Noninvasive Assessment of Pulmonary Artery Pressures
Moving Beyond Tricuspid Regurgitation Velocities
- pulmonary imaging
- pulmonary heart disease
- systolic time intervals
Pulmonary hypertension (PHTN) has been classified according to the world health organization as (1) pulmonary arterial hypertension (including idiopathic, familial, and associated with collagen vascular disease or HIV), (2) PHTN with left heart disease, (3) PHTN associated with lung diseases and/or hypoxemia, (4) PHTN caused by chronic thrombotic and/or embolic disease, and (5) miscellaneous.1 PHTN commonly causes symptoms of breathlessness, fatigue, and eventually right heart failure. In addition to the functional limitations, elevated pulmonary artery pressures are associated with reduced long-term survival that is related to the severity of PHTN, the patient’s functional class, and the underlying etiology of the PHTN.2 The prognosis is worse in patients with HIV or collagen vascular disease, intermediate in those with idiopathic pulmonary hypertension, and best in those with congenital heart disease.2 Some medical therapies have been shown to improve functional class and survival in patients with PHTN.3 Because of the morbidity and mortality associated with this condition, reliable methods for diagnosing PHTN are needed. Equally as important, given the substantial expense of current medical treatments, it is imperative that we have reproducible methods for serially assessing pulmonary artery pressure noninvasively.
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Echocardiography with Doppler interrogation of the tricuspid and pulmonic valves has been recommended by the European Society of Cardiology as one of the first steps in evaluation of the patient with suspected PHTN.4 The velocity of the tricuspid regurgitation (TR) jet measured with continuous-wave Doppler echocardiography correlates …