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 the ratio of peak Pb to peak Pf.Results: Wave reflection indices by echo-Doppler agreed well with corresponding indices by catheter (Pb: mean difference = 0.4 mmHg, 95% limits of agreement = −4.3 to 5.0 mmHg; RC: bias = 0.13, 95% limits of agreement = −0.25 to 0.26). RC correlated negatively with PA compliance.Conclusion: This echo-Doppler method yields reasonable measurement of reflected wave in the pulmonary circulation, paving the way to a more integrative assessment of pulmonary hemodynamics in the clinical setting.
Highlights
Pulmonary hypertension (PH) is a serious disease characterized by increased pulmonary artery pressure (PAP) associated with pulmonary vascular remodeling
The present study investigated that pulmonary arterial wave reflection can be assessed noninvasively using Doppler echocardiography
We reported that the echo-Doppler method yields reasonable measurement of pulmonary arterial wave reflection and may detect the alterations associated with the development of PH
Summary
Pulmonary hypertension (PH) is a serious disease characterized by increased pulmonary artery pressure (PAP) associated with pulmonary vascular remodeling It causes right-sided heart failure due to increased afterload on the right ventricle and has been shown to carry poor prognosis (Benza et al, 2012). Mean PAP and PVR have been shown to correlate, but not closely, with the degree of right ventricular dysfunction and adverse clinical outcomes (Kawut et al, 2009; Maron et al, 2020). These inherent limitations may be because they do not represent all components of load faced by the right ventricle. We tested the hypothesis that PA pressure and flow waveforms estimated by Doppler echocardiography could be used to quantify PA wave reflection
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