Echocardiographic Estimation of Pulmonary Pressure — Still Tricky

Background: Multiple methods exist for estimating mean pulmonary artery pressure (mPAP). Objective: To compare echocardiographic methods for estimating mPAP to right heart catheterization (RHC) in a real-world cohort. Participants: 122 consecutive patients undergoing clinically indicated RHC had transthoracic echocardiogram within 24 hours. Methods: The tricuspid and pulmonic valves were assessed with pulsed wave and continuous wave Doppler from multiple views. The authors used 4 methods to estimate mPAP: (1) estimated systolic PAP (sPAP=4 * V 2 of peak tricuspid regurgitation [TR] jet) + mean right atrial pressure (mRAP); estimated diastolic PAP (dPAP=4 * V 2 of end-diastolic pulmonary regurgitant [PR] jet) + mRAP; mPAP=(1/3 sPAP) + (2/3 dPAP); (2) (mean TR gradient) + mRAP; (3) for pulmonary acceleration time (AT) ≥120 m/sec: 79 – (0.45 * AT), otherwise 90 – (0.62 * AT); and (4) (4 * V 2 of early PR jet) + mRAP. Two other methods were used based on Stephen et al and Amsallem et al. more...