A Novel Non-Invasive Method of Estimating Pulmonary Vascular Resistance in Patients With Pulmonary Arterial Hypertension
Background The assessment of pulmonary vascular resistance (PVR) plays an important role in the diagnosis and management of pulmonary arterial hypertension (PAH). The main objective of this study was to determine whether the noninvasive index of systolic pulmonary arterial pressure (SPAP) to heart r...
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| Veröffentlicht in: | Journal of the American Society of Echocardiography 2009-05, Vol.22 (5), p.523-529 |
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| creator | Haddad, François, MD Zamanian, Roham, MD Beraud, Anne-Sophie, MD Schnittger, Ingela, MD Feinstein, Jeffrey, MD, MPH Peterson, Tyler, MD Yang, Phil, MD Doyle, Ramona, MD Rosenthal, David, MD |
| description | Background The assessment of pulmonary vascular resistance (PVR) plays an important role in the diagnosis and management of pulmonary arterial hypertension (PAH). The main objective of this study was to determine whether the noninvasive index of systolic pulmonary arterial pressure (SPAP) to heart rate (HR) times the right ventricular outflow tract time-velocity integral (TVIRVOT ) (SPAP/[HR × TVIRVOT ]) provides clinically useful estimations of PVR in PAH. Methods Doppler echocardiography and right-heart catheterization were performed in 51 consecutive patients with established PAH. The ratio of SPAP/(HR × TVIRVOT ) was then correlated with invasive indexed PVR (PVRI) using regression and Bland-Altman analysis. Using receiver operating characteristic curve analysis, a cutoff value for the Doppler equation was generated to identify patients with PVRI ≥ 15 Wood units (WU)/m2. Results The mean pulmonary arterial pressure was 52 ± 15 mm Hg, the mean cardiac index was 2.2 ± 0.6 L/min/m2 , and the mean PVRI was 20.5 ± 9.6 WU/m2 . The ratio of SPAP/(HR × TVIRVOT ) correlated very well with invasive PVRI measurements ( r = 0.860; 95% confidence interval, 0.759-0.920). A cutoff value of 0.076 provided well-balanced sensitivity (86%) and specificity (82%) to determine PVRI > 15 WU/m2 . A cutoff value of 0.057 increased sensitivity to 97% and decreased specificity to 65%. Conclusion The novel index of SPAP/(HR × TVIRVOT ) provides useful estimations of PVRI in patients with PAH. |
| doi_str_mv | 10.1016/j.echo.2009.01.021 |
| format | Article |
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The main objective of this study was to determine whether the noninvasive index of systolic pulmonary arterial pressure (SPAP) to heart rate (HR) times the right ventricular outflow tract time-velocity integral (TVIRVOT ) (SPAP/[HR × TVIRVOT ]) provides clinically useful estimations of PVR in PAH. Methods Doppler echocardiography and right-heart catheterization were performed in 51 consecutive patients with established PAH. The ratio of SPAP/(HR × TVIRVOT ) was then correlated with invasive indexed PVR (PVRI) using regression and Bland-Altman analysis. Using receiver operating characteristic curve analysis, a cutoff value for the Doppler equation was generated to identify patients with PVRI ≥ 15 Wood units (WU)/m2. Results The mean pulmonary arterial pressure was 52 ± 15 mm Hg, the mean cardiac index was 2.2 ± 0.6 L/min/m2 , and the mean PVRI was 20.5 ± 9.6 WU/m2 . The ratio of SPAP/(HR × TVIRVOT ) correlated very well with invasive PVRI measurements ( r = 0.860; 95% confidence interval, 0.759-0.920). A cutoff value of 0.076 provided well-balanced sensitivity (86%) and specificity (82%) to determine PVRI > 15 WU/m2 . A cutoff value of 0.057 increased sensitivity to 97% and decreased specificity to 65%. Conclusion The novel index of SPAP/(HR × TVIRVOT ) provides useful estimations of PVRI in patients with PAH.