title: Reliability of Doppler-Based Measurement of Pulmonary Vascular Resistance in Congenital Heart Disease with Left-to-Right Shunt Lesions.
abstract: BACKGROUND
  Pulmonary vascular resistance (PVR) is a crucial parameter in the management of patients with left-to-right shunt lesions. Cardiac catheterization (Cath) is the gold standard test to assess PVR (PVRcath ), but it is invasive and hence, risky in children with pulmonary arterial hypertension (PAH). A noninvasive tool to assess PVR is desirable. Ratio of tricuspid regurgitation velocity (TRV) and time-velocity integral of right ventricular outflow tract (TVIRVOT ) by Doppler was previously shown to be a reliable noninvasive method for estimation of PVR in acquired PAH.
  
  
  METHODS
  Peak TR velocity and TVIRVOT were recorded from 63 prospective patients with various congenital shunt lesions. Subsequently, the patients were subjected to cath in less than 2 hours. The patients were subdivided into four subsets based on age and pulmonary arterial mean pressure (PAMP). A regression equation was developed for calculation of PVR from TRV/TVIRVOT (PVREcho ) which was indexed for BSA (PVRIEcho ). Bland-Altman analysis was done for agreement between PVRIcath and PVRIEcho . Receiver operating characteristic (ROC) curves were plotted to test the identity of the two methods and also the applicability of PVRIEcho across a wide range of Wood units.
  
  
  RESULTS
  Receiver operating characteristic curve plotted between the two methods showed good identity. Bland-Altman analysis showed excellent agreement between the two methods with negligible bias. ROC curves showed that PVRIEcho was accurate in distinguishing different cutoff values of PVR in each of the 4 groups.
  
  
  CONCLUSIONS
  Noninvasive Doppler estimation of PVR is reliable in patients with shunt lesions over a wide range of PVR.
authors.affiliation: Department of Cardiology, Nizam's Institute of Medical Sciences, Hyderabad, India.
authors.forename: Srinivas
authors.initials: S
authors.lastname: Bhyravavajhala
authors.affiliation: Depatment of Cardiology, Sri Venkateswara Institute of Medical Sciences, Tirupathi, India.
authors.forename: Vanajakshamma
authors.initials: V
authors.lastname: Velam
authors.affiliation: Department of Cardiology, Nizam's Institute of Medical Sciences, Hyderabad, India.
authors.forename: Nishanth V
authors.initials: NV
authors.lastname: Polapragada
authors.affiliation: Department of Cardiology, Nizam's Institute of Medical Sciences, Hyderabad, India.
authors.forename: Pranav
authors.initials: P
authors.lastname: Pallempati
authors.affiliation: Department of Cardiology, Nizam's Institute of Medical Sciences, Hyderabad, India.
authors.forename: Tammi Raju
authors.initials: TR
authors.lastname: Iragavarapu
authors.affiliation: Department of Cardiology, Nizam's Institute of Medical Sciences, Hyderabad, India.
authors.forename: Amar Narayan
authors.initials: AN
authors.lastname: Patnaik
authors.affiliation: Department of Cardiology, Nizam's Institute of Medical Sciences, Hyderabad, India.
authors.forename: Seshagiri Rao
authors.initials: SR
authors.lastname: Damera
mesh_terms: D000293:Adolescent; D000328:Adult; D001783:Blood Flow Velocity; D002648:Child; D002675:Child, Preschool; D015150:Echocardiography, Doppler / Q000379:methods*; D005260:Female; D006330:Heart Defects, Congenital / Q000000981:diagnostic imaging / Q000503:physiopathology*; D006801:Humans; D006976:Hypertension, Pulmonary / Q000000981:diagnostic imaging / Q000503:physiopathology*; D007089:Image Enhancement / Q000379:methods; D007090:Image Interpretation, Computer-Assisted / Q000379:methods; D007223:Infant; D008297:Male; D008875:Middle Aged; D011651:Pulmonary Artery / Q000000981:diagnostic imaging* / Q000503:physiopathology*; D011652:Pulmonary Circulation; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D014655:Vascular Resistance; D055815:Young Adult
keywords: Doppler measurement; congenital heart disease; pulmonary arterial hypertension; pulmonary vascular resistance