis, EMPAP could distinguish patients with MPAP
CATH
≥ 25 mmHg with the area under the curve of 0.93, 100% sensitivity, and 87% specificity. In conclusion, TRPG frequently overestimated RV-RA
CATH
when VC
TR
was >11 mm and sometimes did when VC
TR
was >7 mm, where EMPAP using PRPG was useful for estimating PA pressure.</description><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Atrium</subject><subject>Biomedical Engineering and Bioengineering</subject><subject>Blood Pressure</subject><subject>Cardiac Catheterization</subject><subject>Cardiac Surgery</subject><subject>Cardiology</subject><subject>Echocardiography</subject><subject>Echocardiography, Doppler, Color</subject><subject>Electrocardiography</subject><subject>Estimation</subject><subject>Female</subject><subject>Heart</subject><subject>Heart - physiopathology</subject><subject>Humans</subject><subject>Japan</subject><subject>Linear Models</subject><subject>Male</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Middle Aged</subject><subject>Original Article</subject><subject>Patients</subject><subject>Pulmonary arteries</subject><subject>Pulmonary artery</subject><subject>Pulmonary Artery - physiopathology</subject><subject>Pulmonary Valve Insufficiency - diagnostic imaging</subject><subject>Regurgitation</subject><subject>ROC Curve</subject><subject>Systole</subject><subject>Systolic pressure</subject><subject>Tricuspid Valve Insufficiency - diagnostic imaging</subject><subject>Ultrasonic imaging</subject><subject>Vascular Surgery</subject><subject>Ventricle</subject><issn>0910-8327</issn><issn>1615-2573</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2017</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>8G5</sourceid><sourceid>BENPR</sourceid><sourceid>GUQSH</sourceid><sourceid>M2O</sourceid><recordid>eNp1ks1v1DAQxQMC0aUgzlyQpV64BGwnjuMjqiggVeoFzpFjT7IuWTv4Y1H-exyyCwiBL5Zmfm_mjfSK4iXBbwjG_G3AuGpxiUlTYkFFWT8sdqQhrKSMV4-KHRYEl21F-UXxNIR7jAkTRDwpLigX-dXt7sGLuyN4CNEcZDTOon5BoPZOSa-NG72c9wtyA4p7QDPIrygsIbrJKDRnVUgeUIa0ARtRD_E7gP3JejPuIzrmsjdqAiStPtVkrqQD0glQdGhtpzCb3IUx-dHEzcbKr3NSgCFNNq86uwDppwVpI08-opc2zGk6OCv9go5yOsI_zA3Oo_OZdkS_BdJHyN9Z8ax4PMgpwPPTf1l8uXn_-fpjeXv34dP1u9tSsVrEstG80oqKptWCY9XUSrOeKKFqSjRTfa9ZTWnbZ7jCkgpKCamYYhRTMeieVJfF623u7N23lJ11BxMUTJO04FLoSMsIFVzUOKNXf6H3Lnmb3XVEkJpzzBqeKbJRyrsQPAzd7PO1fukI7ta0dFtaupyWbk1LV2fNq9Pk1B9A_1Kc45EBugEht-wI_o_V_536A--S0yc</recordid><startdate>20170701</startdate><enddate>20170701</enddate><creator>Hioka, Takuma</creator><creator>Kaga, Sanae</creator><creator>Mikami, Taisei</creator><creator>Okada, Kazunori</creator><creator>Murayama, Michito</creator><creator>Masauzi, Nobuo</creator><creator>Nakabachi, Masahiro</creator><creator>Nishino, Hisao</creator><creator>Yokoyama, Shinobu</creator><creator>Nishida, Mutsumi</creator><creator>Iwano, Hiroyuki</creator><creator>Sakakibara, Mamoru</creator><creator>Yamada, Satoshi</creator><creator>Tsutsui, Hiroyuki</creator><general>Springer Japan</general><general>Springer Nature B.V</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7QO</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8FD</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>8G5</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FR3</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>GUQSH</scope><scope>K9.