title: Pulmonary regurgitation end-diastolic gradient is a Doppler marker of cardiac status: data from the Heart and Soul Study.
abstract: BACKGROUND
  Echocardiograms routinely sample pulmonary regurgitation signals from which it is possible to measure end diastolic gradients; these correlate with pulmonary artery diastolic pressures.
  
  
  METHODS
  We performed echocardiograms in 741 ambulatory adults with coronary artery disease who were recruited for the Heart and Soul Study. We compared indicators of cardiac status among individuals with normal (0-5.0 mm Hg) and elevated (> 5.0 mm Hg) end diastolic pulmonary regurgitation (EDPR) gradients.
  
  
  RESULTS
  Of the 481 participants with measurable EDPR gradients, 21% had elevated EDPR gradients (> 5.0 mm Hg). EDPR gradients > 5.0 mm Hg were associated with higher New York Heart Association functional class (P = .002), higher brain natriuretic peptide (P = .002), fewer metabolic equivalents achieved on treadmill testing (P < 0.001), and higher left ventricular mass (P < 0.001). The EDPR gradient > 5.0 mm Hg had a sensitivity of 25% (95% confidence interval 20-30%) and a specificity of 86% (80-91%) for detecting at least one of the following: systolic dysfunction, diastolic dysfunction, or abnormal wall motion score. The EDPR gradient > 5.0 mm HG was statistically equivalent to the tricuspid regurgitation (TR) gradient > 30 mm Hg in terms of diagnostic value (area under the receiver operating characteristic curve equaled 0.58 for each test). The EDPR gradient increased the yield of pulmonary artery pressures from 61% (TR gradient alone) to 84% (P < .0001).
  
  
  CONCLUSIONS
  The EDPR gradient provides valuable information independent of the TR gradient in evaluating pulmonary artery pressures and cardiac dysfunction.
authors.affiliation: California Pacific Medical Center, San Francisco, California 94115, USA. ristowb@sutterhealth.org
authors.forename: Bryan
authors.initials: B
authors.lastname: Ristow
authors.forename: Syed
authors.initials: S
authors.lastname: Ahmed
authors.forename: Lianyi
authors.initials: L
authors.lastname: Wang
authors.forename: Haiying
authors.initials: H
authors.lastname: Liu
authors.forename: Brad G
authors.initials: BG
authors.lastname: Angeja
authors.forename: Mary A
authors.initials: MA
authors.lastname: Whooley
authors.forename: Nelson B
authors.initials: NB
authors.lastname: Schiller
mesh_terms: D000368:Aged; D001794:Blood Pressure; D002140:California / Q000453:epidemiology; D015897:Comorbidity; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging* / Q000453:epidemiology*; D003971:Diastole; D015150:Echocardiography, Doppler / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D011665:Pulmonary Valve Insufficiency / Q000000981:diagnostic imaging* / Q000453:epidemiology*; D012372:ROC Curve; D015203:Reproducibility of Results; D018570:Risk Assessment / Q000379:methods; D012307:Risk Factors; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index