</description><identifier>ISSN: 0894-7317</identifier><identifier>EISSN: 1097-6795</identifier><identifier>DOI: 10.1016/j.echo.2009.01.021</identifier><identifier>PMID: 19307098</identifier><language>eng</language><publisher>United States: Mosby, Inc</publisher><subject>Blood Flow Velocity ; Blood Pressure ; Blood Pressure Determination - methods ; Cardiovascular ; Doppler echocardiography ; Echocardiography, Doppler - methods ; Hemodynamics ; Humans ; Hypertension, Pulmonary - diagnostic imaging ; Hypertension, Pulmonary - physiopathology ; Image Interpretation, Computer-Assisted - methods ; Male ; Middle Aged ; Noninvasive imaging ; Pulmonary Artery - diagnostic imaging ; Pulmonary Artery - physiopathology ; Pulmonary hypertension ; Vascular Resistance</subject><ispartof>Journal of the American Society of Echocardiography, 2009-05, Vol.22 (5), p.523-529</ispartof><rights>American Society of Echocardiography</rights><rights>2009 American Society of Echocardiography</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c409t-9ce50e8ba3c5527b59048621e5e356483d63f4b5c5bfebf9912c441b8e00901d3</citedby><cites>FETCH-LOGICAL-c409t-9ce50e8ba3c5527b59048621e5e356483d63f4b5c5bfebf9912c441b8e00901d3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.sciencedirect.com/science/article/pii/S0894731709000698$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>314,776,780,3537,27901,27902,65306</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/19307098$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Haddad, François, MD</creatorcontrib><creatorcontrib>Zamanian, Roham, MD</creatorcontrib><creatorcontrib>Beraud, Anne-Sophie, MD</creatorcontrib><creatorcontrib>Schnittger, Ingela, MD</creatorcontrib><creatorcontrib>Feinstein, Jeffrey, MD, MPH</creatorcontrib><creatorcontrib>Peterson, Tyler, MD</creatorcontrib><creatorcontrib>Yang, Phil, MD</creatorcontrib><creatorcontrib>Doyle, Ramona, MD</creatorcontrib><creatorcontrib>Rosenthal, David, MD</creatorcontrib><title>A Novel Non-Invasive Method of Estimating Pulmonary Vascular Resistance in Patients With Pulmonary Arterial Hypertension</title><title>Journal of the American Society of Echocardiography</title><addtitle>J Am Soc Echocardiogr</addtitle><description>Background The assessment of pulmonary vascular resistance (PVR) plays an important role in the diagnosis and management of pulmonary arterial hypertension (PAH). The main objective of this study was to determine whether the noninvasive index of systolic pulmonary arterial pressure (SPAP) to heart rate (HR) times the right ventricular outflow tract time-velocity integral (TVIRVOT ) (SPAP/[HR × TVIRVOT ]) provides clinically useful estimations of PVR in PAH. Methods Doppler echocardiography and right-heart catheterization were performed in 51 consecutive patients with established PAH. The ratio of SPAP/(HR × TVIRVOT ) was then correlated with invasive indexed PVR (PVRI) using regression and Bland-Altman analysis. Using receiver operating characteristic curve analysis, a cutoff value for the Doppler equation was generated to identify patients with PVRI ≥ 15 Wood units (WU)/m2. Results The mean pulmonary arterial pressure was 52 ± 15 mm Hg, the mean cardiac index was 2.2 ± 0.6 L/min/m2 , and the mean PVRI was 20.5 ± 9.6 WU/m2 . The ratio of SPAP/(HR × TVIRVOT ) correlated very well with invasive PVRI measurements ( r = 0.860; 95% confidence interval, 0.759-0.920). A cutoff value of 0.076 provided well-balanced sensitivity (86%) and specificity (82%) to determine PVRI > 15 WU/m2 . A cutoff value of 0.057 increased sensitivity to 97% and decreased specificity to 65%. Conclusion The novel index of SPAP/(HR × TVIRVOT ) provides useful estimations of PVRI in patients with PAH.