Mean Pulmonary Artery Pressure Using Echocardiography in Chronic Thromboembolic Pulmonary Hypertension

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  • Kasai Hajime
    Department of Respirology, Graduate School of Medicine, Chiba University
  • Matsumura Akane
    Department of Respirology, Graduate School of Medicine, Chiba University
  • Sugiura Toshihiko
    Department of Respirology, Graduate School of Medicine, Chiba University
  • Shigeta Ayako
    Department of Respirology, Graduate School of Medicine, Chiba University
  • Tanabe Nobuhiro
    Department of Respirology, Graduate School of Medicine, Chiba University Department of Advanced Medicine in Pulmonary Hypertension, Graduate School of Medicine, Chiba University
  • Yamamoto Keiko
    Department of Respirology, Graduate School of Medicine, Chiba University
  • Miwa Hideki
    Department of Respirology, Graduate School of Medicine, Chiba University
  • Ema Ryogo
    Department of Respirology, Graduate School of Medicine, Chiba University
  • Sakao Seiichiro
    Department of Respirology, Graduate School of Medicine, Chiba University
  • Tatsumi Koichiro
    Department of Respirology, Graduate School of Medicine, Chiba University

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Abstract

Background:Mean pulmonary arterial pressure (MPAP) is an important pulmonary hemodynamic parameter used in the management of patients with chronic thromboembolic pulmonary hypertension (CTEPH). We compared echocardiography-derived estimates of MPAP with right heart catheterization (RHC) to identify reliable noninvasive methods of estimating MPAP-derived RHC (MPAPRHC) in these patients.Methods and Results:Echocardiography and RHC were performed in 56 patients with CTEPH (60.5±12.0 years; 44 females). We measured the tricuspid regurgitation (TR) pressure gradient (TRPG) using echocardiography. The mean systolic right ventricular (RV)-right atrial (RA) gradient was calculated by tracing the TR time velocity flow. Systolic and mean pulmonary artery pressures (SPAPTRand MPAPTR) estimated from TRPG and mean systolic RV-RA gradient were calculated by adding RA pressure based on the inferior vena cava. MPAPChemlawas calculated using Chemla’s formula: 0.61×SPAPTR+2 mmHg. MPAPRHCand pulmonary vascular resistance were 35.9±11.3 mmHg and 6.6±3.6 Wood units, respectively. The mean difference from MPAPRHCand limits of agreement were −1.5 mmHg and −19.6 to 16.5 mmHg for MPAPTR, and −4.6 mmHg and −24.5 to 15.2 mmHg for MPAPChemla. Accuracy within 10 mmHg and 5 mmHg of MPAPRHCwas 80.4% and 46.4% for MPAPTR, and 71.4% and 48.2% for MPAPChemla, respectively.Conclusions:MPAPTRand MPAPChemlaare reliable estimates for MPAPRHCin patients with CTEPH. (Circ J 2016; 80: 1259–1264)

Journal

  • Circulation Journal

    Circulation Journal 80 (5), 1259-1264, 2016

    The Japanese Circulation Society

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