Overestimation by echocardiography of the peak systolic pressure gradient between the right ventricle and right atrium due to tricuspid regurgitation and the usefulness of the early diastolic transpulmonary valve pressure gradient for estimating pulmonary artery pressure

Takuma Hioka, Sanae Kaga, Taisei Mikami, Kazunori Okada, Michito Murayama, Nobuo Masauzi, Masahiro Nakabachi, Hisao Nishino, Shinobu Yokoyama, Mutsumi Nishida, Hiroyuki Iwano, Mamoru Sakakibara, Satoshi Yamada, Hiroyuki Tsutsui

Research output: Contribution to journalArticle

10 Citations (Scopus)

Abstract

We investigated the influence of tricuspid regurgitation (TR) severity on the echocardiographic peak systolic transtricuspid pressure gradient (TRPG) and evaluated the usefulness of the peak early diastolic transpulmonary valve pressure gradient (PRPG) for estimating pulmonary artery (PA) pressure. In 55 consecutive right heart-catheterized patients, we measured the peak systolic right ventricular (RV)–right atrial (RA) pressure gradient (RV-RACATH), peak early diastolic PA-RV pressure gradient (PA-RVCATH), and mean PA pressure (MPAPCATH). Using echocardiography, we obtained the TRPG, PRPG, and an estimate of the mean PA pressure (EMPAP) as the sum of PRPG and the estimated RA pressure, and measured the vena contracta width of TR (VCTR). The difference between the TRPG and RV-RACATH was significantly greater in the very severe TR group (VCTR > 11 mm) than in the mild, moderate, and severe TR groups, and significantly greater in the severe TR group (7 < VCTR ≤ 11 mm) than in the mild TR group. The overestimation of the pressure gradient >10 mmHg by TRPG was not seen in the mild or moderate TR groups, but was observed in the severe and very severe TR groups (22 and 83%, respectively). In the ROC analysis, EMPAP could distinguish patients with MPAPCATH ≥ 25 mmHg with the area under the curve of 0.93, 100% sensitivity, and 87% specificity. In conclusion, TRPG frequently overestimated RV-RACATH when VCTR was >11 mm and sometimes did when VCTR was >7 mm, where EMPAP using PRPG was useful for estimating PA pressure.

Original languageEnglish
Pages (from-to)833-842
Number of pages10
JournalHeart and Vessels
Volume32
Issue number7
DOIs
Publication statusPublished - Jul 1 2017
Externally publishedYes

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Tricuspid Valve Insufficiency
Heart Atria
Pulmonary Artery
Heart Ventricles
Echocardiography
Blood Pressure
Pressure
Atrial Pressure
Ventricular Pressure
ROC Curve
Area Under Curve

All Science Journal Classification (ASJC) codes

  • Cardiology and Cardiovascular Medicine

Cite this

Overestimation by echocardiography of the peak systolic pressure gradient between the right ventricle and right atrium due to tricuspid regurgitation and the usefulness of the early diastolic transpulmonary valve pressure gradient for estimating pulmonary artery pressure. / Hioka, Takuma; Kaga, Sanae; Mikami, Taisei; Okada, Kazunori; Murayama, Michito; Masauzi, Nobuo; Nakabachi, Masahiro; Nishino, Hisao; Yokoyama, Shinobu; Nishida, Mutsumi; Iwano, Hiroyuki; Sakakibara, Mamoru; Yamada, Satoshi; Tsutsui, Hiroyuki.

In: Heart and Vessels, Vol. 32, No. 7, 01.07.2017, p. 833-842.

Research output: Contribution to journalArticle

Hioka, Takuma ; Kaga, Sanae ; Mikami, Taisei ; Okada, Kazunori ; Murayama, Michito ; Masauzi, Nobuo ; Nakabachi, Masahiro ; Nishino, Hisao ; Yokoyama, Shinobu ; Nishida, Mutsumi ; Iwano, Hiroyuki ; Sakakibara, Mamoru ; Yamada, Satoshi ; Tsutsui, Hiroyuki. / Overestimation by echocardiography of the peak systolic pressure gradient between the right ventricle and right atrium due to tricuspid regurgitation and the usefulness of the early diastolic transpulmonary valve pressure gradient for estimating pulmonary artery pressure. In: Heart and Vessels. 2017 ; Vol. 32, No. 7. pp. 833-842.
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T1 - Overestimation by echocardiography of the peak systolic pressure gradient between the right ventricle and right atrium due to tricuspid regurgitation and the usefulness of the early diastolic transpulmonary valve pressure gradient for estimating pulmonary artery pressure

AU - Hioka, Takuma

AU - Kaga, Sanae

AU - Mikami, Taisei

AU - Okada, Kazunori

AU - Murayama, Michito

AU - Masauzi, Nobuo

AU - Nakabachi, Masahiro

AU - Nishino, Hisao

AU - Yokoyama, Shinobu

AU - Nishida, Mutsumi

AU - Iwano, Hiroyuki

AU - Sakakibara, Mamoru

AU - Yamada, Satoshi

AU - Tsutsui, Hiroyuki

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N2 - We investigated the influence of tricuspid regurgitation (TR) severity on the echocardiographic peak systolic transtricuspid pressure gradient (TRPG) and evaluated the usefulness of the peak early diastolic transpulmonary valve pressure gradient (PRPG) for estimating pulmonary artery (PA) pressure. In 55 consecutive right heart-catheterized patients, we measured the peak systolic right ventricular (RV)–right atrial (RA) pressure gradient (RV-RACATH), peak early diastolic PA-RV pressure gradient (PA-RVCATH), and mean PA pressure (MPAPCATH). Using echocardiography, we obtained the TRPG, PRPG, and an estimate of the mean PA pressure (EMPAP) as the sum of PRPG and the estimated RA pressure, and measured the vena contracta width of TR (VCTR). The difference between the TRPG and RV-RACATH was significantly greater in the very severe TR group (VCTR > 11 mm) than in the mild, moderate, and severe TR groups, and significantly greater in the severe TR group (7 < VCTR ≤ 11 mm) than in the mild TR group. The overestimation of the pressure gradient >10 mmHg by TRPG was not seen in the mild or moderate TR groups, but was observed in the severe and very severe TR groups (22 and 83%, respectively). In the ROC analysis, EMPAP could distinguish patients with MPAPCATH ≥ 25 mmHg with the area under the curve of 0.93, 100% sensitivity, and 87% specificity. In conclusion, TRPG frequently overestimated RV-RACATH when VCTR was >11 mm and sometimes did when VCTR was >7 mm, where EMPAP using PRPG was useful for estimating PA pressure.

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