Janne Mykland Hilde1,2, Ingunn Skjørten3,2, Viggo Hansteen1, Morten Nissen Melsom4, Dan Atar5,2, Jonny Hisdal2,6, Sjur Humerfelt3, Kjetil Steine2,7. 1. a 1 Department of Cardiology, Oslo University Hospital , Aker , Norway. 2. e 5 Faculty of Medicine, Institute of Clinical Sciences, University of Oslo , Aker , Norway. 3. b 2 Department of Pulmonary Medicine, Oslo University Hospital , Aker , Norway. 4. c 3 Department of Pulmonary Medicine, The Glittre Clinic , Hakadal , Norway. 5. d 4 Department of Cardiology, Oslo University Hospital , Ullevål , Norway. 6. f 6 Section of Vascular Investigations, Oslo University Hospital , Aker , Norway. 7. g 7 Department of Cardiology, Akershus University Hospital , Lorenskog , Norway.
Abstract
BACKGROUND: We aimed to study whether pulmonary hypertension (PH) and elevated pulmonary vascular resistance (PVR) could be predicted by conventional echo Doppler and novel tissue Doppler imaging (TDI) in a population of chronic obstructive pulmonary disease (COPD) free of LV disease and co-morbidities. METHODS: Echocardiography and right heart catheterization was performed in 100 outpatients with COPD. By echocardiography the time-integral of the TDI index, right ventricular systolic velocity (RVSmVTI) and pulmonary acceleration-time (PAAcT) were measured and adjusted for heart rate. The COPD patients were randomly divided in a derivation (n = 50) and a validation cohort (n = 50). RESULTS: PH (mean pulmonary artery pressure (mPAP) ≥ 25mmHg) and elevated PVR ≥ 2Wood unit (WU) were predicted by satisfactory area under the curve for RVSmVTI of 0.93 and 0.93 and for PAAcT of 0.96 and 0.96, respectively. Both echo indices were 100% feasible, contrasting 84% feasibility for parameters relying on contrast enhanced tricuspid-regurgitation. RVSmVTI and PAAcT showed best correlations to invasive measured mPAP, but less so to PVR. PAAcT was accurate in 90- and 78% and RVSmVTI in 90- and 84% in the calculation of mPAP and PVR, respectively. CONCLUSIONS: Heart rate adjusted-PAAcT and RVSmVTI are simple and reproducible methods that correlate well with pulmonary artery pressure and PVR and showed high accuracy in detecting PH and increased PVR in patients with COPD. Taken into account the high feasibility of these two echo indices, they should be considered in the echocardiographic assessment of COPD patients.
BACKGROUND: We aimed to study whether pulmonary hypertension (PH) and elevated pulmonary vascular resistance (PVR) could be predicted by conventional echo Doppler and novel tissue Doppler imaging (TDI) in a population of chronic obstructive pulmonary disease (COPD) free of LV disease and co-morbidities. METHODS: Echocardiography and right heart catheterization was performed in 100 outpatients with COPD. By echocardiography the time-integral of the TDI index, right ventricular systolic velocity (RVSmVTI) and pulmonary acceleration-time (PAAcT) were measured and adjusted for heart rate. The COPDpatients were randomly divided in a derivation (n = 50) and a validation cohort (n = 50). RESULTS: PH (mean pulmonary artery pressure (mPAP) ≥ 25mmHg) and elevated PVR ≥ 2Wood unit (WU) were predicted by satisfactory area under the curve for RVSmVTI of 0.93 and 0.93 and for PAAcT of 0.96 and 0.96, respectively. Both echo indices were 100% feasible, contrasting 84% feasibility for parameters relying on contrast enhanced tricuspid-regurgitation. RVSmVTI and PAAcT showed best correlations to invasive measured mPAP, but less so to PVR. PAAcT was accurate in 90- and 78% and RVSmVTI in 90- and 84% in the calculation of mPAP and PVR, respectively. CONCLUSIONS: Heart rate adjusted-PAAcT and RVSmVTI are simple and reproducible methods that correlate well with pulmonary artery pressure and PVR and showed high accuracy in detecting PH and increased PVR in patients with COPD. Taken into account the high feasibility of these two echo indices, they should be considered in the echocardiographic assessment of COPDpatients.
Authors: Myriam Amsallem; David Boulate; Zoe Kooreman; Roham T Zamanian; Guillaume Fadel; Ingela Schnittger; Elie Fadel; Michael V McConnell; Gundeep Dhillon; Olaf Mercier; François Haddad Journal: Int J Cardiovasc Imaging Date: 2017-01-24 Impact factor: 2.357