Shape of the Pulmonary Artery Doppler-Flow Profile Predicts the Hemodynamics of Pulmonary Hypertension Caused by Left-Sided Heart Disease.

Abstract

Previous studies demonstrated a relationship between pulmonary hemodynamics and shape of pulmonary artery (PA) Doppler-flow profiles in a mixed pulmonary hypertension (PH) cohort. Shape of PA Doppler-flow profiles could illustrate the hemodynamic characteristics of pulmonary venous hypertension (PVH), especially identifying it with or without pulmonary vascular disease (PVD). We retrospectively analyzed hemodynamic, echocardiographic, and clinical data from 47 patients referred for PH caused by left-sided heart disease (PH-LHD). All patients underwent right-sided heart catheterization within 1 week of echocardiography. We concluded a simple echocardiographic prediction rule to give hemodynamic differentiation of PVH with PVD, defined as capillary wedge pressure >15 mm Hg and pulmonary vascular resistance (PVR) >3 Wood units (WU). The PA Doppler-flow profiles were categorized into 2 groups, no notch (NN) and MSN/LSN. The PVR was higher in the MSN/LSN group at 4.04 WU (interquartile range, 3.1-5.3) vs the NN group at 1.91 WU (interquartile range, 1.8-3.0; P < 0.001). Pulmonary artery Doppler-flow notching (MSN and LSN) was highly associated with PVR >3 WU, whereas the NN pattern predicted a PVR ≤3 WU (odds ratio: 19.8, 95% confidence interval: 4.3-91.3) and normal transpulmonary pressure gradient ≤12 mm Hg (odds ratio: 4.7, 95% confidence interval: 1.3-16.2). The NN pattern had 74% specificity and 88% sensitivity for PVR ≤3 WU. Absence of PA Doppler-flow notching was highly associated with PVH, and a notching pattern indicated PVH with PVD in the PH-LHD cohort.