title: Diagnostic value of resting tricuspid regurgitation velocity and right ventricular ejection flow parameters for the detection of exercise induced pulmonary arterial hypertension.
abstract: Our objectives were to evaluate resting tricuspid regurgitation velocity (TRV) and right ventricular outflow tract velocity curve (RVOTvc) profiles as markers for development of exercise induced pulmonary arterial hypertension (ExPHT). ExPHT is an elusive cause of dyspnea and fatigue. When present, Doppler echocardiography can detect and quantify elevated pulmonary pressure. However, the characteristics and diagnostic value of resting TRV and RVOTvc indices in patients with ExPHT have not been fully addressed. The study population consisted of 52 subjects (mean age 40.5 +/- 10.9, range 22-68 years) and was divided into three subsets as follows: 1. Patients (n = 22) with overt pulmonary hypertension (PHT), 2. Patients (n = 8) with ExPHT, 3. Healthy, asymptomatic volunteers (n = 22). RVOTvc indices included: Mean and peak velocity, systolic velocity time integral (VTI); velocity time integral at peak velocity (VTImax), acceleration time; ejection time. TRV was used as an index of pulmonary artery systolic pressure. There were significant differences between normals and ExPHT for TRV, acceleration time, VTI(Vmax). TRV and VTImax were predictive of EXPHT in a logistic regression model.
  
  
  CONCLUSIONS
  (1) Patients with ExPHT have distinct Doppler velocity patterns suggesting the presence of a compromised pulmonary vascular bed even with normal pulmonary pressure at rest. (2) TRV and RVOTvc indices have potential diagnostic value in the early detection of ExPHT.
authors.affiliation: Department of Echocardiographic Research, San Donato Hospital, University of Milan, Italy.
authors.forename: E
authors.initials: E
authors.lastname: Bossone
authors.forename: E
authors.initials: E
authors.lastname: Avelar
authors.forename: D S
authors.initials: DS
authors.lastname: Bach
authors.forename: B
authors.initials: B
authors.lastname: Gillespie
authors.forename: M
authors.initials: M
authors.lastname: Rubenfire
authors.forename: W F
authors.initials: WF
authors.lastname: Armstrong
mesh_terms: D000328:Adult; D000704:Analysis of Variance; D015415:Biomarkers / Q000032:analysis; D001783:Blood Flow Velocity; D015150:Echocardiography, Doppler; D005080:Exercise Test; D005260:Female; D006334:Heart Function Tests; D006801:Humans; D006976:Hypertension, Pulmonary / Q000150:complications / Q000000981:diagnostic imaging*; D017379:Hypertrophy, Left Ventricular / Q000150:complications / Q000000981:diagnostic imaging*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D008944:Mitral Valve Insufficiency / Q000150:complications / Q000000981:diagnostic imaging*; D012016:Reference Values; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D018497:Ventricular Dysfunction, Right / Q000150:complications / Q000000981:diagnostic imaging*
chemical_list: D015415:Biomarkers