</scope><scope>M0S</scope><scope>M1P</scope><scope>M2O</scope><scope>MBDVC</scope><scope>P64</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>Q9U</scope><scope>7X8</scope></search><sort><creationdate>20170701</creationdate><title>Overestimation by echocardiography of the peak systolic pressure gradient between the right ventricle and right atrium due to tricuspid regurgitation and the usefulness of the early diastolic transpulmonary valve pressure gradient for estimating pulmonary artery pressure</title><author>Hioka, Takuma ; Kaga, Sanae ; Mikami, Taisei ; Okada, Kazunori ; Murayama, Michito ; Masauzi, Nobuo ; Nakabachi, Masahiro ; Nishino, Hisao ; Yokoyama, Shinobu ; Nishida, Mutsumi ; Iwano, Hiroyuki ; Sakakibara, Mamoru ; Yamada, Satoshi ; Tsutsui, Hiroyuki</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c549t-6d73dc2968d970c64cd5b1c9c421d5cbbd54228b54930a29221135c52029fdb13</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2017</creationdate><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Atrium</topic><topic>Biomedical Engineering and Bioengineering</topic><topic>Blood Pressure</topic><topic>Cardiac Catheterization</topic><topic>Cardiac Surgery</topic><topic>Cardiology</topic><topic>Echocardiography</topic><topic>Echocardiography, Doppler, Color</topic><topic>Electrocardiography</topic><topic>Estimation</topic><topic>Female</topic><topic>Heart</topic><topic>Heart - physiopathology</topic><topic>Humans</topic><topic>Japan</topic><topic>Linear Models</topic><topic>Male</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Middle Aged</topic><topic>Original Article</topic><topic>Patients</topic><topic>Pulmonary arteries</topic><topic>Pulmonary artery</topic><topic>Pulmonary Artery - physiopathology</topic><topic>Pulmonary Valve Insufficiency - diagnostic imaging</topic><topic>Regurgitation</topic><topic>ROC Curve</topic><topic>Systole</topic><topic>Systolic pressure</topic><topic>Tricuspid Valve Insufficiency - diagnostic imaging</topic><topic>Ultrasonic imaging</topic><topic>Vascular Surgery</topic><topic>Ventricle</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Hioka, Takuma</creatorcontrib><creatorcontrib>Kaga, Sanae</creatorcontrib><creatorcontrib>Mikami, Taisei</creatorcontrib><creatorcontrib>Okada, Kazunori</creatorcontrib><creatorcontrib>Murayama, Michito</creatorcontrib><creatorcontrib>Masauzi, Nobuo</creatorcontrib><creatorcontrib>Nakabachi, Masahiro</creatorcontrib><creatorcontrib>Nishino, Hisao</creatorcontrib><creatorcontrib>Yokoyama, Shinobu</creatorcontrib><creatorcontrib>Nishida, Mutsumi</creatorcontrib><creatorcontrib>Iwano, Hiroyuki</creatorcontrib><creatorcontrib>Sakakibara, Mamoru</creatorcontrib><creatorcontrib>Yamada, Satoshi</creatorcontrib><creatorcontrib>Tsutsui, Hiroyuki</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Biotechnology Research Abstracts</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>Technology Research Database</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>Research Library (Alumni Edition)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central Essentials</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central Korea</collection><collection>Engineering Research Database</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Central Student</collection><collection>Research Library Prep</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Research Library</collection><collection>Research Library (Corporate)</collection><collection>Biotechnology and BioEngineering Abstracts</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central Basic</collection><collection>MEDLINE - Academic</collection><jtitle>Heart and vessels</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Hioka, Takuma</au><au>Kaga, Sanae</au><au>Mikami, Taisei</au><au>Okada, Kazunori</au><au>Murayama, Michito</au><au>Masauzi, Nobuo</au><au>Nakabachi, Masahiro</au><au>Nishino, Hisao</au><au>Yokoyama, Shinobu</au><au>Nishida, Mutsumi</au><au>Iwano, Hiroyuki</au><au>Sakakibara, Mamoru</au><au>Yamada, Satoshi</au><au>Tsutsui, Hiroyuki</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Overestimation