</description><subject>Blood Flow Velocity</subject><subject>Blood Pressure</subject><subject>Blood Pressure Determination - methods</subject><subject>Cardiovascular</subject><subject>Doppler echocardiography</subject><subject>Echocardiography, Doppler - methods</subject><subject>Hemodynamics</subject><subject>Humans</subject><subject>Hypertension, Pulmonary - diagnostic imaging</subject><subject>Hypertension, Pulmonary - physiopathology</subject><subject>Image Interpretation, Computer-Assisted - methods</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Noninvasive imaging</subject><subject>Pulmonary Artery - diagnostic imaging</subject><subject>Pulmonary Artery - physiopathology</subject><subject>Pulmonary hypertension</subject><subject>Vascular Resistance</subject><issn>0894-7317</issn><issn>1097-6795</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2009</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9kc1u1DAURi0EotPCC7BAXrFLuE7iJJYQ0qgqtFJLK36XluPcMB4y9tR2Rp23x9GMVMSiG9uLcz_rO5eQNwxyBqx-v85Rr1xeAIgcWA4Fe0YWDEST1Y3gz8kCWlFlTcmaE3IawhoAeAvwkpwwUUIDol2QhyX94nY4ptNmV3angtkhvcG4cj11A70I0WxUNPY3vZvGjbPK7-lPFfQ0Kk-_YjAhKquRGkvvEoc2BvrLxNU_-NJH9EaN9HK_xfS2wTj7irwY1Bjw9fE-Iz8-XXw_v8yubz9fnS-vM12BiJnQyAHbTpWa86LpuICqrQuGHEteV23Z1-VQdVzzbsBuEIIVuqpY12KyAqwvz8i7Q-7Wu_sJQ5QbEzSOo7LopiDrpuAtb-oEFgdQexeCx0Fufaru95KBnH3LtZx9y9m3BCaT7zT09pg-dRvsH0eOghPw4QBg6rgz6GXQSZLG3njUUfbOPJ3_8b9xPRprtBr_4B7D2k3eJnuSyVBIkN_mjc8LT90B6vT_X5Wup4c</recordid><startdate>20090501</startdate><enddate>20090501</enddate><creator>Haddad, François, MD</creator><creator>Zamanian, Roham, MD</creator><creator>Beraud, Anne-Sophie, MD</creator><creator>Schnittger, Ingela, MD</creator><creator>Feinstein, Jeffrey, MD, MPH</creator><creator>Peterson, Tyler, MD</creator><creator>Yang, Phil, MD</creator><creator>Doyle, Ramona, MD</creator><creator>Rosenthal, David, MD</creator><general>Mosby, Inc</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>7X8</scope></search><sort><creationdate>20090501</creationdate><title>A Novel Non-Invasive Method of Estimating Pulmonary Vascular Resistance in Patients With Pulmonary Arterial Hypertension</title><author>Haddad, François, MD ; Zamanian, Roham, MD ; Beraud, Anne-Sophie, MD ; Schnittger, Ingela, MD ; Feinstein, Jeffrey, MD, MPH ; Peterson, Tyler, MD ; Yang, Phil, MD ; Doyle, Ramona, MD ; Rosenthal, David, MD</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c409t-9ce50e8ba3c5527b59048621e5e356483d63f4b5c5bfebf9912c441b8e00901d3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2009</creationdate><topic>Blood Flow Velocity</topic><topic>Blood Pressure</topic><topic>Blood Pressure Determination - methods</topic><topic>Cardiovascular</topic><topic>Doppler echocardiography</topic><topic>Echocardiography, Doppler - methods</topic><topic>Hemodynamics</topic><topic>Humans</topic><topic>Hypertension, Pulmonary - diagnostic imaging</topic><topic>Hypertension, Pulmonary - physiopathology</topic><topic>Image Interpretation, Computer-Assisted - methods</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Noninvasive imaging</topic><topic>Pulmonary Artery - diagnostic imaging</topic><topic>Pulmonary Artery - physiopathology</topic><topic>Pulmonary hypertension</topic><topic>Vascular