title: Assessment of Right Ventricular Afterload in COPD.
abstract: BACKGROUND
  We aimed to study whether pulmonary hypertension (PH) and elevated pulmonary vascular resistance (PVR) could be predicted by conventional echo Doppler and novel tissue Doppler imaging (TDI) in a population of chronic obstructive pulmonary disease (COPD) free of LV disease and co-morbidities.
  
  
  METHODS
  Echocardiography and right heart catheterization was performed in 100 outpatients with COPD. By echocardiography the time-integral of the TDI index, right ventricular systolic velocity (RVSmVTI) and pulmonary acceleration-time (PAAcT) were measured and adjusted for heart rate. The COPD patients were randomly divided in a derivation (n = 50) and a validation cohort (n = 50).
  
  
  RESULTS
  PH (mean pulmonary artery pressure (mPAP) ≥ 25mmHg) and elevated PVR ≥ 2Wood unit (WU) were predicted by satisfactory area under the curve for RVSmVTI of 0.93 and 0.93 and for PAAcT of 0.96 and 0.96, respectively. Both echo indices were 100% feasible, contrasting 84% feasibility for parameters relying on contrast enhanced tricuspid-regurgitation. RVSmVTI and PAAcT showed best correlations to invasive measured mPAP, but less so to PVR. PAAcT was accurate in 90- and 78% and RVSmVTI in 90- and 84% in the calculation of mPAP and PVR, respectively.
  
  
  CONCLUSIONS
  Heart rate adjusted-PAAcT and RVSmVTI are simple and reproducible methods that correlate well with pulmonary artery pressure and PVR and showed high accuracy in detecting PH and increased PVR in patients with COPD. Taken into account the high feasibility of these two echo indices, they should be considered in the echocardiographic assessment of COPD patients.
authors.affiliation: a 1 Department of Cardiology, Oslo University Hospital , Aker , Norway.|e 5 Faculty of Medicine, Institute of Clinical Sciences, University of Oslo , Aker , Norway.
authors.forename: Janne Mykland
authors.initials: JM
authors.lastname: Hilde
authors.affiliation: b 2 Department of Pulmonary Medicine, Oslo University Hospital , Aker , Norway.|e 5 Faculty of Medicine, Institute of Clinical Sciences, University of Oslo , Aker , Norway.
authors.forename: Ingunn
authors.initials: I
authors.lastname: Skjørten
authors.affiliation: a 1 Department of Cardiology, Oslo University Hospital , Aker , Norway.
authors.forename: Viggo
authors.initials: V
authors.lastname: Hansteen
authors.affiliation: c 3 Department of Pulmonary Medicine, The Glittre Clinic , Hakadal , Norway.
authors.forename: Morten Nissen
authors.initials: MN
authors.lastname: Melsom
authors.affiliation: d 4 Department of Cardiology, Oslo University Hospital , Ullevål , Norway.|e 5 Faculty of Medicine, Institute of Clinical Sciences, University of Oslo , Aker , Norway.
authors.forename: Dan
authors.initials: D
authors.lastname: Atar
authors.affiliation: e 5 Faculty of Medicine, Institute of Clinical Sciences, University of Oslo , Aker , Norway.|f 6 Section of Vascular Investigations, Oslo University Hospital , Aker , Norway.
authors.forename: Jonny
authors.initials: J
authors.lastname: Hisdal
authors.affiliation: b 2 Department of Pulmonary Medicine, Oslo University Hospital , Aker , Norway.
authors.forename: Sjur
authors.initials: S
authors.lastname: Humerfelt
authors.affiliation: e 5 Faculty of Medicine, Institute of Clinical Sciences, University of Oslo , Aker , Norway.|g 7 Department of Cardiology, Akershus University Hospital , Lorenskog , Norway.
authors.forename: Kjetil
authors.initials: K
authors.lastname: Steine
mesh_terms: D000328:Adult; D000368:Aged; D006328:Cardiac Catheterization; D003430:Cross-Sectional Studies; D015150:Echocardiography, Doppler; D005260:Female; D005500:Follow-Up Studies; D006352:Heart Ventricles / Q000000981:diagnostic imaging / Q000503:physiopathology*; D006801:Humans; D006976:Hypertension, Pulmonary / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D029424:Pulmonary Disease, Chronic Obstructive / Q000150:complications / Q000175:diagnosis / Q000503:physiopathology*; D011669:Pulmonary Wedge Pressure / Q000502:physiology*; D012720:Severity of Illness Index; D014655:Vascular Resistance / Q000502:physiology*; D016278:Ventricular Function, Right / Q000502:physiology*
keywords: COPD; Tissue Doppler imaging; pulmonary pressure; pulmonary vascular resistanceright heart catheterization; right ventricular afterload