Echocardiographic estimation of pulmonary vascular resistance in advanced lung disease
Abstract Noninvasive assessment of pulmonary hemodynamics is often performed by echocardiographic estimation of the pulmonary artery systolic pressure (ePASP), despite limitations in the advanced lung disease population. Other noninvasive hemodynamic variables, such as echocardiographic pulmonary va...
| Main Authors: | , , , , , , , , |
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| Format: | Article |
| Language: | English |
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Wiley
2023-01-01
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| Series: | Pulmonary Circulation |
| Subjects: | |
| Online Access: | https://doi.org/10.1002/pul2.12183 |
| _version_ | 1797824194580316160 |
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| author | Jacqueline T. DesJardin Yana Svetlichnaya Nicholas A. Kolaitis Steven R. Hays Jasleen Kukreja Nelson B. Schiller Lucas S. Zier Jonathan P. Singer Teresa De Marco |
| author_facet | Jacqueline T. DesJardin Yana Svetlichnaya Nicholas A. Kolaitis Steven R. Hays Jasleen Kukreja Nelson B. Schiller Lucas S. Zier Jonathan P. Singer Teresa De Marco |
| author_sort | Jacqueline T. DesJardin |
| collection | DOAJ |
| description | Abstract Noninvasive assessment of pulmonary hemodynamics is often performed by echocardiographic estimation of the pulmonary artery systolic pressure (ePASP), despite limitations in the advanced lung disease population. Other noninvasive hemodynamic variables, such as echocardiographic pulmonary vascular resistance (ePVR), have not been studied in this population. We performed a retrospective analysis of 147 advanced lung disease patients who received both echocardiography and right heart catheterization for lung transplant evaluation. The ePVR was estimated by four previously described equations. Noninvasive and invasive hemodynamic parameters were compared in terms of correlation, agreement, and accuracy. The ePVR models strongly correlated with invasively determined PVR and had good accuracy with biases of <1 Wood units (WU), although with moderate precision and wide 95% limits of agreement varying from 5.9 to 7.8 Wood units. The ePVR models were accurate to within 1.9 WU in over 75% of patients. In comparison to the ePASP, ePVR models performed similarly in terms of correlation, accuracy, and precision when estimating invasive hemodynamics. In screening for pulmonary hypertension, ePVR models had equivalent testing characteristics to the ePASP. Mid‐systolic notching of the right ventricular outflow tract Doppler signal identified a subgroup of 11 patients (7%) with significantly elevated PVR and mean pulmonary artery pressures without relying on the acquisition of a tricuspid regurgitation signal. Analysis of ePVR and determination of the notching pattern of the right ventricular outflow tract Doppler flow velocity envelope provide reliable insights into hemodynamics in advanced lung disease patients, although limitations in precision exist. |
| first_indexed | 2024-03-13T10:35:20Z |
| format | Article |
| id | doaj.art-b12b90c63add41f6a19965d127ea30a5 |
| institution | Directory Open Access Journal |
| issn | 2045-8940 |
| language | English |
| last_indexed | 2024-03-13T10:35:20Z |
| publishDate | 2023-01-01 |
| publisher | Wiley |
| record_format | Article |
| series | Pulmonary Circulation |
| spelling | doaj.art-b12b90c63add41f6a19965d127ea30a52023-05-18T06:26:29ZengWileyPulmonary Circulation2045-89402023-01-01131n/an/a10.1002/pul2.12183Echocardiographic estimation of pulmonary vascular resistance in advanced lung diseaseJacqueline T. DesJardin0Yana Svetlichnaya1Nicholas A. Kolaitis2Steven R. Hays3Jasleen Kukreja4Nelson B. Schiller5Lucas S. Zier6Jonathan P. Singer7Teresa De Marco8Division of Cardiology University of California San Francisco San Francisco California USADivision of Cardiology Kaiser Permanente San Francisco California USADivision of Pulmonary, Critical Care, Allergy, and Sleep Medicine University of California San Francisco San Francisco California USADivision of Pulmonary, Critical Care, Allergy, and Sleep Medicine University of California San Francisco San Francisco California USADivision of Adult Cardiothoracic Surgery University of California San Francisco San Francisco California USADivision of Cardiology University of California San Francisco San Francisco California USADivision of Cardiology University of California San Francisco San Francisco California USADivision of Pulmonary, Critical Care, Allergy, and Sleep Medicine University of California San Francisco San Francisco California USADivision of Cardiology University of California San Francisco San Francisco California USAAbstract Noninvasive assessment of pulmonary hemodynamics is often performed by echocardiographic estimation of the pulmonary artery systolic pressure (ePASP), despite limitations in the advanced lung disease population. Other noninvasive hemodynamic variables, such as echocardiographic pulmonary vascular resistance (ePVR), have not been studied in this population. We performed a retrospective analysis of 147 advanced lung disease patients who received both echocardiography and right heart catheterization for lung transplant evaluation. The ePVR was estimated by four previously described equations. Noninvasive and invasive hemodynamic parameters were compared in terms of correlation, agreement, and accuracy. The ePVR models strongly correlated with invasively determined PVR and had good accuracy with biases of <1 Wood units (WU), although with moderate precision and wide 95% limits of agreement varying from 5.9 to 7.8 Wood units. The ePVR models were accurate to within 1.9 WU in over 75% of patients. In comparison to the ePASP, ePVR models performed similarly in terms of correlation, accuracy, and precision when estimating invasive hemodynamics. In screening for pulmonary hypertension, ePVR models had equivalent testing characteristics to the ePASP. Mid‐systolic notching of the right ventricular outflow tract Doppler signal identified a subgroup of 11 patients (7%) with significantly elevated PVR and mean pulmonary artery pressures without relying on the acquisition of a tricuspid regurgitation signal. Analysis of ePVR and determination of the notching pattern of the right ventricular outflow tract Doppler flow velocity envelope provide reliable insights into hemodynamics in advanced lung disease patients, although limitations in precision exist.https://doi.org/10.1002/pul2.12183chronic obstructive pulmonary diseasehemodynamicsinterstitial lung diseaselung transplantpulmonary hypertension |
| spellingShingle | Jacqueline T. DesJardin Yana Svetlichnaya Nicholas A. Kolaitis Steven R. Hays Jasleen Kukreja Nelson B. Schiller Lucas S. Zier Jonathan P. Singer Teresa De Marco Echocardiographic estimation of pulmonary vascular resistance in advanced lung disease Pulmonary Circulation chronic obstructive pulmonary disease hemodynamics interstitial lung disease lung transplant pulmonary hypertension |
| title | Echocardiographic estimation of pulmonary vascular resistance in advanced lung disease |
| title_full | Echocardiographic estimation of pulmonary vascular resistance in advanced lung disease |
| title_fullStr | Echocardiographic estimation of pulmonary vascular resistance in advanced lung disease |
| title_full_unstemmed | Echocardiographic estimation of pulmonary vascular resistance in advanced lung disease |
| title_short | Echocardiographic estimation of pulmonary vascular resistance in advanced lung disease |
| title_sort | echocardiographic estimation of pulmonary vascular resistance in advanced lung disease |
| topic | chronic obstructive pulmonary disease hemodynamics interstitial lung disease lung transplant pulmonary hypertension |
| url | https://doi.org/10.1002/pul2.12183 |
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