Arindam Pande1, Achyut Sarkar2, Imran Ahmed1, GS Naveen Chandra3, Shailesh Kumar Patil1, Chanchal Kumar Kundu1, Rahul Arora1, Ajanta Samanta4
1 Department of Cardiology, Institute of Post-Graduate Medical Education and Research and Seth Sukhlal Karnani Memorial Hospital, Kolkata, West Bengal, India
2 Associate Professor of Cardiology and Incharge - Pediatric Cardiology Unit, Institute of Post-Graduate Medical Education and Research and Seth Sukhlal Karnani Memorial Hospital, Kolkata, West Bengal, India
3 Assistant Professor, Kasturba Medical College, Manipal, Karnataka, India
4 Clinical Tutor, Department of Gynaecology and Obstetrics, Radha Gobinda Kar Medical College and Hospital, Kolkata, West Bengal, India
Context: Pulmonary vascular resistance (PVR) is a critical and essential parameter during the assessment and selection of modality of treatment in patients with congenital heart disease accompanied by pulmonary arterial hypertension.
Aim: The present study was planned to evaluate non-invasive echocardiographic parameters to assess pulmonary vascular resistance.
Settings and Design: This prospective observational study included 44 patients admitted in the cardiology and pediatric cardiology ward of our institution for diagnostic or pre-operative catheter based evaluation of pulmonary arterial pressure and PVR.
Materials and Methods: Detailed echocardiographic evaluation was carried out including tricuspid regurgitation velocity (TRV) and velocity time integral of the right-ventricular outflow tract (VTI RVOT ). These parameters were correlated with catheter-based measurements of PVR.
Results: The TRV/VTI RVOT ratio correlated well with PVR measured at catheterization (PVRcath) (r = 0.896, 95% confidence interval [CI] 0.816 to 0.9423, P < 0.001). Using the Bland-Altman analysis, PVR measurements derived from Doppler data showed satisfactory limits of agreement with catheterization estimated PVR. For a PVR of 6 Wood units (WU), a TRV/VTI RVOT value of 0.14 provided a sensitivity of 96.67% and a specificity of 92.86% (area under the curve 0.963, 95% confidence interval 0.858 to 0.997) and for PVR of 8 WU a TRV/VTI RVOT value of 0.17 provided a sensitivity of 79.17% and a specificity of 95% (area under the curve 0. 0.923, 95% confidence interval 0.801 to 0.982).
Conclusions: Doppler-derived ratio of TRV/VTI RVOT is a simple, non-invasive index, which can be used to estimate PVR.
Dr. Arindam Pande
Flat-U 302, Binayak Enclave, 59 Kali Charan Ghosh Road, Kolkata-700 050, West Bengal
Source of Support: None, Conflict of Interest: None
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