Noninvasive estimation of right ventricular systolic pressure by Doppler ultrasound in patients with tricuspid regurgitation
TL;DR: The tricuspid gradient method provides an accurate and widely applicable method for noninvasive estimation of elevated right ventricular systolic pressures in patients with tric Suspid regurgitation detected by Doppler ultrasound.
Abstract: We evaluated the accuracy of a noninvasive method for estimating right ventricular systolic pressures in patients with tricuspid regurgitation detected by Doppler ultrasound. Of 62 patients with clinical signs of elevated right-sided pressures, 54 (87%) had jets of tricuspid regurgitation clearly recorded by continuous-wave Doppler ultrasound. By use of the maximum velocity (V) of the regurgitant jet, the systolic pressure gradient (delta P) between right ventricle and right atrium was calculated by the modified Bernoulli equation (delta P = 4V2). Adding the transtricuspid gradient to the mean right atrial pressure (estimated clinically from the jugular veins) gave predictions of right ventricular systolic pressure that correlated well with catheterization values (r = .93, SEE = 8 mm Hg). The tricuspid gradient method provides an accurate and widely applicable method for noninvasive estimation of elevated right ventricular systolic pressures.
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TL;DR: The Society of Echocardiography (SEDC) is an educational activity for cardiovascular physicians and cardiac sonographers with a knowledge base in the field of echo-cardiography as discussed by the authors.
Abstract: on Statement: Society of Echocardiography is accreditedby theAccreditationCouncil for edical Education to provide continuingmedical education for physicians. n Society of Echocardiography designates this educational activity for of 1.0 AMA PRA Category 1 Credits . Physicians should only claim credit te with the extent of their participation in the activity. CCI recognize ASE’s certificates and have agreed to honor the credit hours registry requirements for sonographers. Society of Echocardiography is committed to ensuring that its educational ll sponsored educational programs are not influencedby the special interests ation or individual, and itsmandate is to retain only those authors whose fists canbeeffectively resolved tomaintain thegoals andeducational integrity y. While a monetary or professional affiliation with a corporation does not fluence an author’s presentation, the Essential Areas and policies of the ire that any relationships that could possibly conflict with the educational activity be resolved prior to publication and disclosed to the audience. f faculty and commercial support relationships, if any, have been indicated. ience: is designed for all cardiovascular physicians and cardiac sonographers with erest and knowledge base in the field of echocardiography; in addition, reschers, clinicians, intensivists, and other medical professionals with a spein cardiac ultrasound will find this activity beneficial.
5,151 citations
01 Jan 2014
TL;DR: This activity is designed for all cardiovascular physicians and cardiac sonographers with arest and knowledge base in the field of echocardiography and reschers, clinicians, intensivists, and other medical professionals with a spein cardiac ultrasound will find this activity beneficial.
Abstract: on Statement: Society of Echocardiography is accredited by the Accreditation Council for edical Education to provide continuing medical education for physicians. n Society of Echocardiography designates this educational activity for of 1.0 AMA PRA Category 1 Credits . Physicians should only claim credit te with the extent of their participation in the activity. CCI recognize ASE’s certificates and have agreed to honor the credit hours registry requirements for sonographers. Society of Echocardiography is committed to ensuring that its educational ll sponsored educational programs are not influenced by the special interests ation or individual, and its mandate is to retain only those authors whose fists can be effectively resolved to maintain the goals andeducational integrity y. While a monetary or professional affiliation with a corporation does not fluence an author’s presentation, the Essential Areas and policies of the ire that any relationships that could possibly conflict with the educational activity be resolved prior to publication and disclosed to the audience. f faculty and commercial support relationships, if any, have been indicated. ience: is designed for all cardiovascular physicians and cardiac sonographers with erest and knowledge base in the field of echocardiography; in addition, reschers, clinicians, intensivists, and other medical professionals with a spein cardiac ultrasound will find this activity beneficial.
4,739 citations
Additional excerpts
...RV EF (%) (Figure 8) 12 596 44 (38-50) 58 (53-63) 71 (66-77)...
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...RV longitudinal diameter (mm) (Figure 7, RVD3) 12 359 56 (50-61) 71 (67-75) 86 (80-91) RV end-diastolic area (cm(2)) (Figure 9) 20 623 10 (8-12) 18 (16-19) 25 (24-27) RV end-systolic area (cm(2)) (Figure 9) 16 508 4 (2-5) 9 (8-10) 14 (13-15) RV end-diastolic volume indexed (mL/m(2)) 3 152 44 (32-55) 62 (50-73) 80 (68-91) RV end-systolic volume indexed (mL/m(2)) 1 91 19 (17-21) 33 (31-34) 46 (44-49) 3D RV end-diastolic volume indexed (mL/m(2)) 5 426 40 (28-52) 65 (54-76) 89 (77-101) 3D RV end-systolic volume indexed (mL/m(2)) 4 394 12 (1-23) 28 (18-38) 45 (34-56)...
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...IVRT (ms) 23 1241 23 (16-30) 48 (43-53) 73 (66-80) E0 (cm/s) 40 1688 8 (7-9) 14 (13-14) 20 (19-21) A0 (cm/s) 37 1575 7 (6-8) 13 (12-14) 20 (19-21) E0/A0 ratio 29 1053 0....
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TL;DR: Mitral E velocity, corrected for the influence of relaxation (i.e., the E/Ea ratio), relates well to mean PCWP and may be used to estimate LV filling pressures.
2,911 citations
Cites methods from "Noninvasive estimation of right ven..."
