title: Overestimation by echocardiography of the peak systolic pressure gradient between the right ventricle and right atrium due to tricuspid regurgitation and the usefulness of the early diastolic transpulmonary valve pressure gradient for estimating pulmonary artery pressure.
abstract: We investigated the influence of tricuspid regurgitation (TR) severity on the echocardiographic peak systolic transtricuspid pressure gradient (TRPG) and evaluated the usefulness of the peak early diastolic transpulmonary valve pressure gradient (PRPG) for estimating pulmonary artery (PA) pressure. In 55 consecutive right heart-catheterized patients, we measured the peak systolic right ventricular (RV)-right atrial (RA) pressure gradient (RV-RACATH), peak early diastolic PA-RV pressure gradient (PA-RVCATH), and mean PA pressure (MPAPCATH). Using echocardiography, we obtained the TRPG, PRPG, and an estimate of the mean PA pressure (EMPAP) as the sum of PRPG and the estimated RA pressure, and measured the vena contracta width of TR (VCTR). The difference between the TRPG and RV-RACATHwas significantly greater in the very severe TR group (VCTR> 11 mm) than in the mild, moderate, and severe TR groups, and significantly greater in the severe TR group (7 < VCTR≤ 11 mm) than in the mild TR group. The overestimation of the pressure gradient >10 mmHg by TRPG was not seen in the mild or moderate TR groups, but was observed in the severe and very severe TR groups (22 and 83%, respectively). In the ROC analysis, EMPAP could distinguish patients with MPAPCATH≥ 25 mmHg with the area under the curve of 0.93, 100% sensitivity, and 87% specificity. In conclusion, TRPG frequently overestimated RV-RACATHwhen VCTRwas >11 mm and sometimes did when VCTRwas >7 mm, where EMPAP using PRPG was useful for estimating PA pressure.
authors.affiliation: Division of Laboratory and Transfusion Medicine, Hokkaido University Hospital, Sapporo, Japan.
authors.forename: Takuma
authors.initials: T
authors.lastname: Hioka
authors.affiliation: Faculty of Health Sciences, Hokkaido University, Kita-12, Nishi-5, Kita-ku, Sapporo, 060-0812, Japan.
authors.forename: Sanae
authors.initials: S
authors.lastname: Kaga
authors.affiliation: Faculty of Health Sciences, Hokkaido University, Kita-12, Nishi-5, Kita-ku, Sapporo, 060-0812, Japan. mikami@hs.hokudai.ac.jp.
authors.forename: Taisei
authors.initials: T
authors.lastname: Mikami
authors.affiliation: Faculty of Health Sciences, Hokkaido University, Kita-12, Nishi-5, Kita-ku, Sapporo, 060-0812, Japan.
authors.forename: Kazunori
authors.initials: K
authors.lastname: Okada
authors.affiliation: Graduate School of Health Sciences, Hokkaido University, Sapporo, Japan.
authors.forename: Michito
authors.initials: M
authors.lastname: Murayama
authors.affiliation: Faculty of Health Sciences, Hokkaido University, Kita-12, Nishi-5, Kita-ku, Sapporo, 060-0812, Japan.
authors.forename: Nobuo
authors.initials: N
authors.lastname: Masauzi
authors.affiliation: Division of Laboratory and Transfusion Medicine, Hokkaido University Hospital, Sapporo, Japan.
authors.forename: Masahiro
authors.initials: M
authors.lastname: Nakabachi
authors.affiliation: Division of Laboratory and Transfusion Medicine, Hokkaido University Hospital, Sapporo, Japan.
authors.forename: Hisao
authors.initials: H
authors.lastname: Nishino
authors.affiliation: Division of Laboratory and Transfusion Medicine, Hokkaido University Hospital, Sapporo, Japan.
authors.forename: Shinobu
authors.initials: S
authors.lastname: Yokoyama
authors.affiliation: Division of Laboratory and Transfusion Medicine, Hokkaido University Hospital, Sapporo, Japan.
authors.forename: Mutsumi
authors.initials: M
authors.lastname: Nishida
authors.affiliation: Department of Cardiovascular Medicine, Hokkaido University Graduate School of Medicine, Sapporo, Japan.
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Iwano
authors.affiliation: Department of Cardiovascular Medicine, Hokkaido University Graduate School of Medicine, Sapporo, Japan.
authors.forename: Mamoru
authors.initials: M
authors.lastname: Sakakibara
authors.affiliation: Department of Cardiovascular Medicine, Hokkaido University Graduate School of Medicine, Sapporo, Japan.
authors.forename: Satoshi
authors.initials: S
authors.lastname: Yamada
authors.affiliation: Department of Cardiovascular Medicine, Hokkaido University Graduate School of Medicine, Sapporo, Japan.
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Tsutsui
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001794:Blood Pressure; D006328:Cardiac Catheterization; D018618:Echocardiography, Doppler, Color; D005260:Female; D006321:Heart / Q000503:physiopathology*; D006801:Humans; D007564:Japan; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D011651:Pulmonary Artery / Q000503:physiopathology*; D011665:Pulmonary Valve Insufficiency / Q000000981:diagnostic imaging*; D012372:ROC Curve; D013599:Systole; D014262:Tricuspid Valve Insufficiency / Q000000981:diagnostic imaging*
keywords: Echocardiography; Pulmonary artery pressure; Pulmonary regurgitation; Tricuspid regurgitation