What is the clinical evidence from this study?

Study design: Other. Population: Pulmonary hypertension (n=8). Intervention: Echo-Doppler method vs. Dual sensor-tipped catheter. Primary outcome: Reflection coefficient (RC) agreement between echo-Doppler and catheter (bias 0.13, 95% CI -0.25 to 0.26).

April 14, 2021Open Access

A New Echo-Doppler Method of Assessing Pulmonary Arterial Wave Reflection: In Vivo Validation

Resultado clave

The noninvasive echo-Doppler method for assessing pulmonary arterial wave reflection agreed well with invasive catheter measurements (bias 0.13) in a canine model of pulmonary hypertension.

PICO estructurado

Does noninvasive Doppler echocardiography accurately estimate pulmonary arterial wave reflection compared to invasive catheter measurements in a canine model of pulmonary hypertension?

Población

8 healthy female Beagle dogs (aged 4-5 years old, 10-13 kg) in a canine model of pulmonary hypertension induced by pulmonary arterial microembolization.

Intervención

Noninvasive estimation of pulmonary arterial pressure and flow waveforms using Doppler echocardiography (tricuspid regurgitation and right ventricular outflow tract flow) to quantify wave reflection.

Comparador

Direct invasive measurements using a dual sensor-tipped pressure and flow wire catheter.

Resultado

Agreement of wave reflection coefficient (RC) between echo-Doppler and catheter-derived measurements.surrogate

A novel echo-Doppler method accurately estimates pulmonary arterial wave reflection noninvasively, providing a potential flow-independent measure of right ventricular pulsatile load for early pulmonary hypertension diagnosis.

Resultado numérico

Estimación del efecto: bias 0.13 (95% CI -0.25 to 0.26)

Limitaciones

The study used an animal model of pulmonary hypertension created by embolizing peripheral pulmonary arteries, which may not reflect all clinical scenarios.
It remains to be investigated whether the method can detect alterations in the magnitude and timing of wave reflection caused by changes in the site of narrowing.
The method assumes right atrial pressure is constant during systole, which may not apply to patients with severe tricuspid regurgitation.
The method assumes a constant RR interval, making it inapplicable to patients with large heart rate variability such as atrial fibrillation.
Echocardiographic estimates of pulmonary arterial systolic pressure can be challenging in clinical practice due to difficulty in obtaining clear spectral Doppler envelopes.

Resumen

Abstract Background: Pulmonary arterial (PA) wave reflection provides additional information for assessing right ventricular afterload, but its applications is hampered by the need for invasive pressure and flow measurements. We tested the hypothesis that PA pressure and flow waveforms estimated by Doppler echocardiography could be used to quantify PA wave reflection. Methods: Doppler echocardiographic images of tricuspid regurgitation and right ventricular outflow tract flow used to estimate PA pressure and flow waveforms were acquired simultaneously with direct measurements with a dual sensor-tipped catheter under various hemodynamic conditions in a canine model of pulmonary hypertension (n=8). Wave separation analysis was performed on echo-Doppler derived as well as catheter derived waveforms to separate PA pressure into forward (Pf) and backward (Pb) pressures and derive wave reflection coefficient (RC) defined as Pb divided by Pf. Results: RC by echo-Doppler agreed well with RC indices by catheter (RC: bias = 0.13, 95% limits of agreement = -0.25 to 0.26). RC correlated negatively with pulmonary arterial compliance and right ventricular systolic function. Conclusions: This echo-Doppler method yields accurate measurement of reflected wave in the pulmonary circulation, paving the way to a more integrative assessment of pulmonary hemodynamics in the clinical setting.

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