title: Estimation of the systolic pulmonary arterial pressure using contrast-enhanced continuous-wave Doppler in patients with trivial tricuspid regurgitation.
abstract: Noninvasive estimation of pulmonary arterial pressure is important for hemodynamic monitoring of patients with heart disease. In patients with tricuspid regurgitation (TR), the peak velocity of TR on continuous-wave (CW) Doppler can be used to estimate the systolic pulmonary arterial pressure (PAPs) using the simplified Bernoulli equation. We evaluated a new technique of contrast-enhanced CW Doppler for calculating PAPs in patients with trivial TR. Forty-one patients without visible TR detected by color Doppler, pulsed Doppler or CW Doppler were evaluated. Age ranged from 19 to 73 (55 +/- 12) years old. Tricuspid flow signals were recorded on CW Doppler after intravenous administration of indocyanin green (ICG) or Albunex. PAPs was calculated as; PAPs = 4 x VTR2 + 10 mmHg, where VTR is the peak velocity of TR. PAPs calculated using contrast-enhanced CW Doppler was compared with PAPs measured by the following cardiac catheterization. 1) TR signals were recorded using the contrast-enhanced CW Doppler technique in 39 of 41 patients (95%) after intravenous administration of contrast agents. 2) The error of estimate of PAPs using the contrast-enhanced CW Doppler technique was -2.4 +/- 7.5 mmHg, and the percent error was -10.7 +/- 32.4% in all patients. In 20 of 39 patients (51%), the error of estimate was within +/- 5 mmHg. 3) PAPs was overestimated by 12.2 +/- 6.1 mmHg in patients with good contrast enhancement of TR signals. The contrast-enhanced CW Doppler technique is useful for estimating PAPs noninvasively in patients with trivial TR. It is better to assume the right atrial pressure as 3-5 mmHg, not 10 mmHg, in patients with good enhancement of trivial TR. Physiological TR may be enhanced by contrast agents in these patients.
authors.affiliation: Department of Internal Medicine, Saga Medical School, Japan.
authors.forename: T
authors.initials: T
authors.lastname: Tokushima
authors.forename: T
authors.initials: T
authors.lastname: Utsunomiya
authors.forename: K
authors.initials: K
authors.lastname: Yoshida
authors.forename: T
authors.initials: T
authors.lastname: Ogawa
authors.forename: K
authors.initials: K
authors.lastname: Kido
authors.forename: Y
authors.initials: Y
authors.lastname: Ohtsubo
authors.forename: T
authors.initials: T
authors.lastname: Ryu
authors.forename: T
authors.initials: T
authors.lastname: Ogata
authors.forename: S
authors.initials: S
authors.lastname: Tsuji
authors.forename: S
authors.initials: S
authors.lastname: Matsuo
mesh_terms: D000328:Adult; D000368:Aged; D001794:Blood Pressure; D006328:Cardiac Catheterization; D003287:Contrast Media / Q000008:administration & dosage; D004452:Echocardiography; D005260:Female; D006801:Humans; D007089:Image Enhancement; D008297:Male; D008875:Middle Aged; D011651:Pulmonary Artery / Q000503:physiopathology*; D013599:Systole; D014262:Tricuspid Valve Insufficiency / Q000000981:diagnostic imaging / Q000503:physiopathology*; D018608:Ultrasonography, Doppler
chemical_list: D003287:Contrast Media