by echocardiography of the peak systolic pressure gradient between the right ventricle and right atrium due to tricuspid regurgitation and the usefulness of the early diastolic transpulmonary valve pressure gradient for estimating pulmonary artery pressure</atitle><jtitle>Heart and vessels</jtitle><stitle>Heart Vessels</stitle><addtitle>Heart Vessels</addtitle><date>2017-07-01</date><risdate>2017</risdate><volume>32</volume><issue>7</issue><spage>833</spage><epage>842</epage><pages>833-842</pages><issn>0910-8327</issn><eissn>1615-2573</eissn><abstract>We investigated the influence of tricuspid regurgitation (TR) severity on the echocardiographic peak systolic transtricuspid pressure gradient (TRPG) and evaluated the usefulness of the peak early diastolic transpulmonary valve pressure gradient (PRPG) for estimating pulmonary artery (PA) pressure. In 55 consecutive right heart-catheterized patients, we measured the peak systolic right ventricular (RV)–right atrial (RA) pressure gradient (RV-RA
CATH
), peak early diastolic PA-RV pressure gradient (PA-RV
CATH
), and mean PA pressure (MPAP
CATH
). Using echocardiography, we obtained the TRPG, PRPG, and an estimate of the mean PA pressure (EMPAP) as the sum of PRPG and the estimated RA pressure, and measured the vena contracta width of TR (VC
TR
). The difference between the TRPG and RV-RA
CATH
was significantly greater in the very severe TR group (VC
TR
> 11 mm) than in the mild, moderate, and severe TR groups, and significantly greater in the severe TR group (7 < VC
TR
≤ 11 mm) than in the mild TR group. The overestimation of the pressure gradient >10 mmHg by TRPG was not seen in the mild or moderate TR groups, but was observed in the severe and very severe TR groups (22 and 83%, respectively). In the ROC analysis, EMPAP could distinguish patients with MPAP
CATH
≥ 25 mmHg with the area under the curve of 0.93, 100% sensitivity, and 87% specificity. In conclusion, TRPG frequently overestimated RV-RA
CATH
when VC
TR
was >11 mm and sometimes did when VC
TR
was >7 mm, where EMPAP using PRPG was useful for estimating PA pressure.</abstract><cop>Tokyo</cop><pub>Springer Japan</pub><pmid>27999948</pmid><doi>10.1007/s00380-016-0929-4</doi><tpages>10</tpages><oa>free_for_read</oa></addata></record> |
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| ispartof | Heart and vessels, 2017-07, Vol.32 (7), p.833-842 |
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| language | eng |
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| source | MEDLINE; SpringerLink Journals - AutoHoldings |
| subjects | Aged Aged, 80 and over Atrium Biomedical Engineering and Bioengineering Blood Pressure Cardiac Catheterization Cardiac Surgery Cardiology Echocardiography Echocardiography, Doppler, Color Electrocardiography Estimation Female Heart Heart - physiopathology Humans Japan Linear Models Male Medicine Medicine & Public Health Middle Aged Original Article Patients Pulmonary arteries Pulmonary artery Pulmonary Artery - physiopathology Pulmonary Valve Insufficiency - diagnostic imaging Regurgitation ROC Curve Systole Systolic pressure Tricuspid Valve Insufficiency - diagnostic imaging Ultrasonic imaging Vascular Surgery Ventricle |
| title | Overestimation by echocardiography of the peak systolic pressure gradient between the right ventricle and right atrium due to tricuspid regurgitation and the usefulness of the early diastolic transpulmonary valve pressure gradient for estimating pulmonary artery pressure |
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