Septal/free wall curvature ratio: a noninvasive index of pulmonary arterial pressure

The leftward septal shift, a well-recognized feature of pulmonary hypertension, was used to quantify right ventricular pressure in 16 patients with pulmonary hypertension and 11 control patients, all with normal left ventricular function. Pulmonary pressure was calculated from the tricuspid regurgitation jet and left ventricular pressure was taken by arm cuff measurements. Short-axis echocardiographic images were obtained and the midwall curvatures of the septum and the left ventricular free wall were measured for each frame from end diastole to end systole and averaged. The septal/free-wall curvature ratio (CR) was 0.37 +/- 0.19 in the study group compared with 0.79 +/- 0.06 in the control group (p < 0.0001). A tight relationship between the CR and the transseptal/transmural pressure ratio (CR = 0.057 + 0.89 x transseptal/transmural pressure ratio; r = 0.98; p < 0.001) was obtained by linear regression. Given the systolic arterial pressure, the pulmonary systolic pressure is given by: systolic arterial pressure x (1.064-1.12 x CR). Therefore the CR can be used as a noninvasive index that reflects the level of pulmonary pressure in relationship to the systolic arterial pressure.