The use of the right ventricular diameter and tricuspid annular tissue Doppler velocity parameter to predict the presence of pulmonary hypertension.
OBJECTIVE
Detecting the presence of pulmonary hypertension (PH) is important especially with unexplained dyspnoea and suspected thromboembolism. Although PH can be detected invasively by right ventricular (RV) catheterisation, accurate non-invasive assessment by echocardiography has many advantages. This however relies on the presence of tricuspid regurgitation (TR). We examined if the presence of PH can be predicted echocardiographically without relying on TR.


RESULTS
Seventy-six consecutive patients with TR were recruited, and another 32 were used for prediction study. RV end-diastolic diameter (RVD) was measured in the apical view and tissue Doppler imaging (TDI) parameters were obtained from the lateral tricuspid annulus motion. Pulmonary artery systolic pressures (PASP) were estimated from TR. The RVD, and the TDI duration from start of isovolumic contraction to peak systole, T(peak), correlated with PASP. However, the RVD/T(peak) ratio offered the best correlation and, at a cutoff of 22 cm/s, predicted the presence of PH with 80% sensitivity and 83% specificity. The same results were obtained even if the study was confined to patients with or without RV dysfunction. The ratio displayed a good correlation with catheter-derived PASP in nine separate patients.


CONCLUSIONS
While RVD and T(peak) can adequately detect the presence of PH, RVD/T(peak) acted as the best predictor for PH. The results apply regardless of the presence or absence of RV dysfunction.
McLean
Anthony S
AS
Cardiovascular Ultrasound Laboratory, Department of Intensive Care Medicine, Nepean Hospital, University of Sydney, Great Western Highway, Penrith, NSW 2750, Australia. mcleana@med.usyd.edu.au
Ting
Iris
I
Huang
Stephen J
SJ
Wesley
Sarah
S