February 1, 1991
View Full PaperDoppler echocardiographic evaluation of pulmonary artery pressure in chronic obstructive pulmonary disease. A European multicentre study
Key Result
Doppler echocardiography was feasible in 98% of COPD patients, with the transtricuspid gradient showing the best correlation with mean pulmonary artery pressure (r = 0.73, SEE = 7.4 mmHg).
Study Design
Type
Observational (n=100)
Multicenter
Yes
Structured PICO
Does Doppler echocardiography reliably estimate pulmonary artery pressure compared to cardiac catheterization in patients with COPD?
P
Population
100 patients with chronic obstructive pulmonary disease and mean pulmonary artery pressure of 10-62 mmHg undergoing cardiac catheterization.
E
Exposure
Doppler echocardiographic evaluation of pulmonary artery pressure using four methods (transtricuspid gradient, transpulmonary gradient, right ventricular outflow tract velocity profiles/acceleration time, right ventricular isovolumic relaxation time)
C
Comparator
Cardiac catheterization (reference standard)
O
Outcome
Correlation of Doppler echocardiographic estimates with mean pulmonary artery pressure measured by cardiac catheterizationsurrogate
Doppler echocardiography, particularly using the transtricuspid gradient and right ventricular acceleration time, provides a feasible and reliable non-invasive estimate of pulmonary artery pressure in patients with COPD.
Main Result
Effect estimate: r = 0.73
Limitations
- Tricuspid regurgitation jet quality was adequate for measurement in only 30% of patients.
- Pulmonary regurgitation jet velocity was measurable in only five cases.
Abstract
The feasibility, reproducibility and reliability of Doppler echocardiography in evaluation of pulmonary artery pressure in patients with chronic obstructive pulmonary disease (COPD) were determined in a multicentre study. In 100 COPD patients with mean pulmonary artery pressure ranging from 10 to 62 mmHg at cardiac catheterization, pulmonary pressure estimation was attempted by four Doppler echocardiographic methods. These methods comprised the calculation of transtricuspid and transpulmonary pressure gradients from Doppler-detected tricuspid or pulmonary regurgitation, the evaluation of right ventricular outflow tract velocity profiles with the measurement of right ventricular systolic time intervals and the measurement of the right ventricular isovolumic relaxation time. In 98 (98%) patients at least one of the methods could be employed. A tricuspid regurgitation jet was detected in 47 (47%) patients but its quality was adequate for measurement in 30 (30%). Pulmonary regurgitation jet velocity was measured only in five cases. The standard error of estimate in testing intra- and interobserver reproducibility of Doppler systolic time intervals was less than 5%. The predictive value of right ventricular outflow tract acceleration time less than 90 ms in the identification of patients with mean pulmonary artery pressure greater than 20 mmHg was 80%. Of Doppler echocardiographic data, best correlations with mean pulmonary artery pressure were found for the transtricupid gradient (r = 0.73, SEE = 7.4 mmHg), for the right ventricular acceleration time (r = 0.65, SEE = 8 mmHg) and right ventricular isovolumic relaxation time (r = 0.61, SEE = 8.5 mmHg).(ABSTRACT TRUNCATED AT 250 WORDS)