Premium
Reliability of Doppler‐Based Measurement of Pulmonary Vascular Resistance in Congenital Heart Disease with Left‐to‐Right Shunt Lesions
Author(s) -
Bhyravavajhala Srinivas,
Velam Vanajakshamma,
Polapragada Nishanth V.,
Pallempati Pranav,
Iragavarapu Tammi Raju,
Patnaik Amar Narayan,
Damera Seshagiri Rao
Publication year - 2015
Publication title -
echocardiography
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.404
H-Index - 62
eISSN - 1540-8175
pISSN - 0742-2822
DOI - 10.1111/echo.12779
Subject(s) - shunt (medical) , cardiology , medicine , doppler effect , vascular resistance , heart disease , reliability (semiconductor) , hemodynamics , power (physics) , physics , quantum mechanics , astronomy
Background Pulmonary vascular resistance ( PVR ) is a crucial parameter in the management of patients with left‐to‐right shunt lesions. Cardiac catheterization (Cath) is the gold standard test to assess PVR ( PVR cath ), but it is invasive and hence, risky in children with pulmonary arterial hypertension ( PAH ). A noninvasive tool to assess PVR is desirable. Ratio of tricuspid regurgitation velocity ( TRV ) and time‐velocity integral of right ventricular outflow tract ( TVI RVOT ) by Doppler was previously shown to be a reliable noninvasive method for estimation of PVR in acquired PAH . Methods Peak TR velocity and TVI RVOT were recorded from 63 prospective patients with various congenital shunt lesions. Subsequently, the patients were subjected to cath in less than 2 hours. The patients were subdivided into four subsets based on age and pulmonary arterial mean pressure ( PAMP ). A regression equation was developed for calculation of PVR from TRV / TVI RVOT (PVR Echo ) which was indexed for BSA ( PVRI Echo ). Bland–Altman analysis was done for agreement between PVRI cath and PVRI Echo . Receiver operating characteristic ( ROC ) curves were plotted to test the identity of the two methods and also the applicability of PVRI Echo across a wide range of Wood units. Results Receiver operating characteristic curve plotted between the two methods showed good identity. Bland–Altman analysis showed excellent agreement between the two methods with negligible bias. ROC curves showed that PVRI Echo was accurate in distinguishing different cutoff values of PVR in each of the 4 groups. Conclusion Noninvasive Doppler estimation of PVR is reliable in patients with shunt lesions over a wide range of PVR .