scholarly journals Accuracy and Diagnostic Performance of Doppler Echocardiography to Estimate Mean Pulmonary Artery Pressure in Heart Failure

Author(s):  
Alva Bjorkman ◽  
Lars H. Lund ◽  
Ulrika Faxen ◽  
Per Lindqvist ◽  
Ashwin Venkateshvaran

BACKGROUND. Multiple Doppler Echocardiography (DE) algorithms have been proposed to estimate mean pulmonary artery pressure (PAP) and assess pulmonary hypertension (PH) likelihood. We assessed the accuracy of 4 different DE approaches to estimate PAP in patients with heart failure (HF) undergoing near-simultaneous right heart catheterization (RHC), and compared their diagnostic performance to identify PH with recommendation-advised tricuspid regurgitation peak velocity (TRV). METHODS. PAP was retrospectively assessed in 112 HF patients employing 4 previously validated DE algorithms. Association and agreement with invasive PAP were assessed. Diagnostic performance of DE methods vs. TRV=2.8m/sec to identify invasive PAP ≥ 25mmHg were compared. RESULTS. All DE algorithms demonstrated reasonable association (r = 0.41 to 0.65; p<0.001) and good agreement with invasive PAP, with relatively lower mean bias and higher precision observed in algorithms that included TRV or velocity time integral. All methods demonstrated strong ability (AUC=0.70-0.80; p<0.001) to identify PH but did not outperform TRV (AUC=0.84; p<0.001). Echocardiographic estimates of right atrial pressure were considered in 3 of 4 DE algorithms and falsely elevated in as many as 30% of patients. CONCLUSIONS. Echocardiographic estimates of PAP demonstrate reasonable accuracy to represent invasive PAP and strong ability to identify PH in HF. However, even the best performing algorithm did not outperform recommendation-advised TRV. The additional value of echocardiographic estimates of right atrial pressure may need to be re-evaluated.

2020 ◽  
Vol 43 (9) ◽  
pp. 600-605 ◽  
Author(s):  
Yuichiro Kado ◽  
Takuma Miyamoto ◽  
David J Horvath ◽  
Shengqiang Gao ◽  
Kiyotaka Fukamachi ◽  
...  

This study aimed to evaluate a newly designed circulatory mock loop intended to model cardiac and circulatory hemodynamics for mechanical circulatory support device testing. The mock loop was built with dedicated ports suitable for attaching assist devices in various configurations. This biventricular mock loop uses two pneumatic pumps (Abiomed AB5000™, Danvers, MA, USA) driven by a dual-output driver (Thoratec Model 2600, Pleasanton, CA, USA). The drive pressures can be individually modified to simulate a healthy heart and left and/or right heart failure conditions, and variable compliance and fluid volume allow for additional customization. The loop output for a healthy heart was tested at 4.2 L/min with left and right atrial pressures of 1 and 5 mm Hg, respectively; a mean aortic pressure of 93 mm Hg; and pulmonary artery pressure of 17 mm Hg. Under conditions of left heart failure, these values were reduced to 2.1 L/min output, left atrial pressure = 28 mm Hg, right atrial pressure = 3 mm Hg, aortic pressure = 58 mm Hg, and pulmonary artery pressure = 35 mm Hg. Right heart failure resulted in the reverse balance: left atrial pressure = 0 mm Hg, right atrial pressure = 30 mm Hg, aortic pressure = 100 mm Hg, and pulmonary artery pressure = 13 mm Hg with a flow of 3.9 L/min. For biventricular heart failure, flow was decreased to 1.6 L/min, left atrial pressure = 13 mm Hg, right atrial pressure = 13 mm Hg, aortic pressure = 52 mm Hg, and pulmonary artery pressure = 18 mm Hg. This mock loop could become a reliable bench tool to simulate a range of heart failure conditions.


2018 ◽  
Author(s):  
Andrew Accardi ◽  
Thomas Heywood ◽  
Anne Daleiden-Burns

BACKGROUND The treatment of heart failure (HF) in the United States is estimated to exceed $30 billion each year and is anticipated to increase to a staggering $70 billion by the year 2030. This makes the management of HF one of the leading challenges Medicare will face in the years to come. Traditional methods to detect impending congestion such as body weight and physical examination findings are often non-specific and lack sensitivity making them inadequate to recognize fluid overload and prevent decompensation. It has been suggested that bioimpedance spectroscopy (BIS) can be used as a surrogate marker for detecting fluid overload and therefore, serve as an adjunct to clinical exam findings. OBJECTIVE This study examines the relationship between a BIS device and echocardiographic parameters associated with volume overload with same day measurements in the first 8 patients with NYHA Class II/III HF on an IRB approved protocol. METHODS Each patient was followed 3 times a week for 4 weeks within the hospital outpatient setting. At each visit BIS measures were recorded for whole body as well as arms and legs. Additionally, signs and symptoms, weight and echocardiograph findings were all recorded. RESULTS Correlations of BIS measurements with echo parameters were performed. The leg impedance measurement correlated strongly with echo findings; inferior vena cava (IVC) size (p=0.001), right atrial pressure (RAP) (p<0.001), and pulmonary artery systolic pressure (PAS) measurements (p<0.001). CONCLUSIONS Preliminary findings demonstrated excellent correlations with BIS measurements and IVC size, right atrial pressure and pulmonary artery systolic pressure measurements which suggest a possible alternative method to detect fluid overload despite the small sample size. Trending a patient's impedance using the SOZO device at home or the practitioner's office may assist clinicians in providing more accurate, individualized HF care.  CLINICALTRIAL . IRB approval was obtained for this study (Scripps IRB #IRB-16-6852).


2018 ◽  
Vol 2018 ◽  
pp. 1-6 ◽  
Author(s):  
M. Hünlich ◽  
E. Lubos ◽  
B. E. Beuthner ◽  
M. Puls ◽  
A. Bleckmann ◽  
...  

Positive results of MitraClip in terms of improvement in clinical and left ventricular parameters have been described in detail. However, long-term effects on secondary pulmonary hypertension were not investigated in a larger patient cohort to date. 70 patients with severe mitral regurgitation, additional pulmonary hypertension, and right heart failure as a result of left heart disease were treated in the heart centers Hamburg and Göttingen. Immediately after successful MitraClip implantation, a reduction of the RVOT diameter from 3.52 cm to 3.44 cm was observed reaching a statistically significant value of 3.39 cm after 12 months. In contrast, there was a significant reduction in the velocity of the tricuspid regurgitation (TR) from 4.17 m/s to 3.11 m/s, the gradient of the TR from 48.5 mmHg to 39.3 mmHg, and the systolic pulmonary artery pressure (PAPsyst) from 58.6 mmHg to 50.0 mmHg. This decline continued in the following months (Vmax TR 3.09 m/s, peak TR 38.6 mmHg, and PAPsyst 47.4 mmHg). The tricuspid annular plane systolic excursion (TAPSE) increased from 16.5 mm to 18.9 mm after 12 months. MitraClip implantation improves pulmonary artery pressure, tricuspid regurgitation, and TAPSE after 12 months. At the same time, there is a decrease in the RVOT diameter without significant changes in other right ventricular and right atrial dimensions.


2011 ◽  
Vol 161 (3) ◽  
pp. 558-566 ◽  
Author(s):  
William T. Abraham ◽  
Philip B. Adamson ◽  
Ayesha Hasan ◽  
Robert C. Bourge ◽  
Salpy V. Pamboukian ◽  
...  

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