Pulmonary artery acceleration time in identifying pulmonary hypertension patients with raised pulmonary vascular resistance
2013 (English)In: European Heart Journal Cardiovascular Imaging, ISSN 2047-2404, E-ISSN 2047-2412, Vol. 14, no 9, 890-897 p.Article in journal (Refereed) Published
BACKGROUND: In patients with pulmonary hypertension (PH), ascertaining raised vascular resistance as a cause is a clinical objective, for which various Doppler-based measurements have been proposed, but with modest accuracy. We hypothesize that pulmonary acceleration time (PAcT) and the ratio of PAcT/peak pulmonary artery systolic pressure (PASP) reflect better the extent of the vascular resistance, compared with other available methods, and can differentiate accurately between pre- and post-capillary PH.
METHODS AND RESULTS: We investigated 56 patients (mean age 61 ± 13 years, 23 males) in a simultaneous echocardiography and right heart catheterization (RHC) study. Based on the RHC, pulmonary vascular resistance (PVR), and pulmonary capillary wedge pressure (PCWP), patients were divided into four groups: Group 1 = normal PVR [<3 WU (Wood units)] and PCWP (<12 mmHg), Group 2 = raised PVR but normal PCWP, Group 3 = raised PVR and PCWP; and Group 4 = normal PVR but raised PCWP. We used spectral Doppler to measure PAcT (corrected for heart rate) and to estimate PASP (peak tricuspid regurgitation pressure drop + estimated right atrial pressure of 7 mmHg). We also tested other available methods for assessing PVR. There were small age differences between patient groups but no age difference between Groups 2 and 4. PAcT and PAcT/PASP were both significantly (P = 0.008) reduced in Groups 2 and 3 compared with Groups 1 and 4. PAcT ≤90 had an 84% sensitivity and an 85% specificity in identifying patients with PVR ≥3 WU with a positive and a negative predictive value of 88% and 81%, respectively. The non-linear relationship between PVR and PAcT gave a quadratic r = 0.61, P < 0.001. ROC curve analysis showed PAcT having the best accuracy (83%) in detecting a PVR ≥3 WU.
CONCLUSION: PAcT <90 ms can serve as a strong non-invasive predictor of PVR >3 WU, which could differentiate patients with pre- and post-capillary PH.
Place, publisher, year, edition, pages
2013. Vol. 14, no 9, 890-897 p.
Amyloidosis, Cardiomyopathy, Familial amyloid polyneuropathy, Methodology, Neuropathy, Registry, Transthyretin
Cardiac and Cardiovascular Systems
IdentifiersURN: urn:nbn:se:umu:diva-65109DOI: 10.1093/ehjci/jes309PubMedID: 23295626OAI: oai:DiVA.org:umu-65109DiVA: diva2:605714