...Left atrial volumes were derived with the method of discs (29) and, when possible, estimation of pulmonary artery systolic pressure was obtained with the tricuspid regurgitant jet (30,31)....
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DOI•
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05 Nov 2009
TL;DR: 结节病易误诊,据王洪武等~([1])收集国内18篇关于此第一印象中拟诊 结核5例,为此应引起临床对本 病诊
Abstract: 结节病易误诊,据王洪武等~([1])收集国内18篇关于此病误诊的文献,误诊率高达63.2%,当然有误诊就会有误治,如孙永昌等~([2])报道26例结节病在影像学检查诊断的第一印象中拟诊结核5例,其中就有2例完成规范的抗结核治疗,为此应引起临床对本病诊治的重视。
1,821 citations
TL;DR: It is concluded that increasing tricuspid regurgitation severity is associated with worse survival in men regardless of LVEF or pulmonary artery pressure.
1,280 citations
References
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TL;DR: This third edition of what has now become a well-established textbook in cardiovascular medicine is again edited by Dr Eugene Braunwald with the assistance of 65 other authors who read like a Who's Who of American Cardiology.
Abstract: This third edition of what has now become a well-established textbook in cardiovascular medicine is again edited by Dr Eugene Braunwald with the assistance of 65 other authors who read like a Who's Who of American Cardiology. Since the second edition, 12 new chapters have been added or substituted and others have been significantly revised. The first volume includes Part I on "Examination of the Patient" and Part II on "Normal and Abnormal Circulatory Function." The second volume deals with specific diseases. Part III, "Diseases of the Heart, Pericardium and Vascular System," includes new sections on "Risk Factors for Coronary Artery Disease," "The Pathogenesis of Atherosclerosis," and "Interventional Catheterization Techniques." Part IV, "Broader Perspectives on Heart Disease and Cardiologic Practice," includes new chapters on "Genetics and Cardiovascular Disease," "Aging in Cardiac Disease," and "Cost Effective Strategies in Cardiology." The last 200 pages of the book (Part V) are devoted to
927 citations
01 Sep 1984
903 citations
TL;DR: A pulsed Doppler technique permitted the noninvasive estimation of the pulmonary artery pressure and the time to peak flow (acceleration time, AcT) and right ventricular ejection time (RVET) were measured from the flow velocity pattern.
Abstract: We used a pulsed Doppler technique to examine the flow velocity pattern in the right ventricular outflow tract in 33 adults. In the patients with normal pulmonary artery pressure (mean pressure less than 20 mm Hg, 16 patients), ejection flow reached a peak level at midsystole (137 +/- 24 msec, mean +/- SD), producing a domelike contour of the flow velocity pattern during systole. In contrast, the flow velocity pattern in patients with pulmonary hypertension (mean pressure greater than or equal to 20 mm Hg, 17 patients) was demonstrated to accelerate rapidly and to reach a peak level sooner (97 +/- 20 msec, p less than .01); in 10 of the pulmonary hypertensive patients a secondary slower rise in flow velocity was observed during a deceleration, resulting in the midsystolic notching. The time to peak flow (acceleration time, AcT) and right ventricular ejection time (RVET) were measured from the flow velocity pattern. Either AcT or AcT/RVET decreased with increase in mean pulmonary artery pressure, and a very high correlation (r = -.90) was found between AcT/RVET and log10 (mean pulmonary artery pressure). The use of this technique permitted the noninvasive estimation of the pulmonary artery pressure.
735 citations
TL;DR: The measurements were easy to perform in most patients and the method seems well suited both to diagnose and to follow patients with mitral stenosis.
Abstract: A noninvasive method is described for measuring the pressure drop across the mitral valve in mitral stensois by Doppler ultrasound. A maximum frequency estimator was used to record maximum velocity in the Doppler signal from the mitral jet. Provided the angle between the ultrasound beam and the maximum velocity is close to zero the pressure drop can be calculated directly. Good correlation was found between Doppler measurements and simultaneous pressure recordings during heart catheterisation in 10 patients. No false negative or false positive diagnoses of mitral stenosis were made among 55 patients (35 patients with mitral stenosis and 20 patients with other valve lesions). The measurements were easy to perform in most patients and the method seems well suited both to diagnose and to follow patients with mitral stenosis.
502 citations
TL;DR: In patients less than 50 years of age the aortic jet was easy to find, the measurement was reproducible, and underestimation of the pressure drop obtained at catheterisation was within 25 per cent in 17 of 18 patients, but pressure drop was significantly underestimated in one-third of patients over 50 years.
Abstract: The peak pressure drop across the aortic valve in aortic stenosis has been measured by Doppler ultrasound. Maximum velocity in the Doppler signal from the aortic jet was recorded using a maximum frequency estimator. With an angle close to zero between ultrasound beam and maximal velocity in the jet, peak pressure drop can be calculated from the maximal velocity measured; a larger angle will underestimate maximal velocity and pressure drop. In 57 of 63 patients with aortic stenosis, the aortic jet could be reached by the ultrasound beam and, in 37 of these, peak pressure drop by ultrasound was compared with that obtained at catheterisation. In patients less than 50 years of age the aortic jet was easy to find, the measurement was reproducible, and underestimation of the pressure drop obtained at catheterisation was within 25 per cent in 17 of 18 patients. In patients over 50 years Doppler signals from the aortic jet were more difficult to obtain, and pressure drop was significantly underestimated in one-third, but time of maximum velocity in systole could indicate whether moderate or severe aortic stenosis was present.
488 citations