Resistance</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Haddad, François, MD</creatorcontrib><creatorcontrib>Zamanian, Roham, MD</creatorcontrib><creatorcontrib>Beraud, Anne-Sophie, MD</creatorcontrib><creatorcontrib>Schnittger, Ingela, MD</creatorcontrib><creatorcontrib>Feinstein, Jeffrey, MD, MPH</creatorcontrib><creatorcontrib>Peterson, Tyler, MD</creatorcontrib><creatorcontrib>Yang, Phil, MD</creatorcontrib><creatorcontrib>Doyle, Ramona, MD</creatorcontrib><creatorcontrib>Rosenthal, David, MD</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Journal of the American Society of Echocardiography</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Haddad, François, MD</au><au>Zamanian, Roham, MD</au><au>Beraud, Anne-Sophie, MD</au><au>Schnittger, Ingela, MD</au><au>Feinstein, Jeffrey, MD, MPH</au><au>Peterson, Tyler, MD</au><au>Yang, Phil, MD</au><au>Doyle, Ramona, MD</au><au>Rosenthal, David, MD</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>A Novel Non-Invasive Method of Estimating Pulmonary Vascular Resistance in Patients With Pulmonary Arterial Hypertension</atitle><jtitle>Journal of the American Society of Echocardiography</jtitle><addtitle>J Am Soc Echocardiogr</addtitle><date>2009-05-01</date><risdate>2009</risdate><volume>22</volume><issue>5</issue><spage>523</spage><epage>529</epage><pages>523-529</pages><issn>0894-7317</issn><eissn>1097-6795</eissn><abstract>Background The assessment of pulmonary vascular resistance (PVR) plays an important role in the diagnosis and management of pulmonary arterial hypertension (PAH). The main objective of this study was to determine whether the noninvasive index of systolic pulmonary arterial pressure (SPAP) to heart rate (HR) times the right ventricular outflow tract time-velocity integral (TVIRVOT ) (SPAP/[HR × TVIRVOT ]) provides clinically useful estimations of PVR in PAH. Methods Doppler echocardiography and right-heart catheterization were performed in 51 consecutive patients with established PAH. The ratio of SPAP/(HR × TVIRVOT ) was then correlated with invasive indexed PVR (PVRI) using regression and Bland-Altman analysis. Using receiver operating characteristic curve analysis, a cutoff value for the Doppler equation was generated to identify patients with PVRI ≥ 15 Wood units (WU)/m2. Results The mean pulmonary arterial pressure was 52 ± 15 mm Hg, the mean cardiac index was 2.2 ± 0.6 L/min/m2 , and the mean PVRI was 20.5 ± 9.6 WU/m2 . The ratio of SPAP/(HR × TVIRVOT ) correlated very well with invasive PVRI measurements ( r = 0.860; 95% confidence interval, 0.759-0.920). A cutoff value of 0.076 provided well-balanced sensitivity (86%) and specificity (82%) to determine PVRI > 15 WU/m2 . A cutoff value of 0.057 increased sensitivity to 97% and decreased specificity to 65%. Conclusion The novel index of SPAP/(HR × TVIRVOT ) provides useful estimations of PVRI in patients with PAH.</abstract><cop>United States</cop><pub>Mosby, Inc</pub><pmid>19307098</pmid><doi>10.1016/j.echo.2009.01.021</doi><tpages>7</tpages></addata></record> |
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| subjects | Blood Flow Velocity Blood Pressure Blood Pressure Determination - methods Cardiovascular Doppler echocardiography Echocardiography, Doppler - methods Hemodynamics Humans Hypertension, Pulmonary - diagnostic imaging Hypertension, Pulmonary - physiopathology Image Interpretation, Computer-Assisted - methods Male Middle Aged Noninvasive imaging Pulmonary Artery - diagnostic imaging Pulmonary Artery - physiopathology Pulmonary hypertension Vascular Resistance |
| title | A Novel Non-Invasive Method of Estimating Pulmonary Vascular Resistance in Patients With Pulmonary Arterial Hypertension |
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