title: A new method to estimate pulmonary vascular resistance using diastolic pulmonary artery-right ventricular pressure gradients derived from continuous-wave Doppler velocity measurements of pulmonary regurgitation.
abstract: Pulmonary vascular resistance (PVR) is an important hemodynamic parameter in patients with heart failure, especially when the pulmonary arterial pressure is lower due to reduced stroke volume. Several echocardiographic methods to estimate PVR have been proposed, but their applications in patients with organic left-sided heart diseases have been limited. The aim of the present study was to examine the usefulness of our new method to estimate PVR (PVRPR) based on the continuous-wave Doppler velocity measurements of pulmonary regurgitation in these patients. In 43 patients who underwent right heart catheterization, PVRPRwas calculated as the difference between the Doppler-derived early- and end-diastolic pulmonary artery (PA)-right ventricular (RV) pressure gradients divided by the cardiac output measured in the left ventricular outflow tract by echocardiography. The PVRPRcorrelated well with invasive PVR (PVRCATH) (r = 0.81, p < 0.001) without any fixed bias in Bland-Altman analysis. The conventional echocardiographic PVRs showed inadequate correlations with PVRCATH, or a obvious overestimation of PVRCATH. In the receiver operating characteristic analyses to determine the patients with abnormal elevation of PVRCATH(>3 Wood units, WU), the area under the curve was the greatest for PVRPR(0.964) compared to the conventional PVRs (0.649-0.839). PVRPRhad 83 % sensitivity and 100 % specificity at the optimal cut-off value of 3.10 WU in identifying patients with PVRCATH>3 WU. Our simple and theoretical PVRPRis useful for the noninvasive estimation of PVR.
authors: Faculty of Health Sciences, Hokkaido University, Kita-12, Nishi-5, Kita-ku, Sapporo, 060-0812, Japan.|Department of Cardiovascular Medicine, Hokkaido University Graduate School of Medicine, Kita-15, Nishi-7, Kita-ku, Sapporo, 060-8638, Japan.
authors: Sanae
authors: S
authors: Kaga
authors: Faculty of Health Sciences, Hokkaido University, Kita-12, Nishi-5, Kita-ku, Sapporo, 060-0812, Japan. mikami@hs.hokudai.ac.jp.
authors: Taisei
authors: T
authors: Mikami
authors: Graduate School of Health Sciences, Hokkaido University, Kita-12, Nishi-5, Kita-ku, Sapporo, 060-0812, Japan.
authors: Michito
authors: M
authors: Murayama
authors: Faculty of Health Sciences, Hokkaido University, Kita-12, Nishi-5, Kita-ku, Sapporo, 060-0812, Japan.
authors: Kazunori
authors: K
authors: Okada
authors: Faculty of Health Sciences, Hokkaido University, Kita-12, Nishi-5, Kita-ku, Sapporo, 060-0812, Japan.
authors: Nobuo
authors: N
authors: Masauzi
authors: Division of Laboratory and Transfusion Medicine, Hokkaido University Hospital, Kita-14, Nishi-5, Kita-ku, Sapporo, 060-8648, Japan.
authors: Masahiro
authors: M
authors: Nakabachi
authors: Division of Laboratory and Transfusion Medicine, Hokkaido University Hospital, Kita-14, Nishi-5, Kita-ku, Sapporo, 060-8648, Japan.
authors: Hisao
authors: H
authors: Nishino
authors: Division of Laboratory and Transfusion Medicine, Hokkaido University Hospital, Kita-14, Nishi-5, Kita-ku, Sapporo, 060-8648, Japan.
authors: Shinobu
authors: S
authors: Yokoyama
authors: Division of Laboratory and Transfusion Medicine, Hokkaido University Hospital, Kita-14, Nishi-5, Kita-ku, Sapporo, 060-8648, Japan.
authors: Mutsumi
authors: M
authors: Nishida
authors: Department of Cardiovascular Medicine, Hokkaido University Graduate School of Medicine, Kita-15, Nishi-7, Kita-ku, Sapporo, 060-8638, Japan.
authors: Taichi
authors: T
authors: Hayashi
authors: Department of Cardiovascular Medicine, Hokkaido University Graduate School of Medicine, Kita-15, Nishi-7, Kita-ku, Sapporo, 060-8638, Japan.
authors: Daisuke
authors: D
authors: Murai
authors: Department of Cardiovascular Medicine, Hokkaido University Graduate School of Medicine, Kita-15, Nishi-7, Kita-ku, Sapporo, 060-8638, Japan.
authors: Hiroyuki
authors: H
authors: Iwano
authors: Department of Cardiovascular Medicine, Hokkaido University Graduate School of Medicine, Kita-15, Nishi-7, Kita-ku, Sapporo, 060-8638, Japan.
authors: Mamoru
authors: M
authors: Sakakibara
authors: Department of Cardiovascular Medicine, Hokkaido University Graduate School of Medicine, Kita-15, Nishi-7, Kita-ku, Sapporo, 060-8638, Japan.
authors: Satoshi
authors: S
authors: Yamada
authors: Department of Cardiovascular Medicine, Hokkaido University Graduate School of Medicine, Kita-15, Nishi-7, Kita-ku, Sapporo, 060-8638, Japan.
authors: Hiroyuki
authors: H
authors: Tsutsui
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019540:Area Under Curve; D062186:Arterial Pressure; D006328:Cardiac Catheterization; D015150:Echocardiography, Doppler; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011651:Pulmonary Artery / Q000000981:diagnostic imaging* / Q000503:physiopathology; D011665:Pulmonary Valve Insufficiency / Q000000981:diagnostic imaging* / Q000503:physiopathology; D012372:ROC Curve; D015203:Reproducibility of Results; D014655:Vascular Resistance; D016277:Ventricular Function, Left; D016278:Ventricular Function, Right; D017725:Ventricular Pressure; D055815:Young Adult
keywords: Echocardiography; Left heart failure; Pulmonary regurgitation; Pulmonary vascular resistance