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Proximal pulmonary emboli modify right ventricular ejection pattern.

A Torbicki1, M Kurzyna, M Ciurzynski

  • 1Dept of Internal Medicine, National Tuberculosis and Lung Disease Research Institute, Warsaw, Poland.

The European Respiratory Journal
|May 8, 1999
PubMed
Summary
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The systolic flow velocity curve (SFVC) is not a reliable measure for pulmonary arterial pressure (P(pa)) as it is significantly affected by the cause of pulmonary hypertension, unlike the tricuspid valve pressure gradient (TVPG).

Area of Science:

  • Cardiology
  • Pulmonary Medicine
  • Medical Imaging

Background:

  • The tricuspid valve pressure gradient (TVPG) is a standard method for assessing pulmonary arterial pressure (P(pa)) using echo-Doppler.
  • The systolic flow velocity curve (SFVC) in the right ventricular outflow tract is being explored as an alternative assessment method.

Purpose of the Study:

  • To investigate if the cause of pulmonary hypertension influences the systolic flow velocity curve (SFVC).
  • To compare the reliability of SFVC and TVPG in estimating pulmonary arterial pressure (P(pa)) across different pulmonary hypertension etiologies.

Main Methods:

  • Retrospective analysis of Doppler recordings from 86 patients with acute or chronic pulmonary embolism, COPD, or primary pulmonary hypertension.
  • Evaluation by two independent observers unaware of the study's purpose.

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  • Correlation analysis between SFVC parameters (acceleration time, time to midsystolic deceleration) and TVPG with direct P(pa) measurements where available.

    • Main Results:

    • Patients with acute pulmonary embolism (AP-PE) showed the shortest acceleration time (t(acc)) and time to midsystolic deceleration (t(msd)) despite the lowest TVPG.
    • SFVC parameters were less abnormal in primary pulmonary hypertension (PPH) even with higher TVPG.
    • TVPG correlated strongly with direct P(pa) measurements, while t(acc) showed no significant correlation with TVPG in the pooled group.

    Conclusions:

    • The systolic flow velocity curve (SFVC) is significantly affected by the underlying cause of pulmonary hypertension, particularly pulmonary embolism.
    • SFVC does not provide a reliable estimate of pulmonary arterial pressure (P(pa)).
    • TVPG remains a more dependable method for assessing pulmonary arterial pressure compared to SFVC.