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case report | DOI: https://doi.org/10.31579/2692-9759/001
1 Department of Cardiology, University Military Hospital ° Dr. Carlos Arvelo °. Caracas, Venezuela.
*Corresponding Author: Tania Muñoz, Department of Cardiology, University Military Hospital ° Dr. Carlos Arvelo °. Caracas, Venezuela.
Citation: Muñoz T, Tovar S, Hirschhaut E, Millan M, Betancourt Y, et al (2019) Valuation of equations derived from the pulmonary flow and tricuspid regurgitation. Utility in the pulmonary vasoreactivity test. J Cardiology Research and Reports 1(1): Doi: 10.31579/2692-9759/001
Copyright: © 2019, Tania Muñoz, This is an open-access article distributed under the terms of The Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Received: 11 November 2019 | Accepted: 10 December 2019 | Published: 17 December 2019
Keywords: doppler echocardiography, pulmonary acceleration time, right catheterization, pulmonary hypertension
Background: Mean Pulmonary artery pressure (MPAP) is an indispensable hemodynamic variable for the diagnosis, classification and prognosis of Pulmonary Hypertension (PH). Its quantification is performed invasively by right heart cathererization (RHC) and non-invasively by Doppler echocardiography. Masuyama proposed its measurement by the transvalvular diastolic pulmonary gradient derived from the initial maximum velocity of pulmonary regurgitation (ΔPRi2) corresponding closely to the invasive measurement. Objectives: to compare 3 known echocardiographic methods to estimate MPAP and demonstrate the usefulness of the Chemla´s method in the Pulmonary Vascular Reactivity Test (PVRT). Methods: prospective, observational, double-blind study divided into two stages. A) 30 patients underwent diagnostic Doppler echocardiography in our center. Tricuspid regurgitation (TR) and pulmonary acceleration time (PAT) were measured to derive the equations: (1) 0.61xSPAP + 1.95 (Chemla) (2) Gradient mean pressure TR (ΔPmTR) + RAP (right atrial pressure) (Aduen). (3) 79-0.45xPAT or 90-0.60xTAP depending on the value of PAT.B) .10 patients enrolled to PVRT comparing the echocardiographic measurement (Chemla) with RHC. Results: in the first part of the study was found a high correlation between the 3 equations: Chemla-Aduen, R2=0.91; Chemla-Kitabatake, R2=0.87; Aduen-Kitabatake, R2=0.91. In the second part comparing the MPAP-Chemla and RHC we obtained high correlation: in time 0, 30 min and recovery: (R2=0.87, 0,99,0.98, respectively). Both parts of the study showed limits concordance satisfactory with mean value of the difference between the methods close to 1 in the t30 and tR of the TRVP. Conclusion: the methods dependent on the measurement of the TR are effective and reliably for estimating MPAP. The Chemla’s method is useful in the PVRT.
The knowledge of pulmonary arterial pressure (PAP) is essential for the treatment of heart disease. Non-invasive measurements can be derived from Doppler interrogation of the right ventricular outflow tract (RVOT), tricuspid regurgitation (TR) and pulmonary regurgitation (RP) signals[17, 25]. For more than 20 years have been able to use echocardiographic equations to obtain the MPAP. Kitabatake et al[5] demonstrated estimation from the PAT obtained with pulsed Doppler in the RVOT and described different flow velocity patterns with the presence of systolic notch in severe cases of PH. Subsequent observations showed that heart rate (HR) outside the normal range reduces the effectiveness of this method. On the other hand, Dabestani et al [20] validated the flow velocity patterns of pulmonary artery and found that a PAT≤100 ms corresponded to high PAP (sensitivity 78%, specificity 100%).This method is less accurate than the estimates derived from TR, especially at high or low heart rates[10] in the present work we find high HR-related limitations for PAT
Regarding the equations derived from TR, the method of Chemla et al [6] reported the inconvenience of the impossibility or underestimation of the maximum velocity of TR and / or wrong measurement of RAP.[10] In this study we could include all patients, with a high correlation between the methods (Chemla-Aduen) . On the other hand Aduen et al, reported in their work superiority in their method when finding an average difference of the MPAP values with respect to the RHC of -1.6, less than the SPAP traditionally obtained with TR (-3.6) and comparing it with the PR method (-13.9) [7]. In a recent retrospective study [25] where they compared the 3 methods analyzed in this study, among others, with invasively obtained measurements, they found superiority with the Aduen equation. Also when this author compared his method, the Chemla equation and the Syyed equation with the measurements obtained invasively, he found a discrete superiority in his method.[17] In this study we didn´t apply the equation derived from PR (Masuyama et al),[1] because its registration was possible in less than 60% of the sample analyzed.
In the second stage of our investigation, we found a very high correlation when comparing the MPAP values obtained by RHC and the Chemla equation in the 6 stages of the PVRT (we show in the study t0. T30 and tR). We show correspondence as indicated by this author: that PAP values> 30 mmHg correspond to PMAP> 20 mmHg, representing approximately 60% of the PSAP constantly. [3] No studies are currently available that report comparative invasive and non-invasive measurements of MPAP in the PVRT because the RHC is considered the gold standard for its implementation[9, 26]. Based on the encouraging results of this work, we recommend developing studies with a larger population of patients who estimate MPAP and other variables involved through echocardiography and RHC.
Conclusions
We have effective and reliable TR-derived equations to estimate MPAP in a large group of patients. The Chemla¨s method is useful and accurate in the PVRT.
Acknowledgments
To God for giving us life and putting us on the path where sensitive people march with a high sense of vocation and service.to Dr. Rita Tamasaukas for advice on statistical analysis, revision and correction of the manuscript To the Medical team, Technicians in echocardiography and nursing who work in the Departments of Cardiology and Intensive Therapy of the University Military Hospital “Dr. Carlos Arvelo.”
Funding
Hospital resources were used to carry out this research
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